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102106482 - Permit
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102106482 - Permit
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Entry Properties
Last modified
9/23/2021 2:25:57 PM
Creation date
9/23/2021 2:25:56 PM
Metadata
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Template:
Permit
Permit Number
102106482
Full Address
1215 N Daisy Ave
Permit ID
274394
Master ID Number
2021-165643
Project Name
Kieu NV
Street Number
001215
Street Direction
N
Street Name
Daisy
Street Suffix
Ave
Building Use Code
Resid-1 unit
Job Types
Alteration
Permit Type
Building
Applied Date
4/21/2021
Issued Date
4/21/2021
Finalized Date
9/1/2021
Flood Zone
X-0602320144J
Description of Work
Legalize windows changed out; remove drywall from garage ceiling.
Nature of Work
Alter - N/V
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K <br />Y<- rF I I 9. I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue Ser- <br />vice, the United States Small Business Administration, the California Department of Benefit Payments, and the California Divi- <br />sion of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at I -800- <br />321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors. <br />JLL-ho I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the <br />party legally and financially responsible for proposed construction activity at the following ad- <br />dress: <br />1 1. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all <br />applicable laws and requirements that govern Owner-Builders as well as employers. <br />LflY-I '1!.'l agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the rnformation I <br />have provided on this form. <br />Licensed contractors are regulated by laws designed to protect the public. lf you contract with someone who does not have a <br />license, the Contractors' State License Board may be unable to assist you with any flnancial loss you may sustain as a result of <br />a complaint. Your only remedy against unlicensed Contractors may be in civil court. lt is also important for you to understand <br />that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held <br />liable for damages. lf you obtarn a permit as Owner-Builder and wish to hire Contactors, you will be responsible for verifying <br />whether or not those Contractors are properly lacensed and the status of their workers' compensation insurance coverage. <br />Before a building permit can be issued, this form must be completed and signed by the property owner and returned <br />to the agency responsible for issuing the permit. /Vofe.' A copv ofthe propeftv owner's driver's license, form notariza- <br />tion, or other verification acceptahle to the aqeoey is required to be presented when the permit is issugd Lo rcdlLthe <br />Signature of Property Owner <br />Print name of Owner <br />AUTHORIZATION OF AGENT TO ACT ON PROPERry OWNER'S BEHALF <br />Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize <br />the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Builder <br />Permit for my project. <br />Scope of Construction Project (or Description of Work) <br />Project Location or Address <br />Name of Authorized Agent <br />Address of Authorized Agent <br />I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above <br />information and certify its accuracy. <br />Property Owner's Signature Date <br />Print Name of Owner <br />Note: A copy of the owner's driver's /icense, torm notarization, or other verification acceptable to the agency is rc- <br />quired to be presented when the permit is rssued to verify the property owner's signature. <br />proDeftv owner's siqnatu re. <br />Uut {-c( -lt{ k-4 Date:kt /-zt/ )tx/------------+--t------.-f- <br />I <br />Phone Number of Authorized Agent:
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