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30243201 - Permit
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30243201 - Permit
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Entry Properties
Last modified
10/5/2021 9:37:51 AM
Creation date
9/30/2021 4:23:53 PM
Metadata
Fields
Template:
Permit
Permit Number
30243201
Full Address
1402 S Maple St
Permit ID
275575
Master ID Number
2021-166449
Project Name
Principe Res. Alt
Street Number
001402
Street Direction
S
Street Name
Maple
Street Suffix
St
Building Use Code
Resid-1 unit
Job Types
Alteration
Permit Type
Plumbing
Applied Date
6/1/2021
Issued Date
6/1/2021
Finalized Date
8/17/2021
Flood Zone
X-0602320276J
Description of Work
Water Heater Change out.
Nature of Work
N/V - Windows, W/H
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Z t understand I may obtain more information regarding my obligations as an "employe/'from the lnternal Revenue Ser-( vibe, 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 1 -800- <br />321-CSLB (2752) or www.cslb.ca.qov for more information about licensed contractors. <br />I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the <br />and fina for ad- <br />dress <br />4't I agree that, as the party legally and financially responsible for this proposed construction activity, I willabide by all <br />f,*0licaOle laws and requirements that govern Owner-Builders as well as employers. <br />ffiagreetonotifytheissuerofthisformimmediatelyofanyadditions,deletions,orchangestoanyoftheinformationllhfie 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 financial 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 obtain a permit as Owner-Builder and wish to hire Contactors, you will be responsible for verifying <br />whether or not those Contractors are properly licensed 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. Note: A coov of the propertv owner's driver's license, form notariza- <br />tion, or other verification acceptable to the aoencv is required to be oresented when the permit is issued to verifu the <br />prooertv own e r's siq n atu re. <br />Signature of Property Owner Date: <br />Print name of Owner <br />AUTHORIZATION OF AGENT TO ACT ON PROPERTY 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 />n at the <br />Name of Authorized Agent: <br />Address of Authorized <br />Phone Number 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 Sig nature: <br />Print Name of Owner: <br />Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is re- <br />quired to be presented when the permit is issued to verffy the property owner's signature. <br />[.)afa'
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