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BPAT2017-0032LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my License is in full force and effect. License Class: License No.: Date:' Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (,�$500).: er I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). LAA I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). 1 am exempt under Sec. B.&P.C. for this reason Date: Owner( CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Na Lender's Llc. No.: WORKER'S COMPENSATION DECLARATION hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' :)mpensation, as provided for by Section 3700 of the Labor Code, for the performance F the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by action 3700 of the Labor Code, for the performance of the work for which this permit issued. My workers'.compensation insurance carrier and policy number are: arrier:_ Policy Number: _ &e_ 1 certify that in the performance of the work for which this permit is issued, I call not employ any person in any manner so as to become subject to the workers' Dmpensation laws of California, and agree that, if I should become subject to the corkers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith Dmply with those provisions. ate: 4XII&WI% Applicant DARNING: F (LURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. ND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ,NE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF OMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, 4TEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT OPORTANT: Application is hereby made to the Building Official for a permit subject to ie conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose aquest and for whose benefit work is performed under or pursuant to any permit .sued as a result of this application , the owner, and the applicant, each agrees to, and hall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and mployees for any act or omission related to the work being performed under or )Ilowing issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is of commenced within 180 days from date of issuance of such permit, or cessation of cork for 180 days will subject permit to cancellation. certify that I have read this application and state that the above information is correct. agree'to comply with all city and county ordinances and state laws relating to building Dnstruction, and hereby authorize representatives of this city to enter upon the bove-mentioned property for inspection purposes. ate: Signature (Applicant or t-)= 44 QUIArom VOICE (760) 777-7125 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 DESIGN &DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 4/18/2017 'Application Number: BPAT2017-0032 Owner:11 J Property Address: 52180 AVENIDA VALLEJO CLAUDE POVEDA J APN: 773223009 74923 US HWY 111 j Application Description: POVEDA / SOLID PATIO COVER AT SIDE YARD 'INDIAN WELLS, CA 92253 ° ue�v -� Property Zoning: o To Application Valuation: $400.00 3 c Applicant: Contractor: n o O CLAUDE POVEDA OWNER BUILDER 74923 US HWY 111 INDIAN WELLS, CA 922S3. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my License is in full force and effect. License Class: License No.: Date:' Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (,�$500).: er I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). LAA I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). 1 am exempt under Sec. B.&P.C. for this reason Date: Owner( CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Na Lender's Llc. No.: WORKER'S COMPENSATION DECLARATION hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' :)mpensation, as provided for by Section 3700 of the Labor Code, for the performance F the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by action 3700 of the Labor Code, for the performance of the work for which this permit issued. My workers'.compensation insurance carrier and policy number are: arrier:_ Policy Number: _ &e_ 1 certify that in the performance of the work for which this permit is issued, I call not employ any person in any manner so as to become subject to the workers' Dmpensation laws of California, and agree that, if I should become subject to the corkers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith Dmply with those provisions. ate: 4XII&WI% Applicant DARNING: F (LURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. ND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ,NE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF OMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, 4TEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT OPORTANT: Application is hereby made to the Building Official for a permit subject to ie conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose aquest and for whose benefit work is performed under or pursuant to any permit .sued as a result of this application , the owner, and the applicant, each agrees to, and hall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and mployees for any act or omission related to the work being performed under or )Ilowing issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is of commenced within 180 days from date of issuance of such permit, or cessation of cork for 180 days will subject permit to cancellation. certify that I have read this application and state that the above information is correct. agree'to comply with all city and county ordinances and state laws relating to building Dnstruction, and hereby authorize representatives of this city to enter upon the bove-mentioned property for inspection purposes. ate: Signature (Applicant or t-)= ''T NANCIAL •• • DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT QTY AMOUNT PATIO COVER, STD, OPEN 101-0000-42404 0 $101.84 DESCRIPTION ACCOUNT QTY AMOUNT PATIO COVER, STD, OPEN PC. 101-0000-42600 0 $100.32 Total Paid for PATIO COVER / COVERED PORCH / LATTICE: $202.16 DESCRIPTION ACCOUNT QTY AMOUNT SMI - RESIDENTIAL 101-0000-20308 0 $0.50 Total Paid for STRONG MOTION INSTRUMENTATION SMI: $0.50 DESCRIPTION ACCOUNT „QTY AMOUNT . TECHNOLOGY ENHANCEMENT FEE. 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 TOTALS: �: r %U - ------------ RW(UR SIZE AND spACINC ROOF P(TCH ........... I. a SPECIFY ROOFING A140 SKEATNt"C OR OPEN (SEE ROOFING NOTE ONREvERSE) ------------ BUILDING DEPARTMENT A*PPROVAL, BELOW U -STRAP OR ANGLE (4) - 16d NAILS OR BOLT AM -v STRAPS CfTY..ST ZIP TELEPHOuE PROVIDE I" CLEARANCE BETWEEN 6*ww.1/6- WITH CONCRETE ANCHOR BOLT (EMBED 7' MIN. INTO CONCRETE) JA) IiidNAILS OR DOLT 0.147 0-H: POST spoc*#G ER4A LENGTH: OVEPAL REM pw sm- IL SETBACK mm.) 2000 P-S.f co14cr,*m f**Sm COO& L__J I WL' Irair F'oOTVV. I I L__j go -m CAW L j PROVIDE, I- CLEARAMCE BETWEEN POST AND ATTIct PATIO VAY BE ATUCHM To CaST114G FASCIA, LAG SCBE*"*MGM %rASCK INTO EACH R"IlER T CDNCRE IE U — STRAP OR ANGLE LAG SCREWS *no STUOS AT 16" O.C.- CoNt*#XXJS LEDGER NON—CORROSIVE PLATE (4)— 16d NAILS OR BOLT BUILDING DEPARTMENT A*PPROVAL, BELOW U -STRAP OR ANGLE (4) - 16d NAILS OR BOLT CfTY..ST ZIP TELEPHOuE PROVIDE I" CLEARANCE BETWEEN POST AND CONCRETE ANCHOR BOLT (EMBED 7' MIN. INTO CONCRETE) TYPICAL PATIO COVER DATE OF APPLICATION OWNER'S NLAAAE STREET ADORESS CfTY..ST ZIP TELEPHOuE RAFTER SPAN TABLE ���� �� Q 00 GRADING RULES� PS 20-70 (FEET & INCHES) Z5 _3 OJ�� o 2x4 i'6' ° O.C. 24' 2x6 16' A.C. ?r4 •i' 32' ` 2x$ 1 !; O.C. 24" ' 32" ' NOTES: 1. 32" RAFTER SPACING IS ALLOWA6LE FOR OPEN LATTICE PATIO COVERS ONLY. 2. FOR SOLID. PATIO COVERS (NOT LATTICE) RAFTER SPAN IS LIMITED TO. 10'-0' USING THIS STANDARD. LATTICE ROOF BUILT—UP ROOF HEADERS HEADERS DOUGLAS FIR NO. 1 DOUGLAS ERS NO. l SIZE SPAN I SIZE SPAN 4Y4 _ 4x4 -4'-O" 4x8 1 1'-4x8 -0 '- 14'-0 4x12 17'-4x12 E:L 6x8 14'-0" 6x8 t ?'-G` 6x10 17'-0 6x10 14'_0 I AW. CONSTRUCTION SHALL CONFOR TO THE PROVISIONS OF THE !A-%�4 t s__ t ROOFING NO S• A. BUILT-UP, ROLLED ROOF: SLOPE TO DRAIN. B. ROCK ROOF: 3/12 MAXIMUM PITCH. Bin f Qty' of La, Quin to L ' Buiidin-a Safety Division Permit u78-495 Calle Tampico La Quinta,fCA'92253 -(760) 777-76i,2 ' Building Permit Application •and Tracking Sheet Project Address: J / r � Q � 1 Q,Q•. LLQ Owner'sNamc• � � DU�V� . - A. P. Number: /, Address: cel �b jJ&A11 j9A 1A -�4-1� Legal Description: City, ST, Zip: v�A J7 )f qzZ S3 r: 7q OConlract eP one:� 4=- O. _ Address: Project Description: City, ST, Zip: ' Telephone: o State Lic. # : City Lic. Arch.,:Engr., Designer: t Address: City, ST, Zip: - t Telephone:hone: Occupancy:an Co s•truc tonTY cY: Type: State Lic- # ProJecttYPe�cit (circleon New Add'n Alter -Repair.air' Demo e)' Name of Contact Person: i Sq. Ft.: t' # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: Vag • APPLICANT: DO NOT WRITE BELOW THIS LINE. H Submittal Req'd Rcc'd TRACKING e PERMIT FEES "Plan Sets Plan Chick submitted Item • Amount Structural Calcs. Reviewed, ready for corrections 1 Plan Check Deposit Truss Calcs. I Called Contact Pcrsort Plan Check Balance. Title 24 Cates. Plans picked up y Construction ' Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Reviciv, ready for corrections/issue t Electrical •Subcontactbr.List Called Contact Person Plumbing ! . Grant Deed Plans picked up S.M.I. II.O.A. Approval flans resubmitted 1 Grading IN If OUSE:- ''d Review, ready for corrections/issue t Developer Impact Fee J• Planning Approval, Called Contact Person A.I•P.P. Pulif Wks. Appr Date of permit issue r School Fees, Total Permit Fees r r C A if r BUILDING & SAFETY DEPARTMENT 78•495 CALLE TAMPICO (760)'777-7012 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 Considering Becoming an Owner -Builder? Important information you need to know BEFORE pulling your permit! 'The term "Owner -Builder" can mean three different things: "Owner as Worker", "Owner as' Contractor" or "Owner as Employer" Understand each has.Beriefits or, Risk, and it is possible to combine them! Hiring a California Licensed Contractor means you do not personally perform any of the construction work, the permit is not taken out in your name, you are not personally responsible for the construction and you are not an Owner -Builder. Instead, you become a "Customer" and Califomia law provides you the benefit of protection from poor workmanship, failure to finish the job and financial risk due to worker injury. Benefit/Risk:.. Highest Benefits and:the Least amount of Risk Owner -as -Worker is a type of Owner -Builder where you personally perform the construction, work, the permit is taken out in your name and you are personally responsible for the construction management, knowledge, workmanship, and completion of the job. You benefit by not paying others to perform this work for you and your risk depends on your own ability to complete the job successfully. Benefit/Risk:. Possible Benefit with Low Financial Risk Owner -as -Contractor is a type of Owner -Builder where you personally act as your own General Contractor, the permit is taken out in your name and you hire California licensed sub -contractors to perform portions of the construction work. WARNING: The benefit of protection provided by law when you hire only California licensed sub -contractors can turn to serious financial risk if you hire unlicensed contractors to perform any of the work: Benefit/Risk: , Possible Benefit and Significant Financial Risk Owner -as -Employer is a type of.Owner-Builder where you pay any unlicensed individual to perform any construction work valued -at more than $500.00, the permit is taken .out in your name and you are. personally. responsible for their employment requirements, supervision, perf&mance, safety and welfare. while on your property. WARNING: Cost savings benefit can turn'to serious financial risk if you fail to deduct payroll taxes or provide workers compensation insurance for each worker. Benefrt/Riski Possible Benefit with Significant Financial Risk -0�- (Health and Safety Code Section 19827) The California Legislature declares an "urgent and statewide public. interest in assuring" 'that contractors comply' with Contractors' License Law, Business and Professions Code and Workers' Compensation Insurance requirements to ensure property owners are informed about, and protected from the following when improving their property as Owner -Builders: Fraudulent representations - Liability for worker's injuries • Liability for material and labor costs unpaid by contractors • Licensing•requirements • Employers tax liabilities Over 20,000 consumer complaints are filed each year. Many complaints relate to owner/builder projects and include workmanship and workers' compensation issues Homeowners suffer financial harm due to defective workmanship and injured employees. Following are alarming examples of what has occurred with Owner -Builder permits: Example 1: Homeowner received insurance money to rebuild burned -down home. • Owner/Builder permit pulled to rebuild structure. . • Unlicensed contractor built substandard structure — must be torn down and replaced. ■ Estimated financial injury is $225,000. Additional financial injury - IRS threatened to- tax insurance payout if house not completed by the end of the year: Example 2: Brother-in-law had active license but fled an exemption from Workers Comp. • Owner -Builder hires brother-in-law to install a new roof. ■ Employee falls and sustains multiple spinal and extremity fractures as. well as ahead injury and remains in a coma to this day. ■ The Owner -Builder, who has sold the home, is now a defendant.in a lawsuit for reimbursement for benefits paid to the injured worker. Example 3: Employee of contractor without Workers Comp is hired by Owner -Builder to install septic system and suffers injury that results in permanent disability.. . ■ The Owner -Builder did not have a homeowner's insurance policy on the house against which to submit a claim. ■ The Owner -Builder is now a defendant in a lawsuit for reimbursement for benefits paid to the injured worker. Did you know — unlicensed persons frequently have the property.owner obtain an "Owner -Builder" building . permit which erroneously implies that the property owner is providing his or her own labor and material personally? Did you know — your homeowner's insurance may not provide coverage for injuries sustained on your property by an unlicensed contractor and his/her employees? Did you know — if you are considered an "employer" under state and federal law, you must register with. the state and federal government; withhold payroll taxes, provide workers compensation and disability insurance and contribute to unemployment compensation for each "employee"? Did you know — that if you fail to abide by these laws'you may be subjected to serious financial risk? OWNERS BEWARE AND CONSIDER"THE RISK BEFORE ACCEPTING FULL RESPONSIBILITY FOR YOUR CONSTRUCTION PERMIT P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT (760)777-7012 FAX (760),777-7011 PROPERTY OWNER'S PACKAGE .. , Disclosures & Forms for Owner -Builders Applying for Construction Permits IMPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building permit has been submitt in your name listing yourself as .the builder of the property improvements specified at We arerovid'i p uig youwith an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk.you may incur by having this perrimit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION DIRECTIONS: Read and initial each statement below to sign f you understand or verify this information. 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as, an Owner -Builder and am aware of the limits of my insurance on my property. coverage for injuries to workers 41JL2. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. �!r, 3. I understand as'an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. d4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. (-7r5. I understand if I employ or otherwise engage any persons, other than. California licensed Contractors; and the total value of my construction is at least five hundred dollars ($500), including labor and. materials, I may be considered an "employer" under state and federal law: '(lf�"6. I understand if I am considered. an "employer" under state and federal' law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance;, and contribute to unemployment compensation for each "employge." I also understand my failure to abide by these laws may subj risk. ect ine to.serious financial �7. I understand under California Contractors' State License Law, an Owner -Builder who builds.single-family residential structures cannot legally build them with the intent to offer them for. sale, unless all work is, performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work. is performed under contract with a licensed general building Contractor. R• 00 L8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by' any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. 6E9. I understand I may obtain more information regarding my, obligations as an. "employer" from the Internal Revenue Service, the United States Small.Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1- 800-321-CSLB (2752) or www.cs1b.ca.gov.for more information about licensed contractors. V '10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally, and financially responsible for proposed construction activity at the following address: 6L11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as -well as employers. 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I ave provided on this form Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an. unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable foi• damages. If you obtain a permit as Owner -Builder and. wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued -to verify the property owner's signature. Signature of property owner � -= �_ Date: - Note: The following Authorization Form is required lobe completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder. AUTHORIZATIONOF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file. the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction.Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally. filled out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owners signature. Property Owner's Signature: Date: