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20171717 - Permit
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721 N Linwood Ave
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20171717 - Permit
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Entry Properties
Last modified
10/6/2021 2:55:46 PM
Creation date
10/6/2021 12:00:01 PM
Metadata
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Template:
Permit
Permit Number
20171717
Full Address
721 N Linwood Ave
Permit ID
267652
Master ID Number
2020-160962
Project Name
Miscellaneous Counter1 Permit
Street Number
000721
Street Direction
N
Street Name
Linwood
Street Suffix
Ave
Building Use Code
Vacant
Job Types
Miscellaneous
Permit Type
Electrical
Applied Date
8/20/2020
Issued Date
8/20/2020
Finalized Date
3/31/2021
Flood Zone
X-0602320163J
Description of Work
Meter upgrade. Handout provided.
Nature of Work
Service meter
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L l understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue Ser- <br />, the United States Small Business Administration, the California Department of Benefit Payments, and the California Divi- <br />sion of lndustrial Accidents. lalso understand I may contact the California Contractors' State License Board (CSLB) at 1-800- <br />321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors. <br />10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the <br />legally and financially responsible for proposed construction activity at the following ad- <br />d ress <br />I NJ f f I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all <br />lUr{icable laws and requirements that govern Owner-Builders as well as employers. <br />n <br />JN_llz I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I <br />hur/ 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 complalnt. 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 pe rmit. /Vote: A copv of the propertv owner's driver's license, form notariza- <br />tion, or other verification acceDtable to the aqencv is required to be presented when the permit is issued to verify the <br />propeftv owner's sionature.1 <br />lr,lSignature of Property Owner ?J/\rLr*-Date <br />(Lo Zo <br />Print name of Owner e shrz.t <br />AUTHORIZATI 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 />Name of Authorized Agent <br />Address of Authorized Agent <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 Signature Date <br />Print Name of Owner: <br />Note: A copy of the owner's driver's license, form notarization, ot other verification acceptable to the agency is re- <br />quired to be presented when the pemit is issued to verily the property owner's signature.
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