02020015 t`'.CITY
EUI D NG DIIVISIONVO' M ° 1CONTRACTOR.IlVEORMATION:
'
y =AERMIT,.
` 'BUILDING ADDRESS „e„ - - PERMIT NO.
I) is .,c _ iir .anhtLl
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• OWNERIS NAME:Lfil :.�::_::':':: ✓, '.. _...._ , .. . .. - .. _. _ _- ..-_ .... APPLICATION SUB DATE- .
1 TAYEbR'r WOODROW' HOMES " "^>'' "' `'02/05/20 02
SANITARY NO. CONTROL NO.
ipp ARCHITECT/ENGINEER:: '•a'i' y"' ,•-J• ;
BUILDING PERMIT NFO
F`� RR BLDG ELECT PLUMB MECH
>y i LICENSED CONTRACTOR 5 DECLARATION job Description'
' loin licenudumin prosismns of Chapmr9lcommelrcmg
DaSCrI
hOn
JZthereby alRnnha
with Section 7")ofDivisi6a3 ofthBusiness and Professio Cadadylicense
s,n ° enpgTKDEMO.
i3i ^ QSBLDG. 5CANNERYDal C I n r ou "* WAREHOUSE
.
' 3 - t 1 ARCHLlECT'S DECLARATION'
-'=O g ' I u dcrnond my,pl i shall be used es publi<rtcoNs 1 '"L -t' 0.f1,1. _ � 1' 'H ..
a n 0 I LIC ri d Pr fel lanai 1 1 .} II
ONNERBUILDERDECLARATION
- 1 III at[,.th 1 I u Pt from the ContractoLicense Law for Ne - - - - -
t,Zlowinirca (Sormn 7031.5:13miness andPof dons CM Any city<rcounty
D •whi h q rce u pe a Irya' II r pr ❑moheh r rcPair anY14^'Tule
sa 1 no 1 ,e ssua tt Isort acs Ned I ails fo h mita fl a nw gamma,- ---
'Nat he sic nsea pursuant,o std prows m nheC tracmr'sLc me Lpq
ns lChapie 9 S l�''t. Floor Area D -
Ilco m cog wqh Suyl ,'(040) fD sm J !Ih B iNNcss and Profcvlot- .
. for Np hekexempl lh rcfrom end.Ne ba sfnr,,he ellFgeH.esempuod Any'vinitn '
',of5 1 ]113156Y n) Ppl afore pe t 61 t tl 'aPPI uo ec Ipenat, ; - ""
'lof no,mlrc thanf n a dart (ssool - -Y ;, b - - '- ?,r•, f , ,_ Occupancy Type '--
I ,. 4 : y , . _„ . .. _ .. - t •,. [t' .JI 1�' �' Ile - t n,..,,.�
r ., .OI e o Mr of Ne property my employ a Ih wagei ns ih v ole c.mPenlauan � '
'wIR db the"work.-and.tht eUv tNtris dol'InmadN or oRertd for wle(Sea]13U;' -- eC -
Boslness and'Prbfessions Code ThaCommctor'sLrcense law docs not apply to an ' '" 110,
'"• -j - " '' - egU17e O$ tort$"•^^""•`• -- '-'
caner of Property Who hu Ids or improves thereon,and wha does such work himself, _.
o „
or N gh I's einpl y p Id a Ihw each Improvcm sore' tole aJ or
.offcrcdf Ir IFM10 ear lneb Iding ur improvemem s o1J wlNm oney vrb( "-'•"_-.. ., ....._._,.. _..... ...._. _._. ._--... ..+ _.. __ _ -_ _ _ ..... .__..._..
complc o , c axm,. I der W 111 have,he burden or proving shot he did not Wild or
ins"mIc far P.W.of,. t
! _ ao' w fah Prortn .d exclusively „ Rlh licensed nmo 1 - MAO L_S„�;'�
,s.s•®
n, Ih project(S Badires dProfessionsCrd )The Contractor s
License i, ones noiapply an ownerof property who Wilds rdes there..,
and hoconvacis for
such i' IN a ontmnor(q.l censed.puuen,.lo Ne R ,s
s
1
's Y
I l
01ContractorsaxeI.cense Le 1
❑lam exempt andel Sec. - B&PCfar this mason ,,, _ - ',r,-• ._... .. _._. ._.
Owner [tai + 1 Cu 1 0(•.. 1
t W� ORKI R S COMPENSATION DECLARATION. �u'`®1�� - ,-
a. '{
�fy � 11'1 hereby affirm
rm d penalty of Pe tory o e c o Dobe fall 1 g dedan,ions:
❑ 1 he and ii ann, n C nifi<am of C ,to wlLlnsurc for worker's it,
.Cpsort as+pro dad. r by Sect LaJor Conde;-for-he., 1 I4.
ari'mm flh w kfuwhich this jammit s issued. � •' N, .
rI
It
1 h v d'w,Al maim In W k s ComPe n, 1 omni as rcquiied by Section - ,;1 •- - - "' '
3]00 of NrlaboF Coda for,he,pe'rfomuntt of,he Work:Or wh¢M1 Pennn,is
su d My Wa k 'C pe uon Insvw ce n r arta Pol cy number 3
arrlr�"�� eae(PDI Cy NJ(//t('Ca00(SGGA11 � �1 r." r '`'
- '- I "71µCERTIPICATION OF EXEMPTION FROM WOItKERS.I'; l ,'s. V. 'rys }J sr ' i�ttg 4'}:� }-1 .iscl'� JgA s� .. rl
. ,< ,[�Z%1a�tJSLq OyMPLNSATION INSURANCE a1 Il ,.1:, r \ 4---------- -...
+' (.1.:1 (Th 'uon rte a noFF(be com l-ted Inhe s's fo rte hundred doll ' rt - -
tom` * ISI110j or lenJl • Fp f :In- X911'- „ l0
,. .
:;1 ¢I GendY lh i m,hc performp a of lh ik f r hlch N Ipemuols i s kI
small mol empl y ony'pe n n ony ma m us io become b) r io the Workers -
Comp s t nCaws of Calf ':Dem" '•'I „ � :
.. NOTICE TO APPLICANT:If;after making this Certificate of Exemption:you should' .,.' .< ♦1,
.become subject io
the Worker's Compense,idn provisions fi(Ihe Labor Cade,you mon ,
folihwilK vomply.Wi,M1 sato plovisiona or this permit shall hdeemed revoked,
Ira(a~a of nthe w1 Iork 1f1oi wh'rth CONSTRUCTION
NpScTmRlUl CT'iIiOxuN eJL(ESNecDI13N0G9]AGLNC
h affthin th1 e c ns nn led g agency
Y fhperfor.m.a.n..c_e. ... ... ........ ..._ ... .._._... __ -
Cin,C) r
..
7i 7
Limit,'.AddI
,
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f -
m I c n fy that I We mud al ."Iiic 1 rid ml that the abo of mon, is
Isl Fr r I gee to c mply uh all city and
V 1 budding o 1; non d hertby euNo zceo rey es andit circ laws relating
rt amiresofIh sstytoene,iiiamp
`
Ne adaiIia mentioned propirty fo umpeeli FEp ryo 1 n A; (W<) g ,o sa e. demmfy and keep hwml ssNe lSty of Cupenmo against y
(Z] lithilikitIs.jidgrin.Fra.cot and caped.which may m any way secrue ag inn said 1 t
U City cb sequenceoPthegrimng finis Partial!'
APPLICANT UNDERSTANDSAND%VILL COMPLY WITHALLN/qN-Pa NT Issued b �'
1 i
S URGE REGULATIONS J y ate
}gnat itTof AI. r4nt/Conlna.1 —. i� DamRe-roofs
HAZARDOUSMATERIALSDISCLOSUREr U .
. I;a WII Ne applicjm or Ponm bu lalgaxupam nWe or,handle hazallolu material Type Of Roof. _
as defnd by,he 6penmoM ilpal Code Chap1r912 end I It rid Sof ly :, r
Cade Sectoq 2553211v1 L ryr , s '. t , r -J 3'�'4 1.} Ir"kg i . r. rr L t •y .It f
,,OYesi .wvnnfW oe',ry ppl f v..714rhs Y 1 s 1 @r
�. _,.,1• t Alisoofs shall,be inspected poor-to,any roofing matena] tieing_Installed.__.- _ -.-
r• WIINcaPpligentorfwrtWilding occupant useequipment aJevleeawnen Ifaroofis•installedtwithout firstobtaininganinspectton,Iagree`to.remove
tbreardous al contaminants asd fineManagement, ., .�
Y Y quilt tial i - -
entl l ^. L r 1 Q '" all new materials for inspection Applicant understands and_will comply,wlth
the B Are.
C4Ye h -r. I p, , J I."�,. C a]Pons-po� t�sourceregulat., on5 _.,;
fahePm to gattaNercwhich
,iW min prior susnce f eC n1f cote of 41c""�^4/" ._ . ._._ .-s/�/fl._•.. ._
S
mels rc u to under Chapter fi 93 of Ne
Occa a aulhonzedafel Code Sectio
Y Oc en< n hm _
o6ca nt of requirements _ rR panrl lit ranatl Signature of Applicant Date
gen, i`: I p .C.µ ,e All roof coverings to be Class `B" or Better'
— OFFICE ,
-
OF
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