02020058 OF
CI sol DING DIVISION
PERMIT CONTRACTOR INFORMATION:
.
BUILDINGADDRESS PERMIT NO.
2944c; T-INDA ANN C.1 02020058
OWNER'S NAME: APPLICATION SUB DA"fE
RARICK JAMES 02/15/2002
PHONE: SANITARY NO. CONTROL NO.
O Q - ARCHITECTfENGINEER: BUILDING PERMIT INFO
PC
be BLDG ELECT PLUMB MECH
yZ L= U 1_=1 I I
<6
LICENSED CONTRACTOR'S DECLARATION
c�yt thereby affirm that lam licensed unser provisions of Chapter 9lcnmmencing Job Description
=yto with Section 7")of Division 3 of the Busine end PmmcssionsCMc,endmylicense
<2E iainBinf IT
Oro
�L' Syr B REMODEL ADD 32 . 5 SQ. FT.
i esd$ ufen c IC Lm. (2 BATHRMS . )
3 L t D e Z ARCHITECr'S DE RA N w,
_ Oy g I undersian0 mY Plans snag be mW oz puhlic mcoNs FI,V ALE
+a+u p O Ueensea Pnefessian d
OWNER-BUILDER DECLARATION 2 3 2002
w � JUL
1 hereby affirm that 1 1. Business
Tann the Contractor's License c Law for the
M z a following reason.(Section]o3 Eruct,alter.
and Professions Code:Any city or county
Y t C which requires n aludsac paras the,,plic improve,demolish,fi repair any slruclvin
..p at Tic i licensed
pubso requires provisions of farme much Comma d s License
La (Chaprcm. - - -- - - --- -----------__-__--___
that been licensed pursuant to the csfDivisiof . the Bmols Licensenaw(LTeptar9 ! }�
or that he
(commencingwithSeniefro Oand the basis
sisotthe Businessaaa Professions Codc) ��rtiV'�t .,I ._4 'G :JezYL:9'i anon
or Shatio ist 1h5 byIany applicant
p m•and the busia forthesubjects
the applicant
to Any violation '
of Section 7031h5 by anydom ollinrapermit suklecu the npplicenrinacivil Penalty
lot not than Ove hundred dollars(SSW). b J ;; Occupancy Type
❑L as owner of the property,or my employees win wages as their sole compensation, '
will-do the"work.and the structure is not intended or'orcered for sale(Sec.]paq' -- - --
t Business end Professions Code:The Commnma License law does not apply to son equired Inspeetions't` '-.�.m-
ow
r of property Who builds or improves Ihcmon,and who dos such work himself 10 2 - PIERS
or offered
o gh n' employees,thprovided-o 1 such improvements arc notintended or --103- .-UFER.--- - --- - -
offe df I('hd ev the building-ormproe et .old wlfi y f . „' -- -"
cmpli nthetw rh ter it[have the h de fp gthtn did to Id 104 - REBAR - e]
pr e for
p rpa: r mile.), e
TilW .. ..._ . .
lrs he nnep ponyam caul s.sly 1 1 sn. d' i 106 SEWER &105__=. ANCHOR_BOLTSWATER 1'
-
construct In[pmJCLI($ 7BM1 Business s a Professions SSiOns f.C M )Th Contractor
-1 r 5 , -
License Law does no]apply t owner ofpopany s,hoWla improves me on, 202 - UNDERFLOOR PLUMBING_
. and who.mnlracm forsuch proleats.with a.commctonsylicensed pursuant or rte_ __ ,- _ _
Committee,License Low_ 203 - UNDERFLOOR MECHANICAL
❑lame pt nder Sec B&PClrthis reason 1 .•.
204 - UNDERFLOOR FRAME ,
WORKERS COM PENSATIONtDECLARATION 205 - UNDERFLOOR INSULATION
° -Ihemhy emrm undcr,penahy of per;ury one of the meowing dedarntions: 301 - ROUGH PLUMBING
01 have and will'meinliin a Cenibcme of Consent to self-insure for worker's 302 - TUB & 0R SHOWER
.- Compensation, I provided for by Section 3700 of the Labor Code, for the 303 - ROUGH MECHANICAL
performance of wank for whmh thispermit is issuee. 304 - ROUGH ELECTRICAL
❑1 have and will ineimnla Worker's Comparma ion Insurance,a required by Section 305 FRAME
k� f /k/!�• rk for nu b this perm C s
> CERTIfl rarjt OF EXEMPT ION pRdPIy number
3700 of the Labo Coca f the pe form of the O
AIJON
issued.My Workers rs Co np s t 1 sumncc cu e 33 y
C' POI cyN ,OM.WORKERS(' �4i:.v l ric3b0;Iii+" R_I,N-.S'.ULATION�:l1�. •^... .- S:1 r...;. - _ _ ._
,,,•, _ i--„--COMPENSATION INSURANCE s' .. ; _. _3-08:_.-.SHETROCK_-_—___�__...—._..__._ -_
O1' •"" ('ILisscniorineeJnmbecompleteJirlhepcnnitisforanehundreddollers 3091'- -'EXTERIOR LATH
rslooJ ' 310 INTERIOR LATH
�:' I 'nif Ihaf in Ih pert nn f m k f r hi h Ib.perm I s s d 1. ._ :.:. -w I ,,.:._. .. ._...
y 311 - SCRATCH, COAT ',.r:: t; -b
'h m t ply any p Y e n s n became un3ecCm the Warkerc. .. •, .
comp q�alion J,aaa br coury,;n a_game. 313 ROOF NAIL
"NOTICE emmesuOAPotheWoTr'sComaking nnsCsionsamL ptmn,yov,houdidwIt -' 501' FINAL ELECTRICAL ENERGY- -•i .-'
Z :71-
become subject m me Workers Colons or this previsions of rte Leber Code,you mum'
z fonnwincomply wnesuch prmiainnanrmi:p mnanaBxd mdrtvoked. SO2 - FINAL PLUMBING 'ENERGY
FINAli'MECHANICAL
ill 4 t
'CONSTRUCTION LENDING AGENCY
lhe byaffnnlh to eamwctodlending agency f thep'erhandeace 1 504 - FINAL BUILDING ENERGY''
O' of th rk orwhich this pandit s ssuN r5 a 109] Ci C)
-Ginae.:N me.... .. . , . _:,. , . - -.. .... ,..,5.05.. _ . FINAL--ELECTRICAL -
;�,'�Z Lende eAddress'I-
506 - GAS TEST:.,,,• ...
U-0 1certify netlhave read nis application end stat'banneaboveinformNon is 507 - FINAL PLUMBING
ka is ,corriii.1 agree to comply,with all city and county ordinances and state laws relating
ItoWildingconsniimion;mdherebyaithmizerepresemativesofthiscitytocnterupon 508 - FINAL MECHANICAL
the above-mentioned propcoy for inspection purposes..., .. ,
Uy' (We) $gme to save.indemnify and keep harenless the f C peninoagainat 509 - FINAL GRADE
:z c yl t"a'ar am gL2nces,`I e�nd e�nsea f his�en y 1 any py eccme against id 5 110 - NA NG
7CA!T IJNC:RSTAN D WILCf Y WIT'HALL ONP INT. ]SSUed b�J.4 - RKS [�
st cE UI c@Ns fl '". 2�[/jft '�,�Z Date
re of Applicanr/Commew •" /'''-' te' Re-roofs
s - HAZARDOU$MATERIALS DISCLOSURE
will IW appl cant or f ter,Wild g occupant stole or handle ju z asoa material Type Of ROOf
a.de0ned by rte Capers Mun c pal Code Ch pte9 12 and th Hcabh and Safey
CMe5 ton 25532fa) \ I (4f`'] r t h• a- 5ypy,^o�'i u{r;C'IlJ�ll lE �.b 1
❑Y (� 0No-
1 I J,�- * I „All roofs shall,ibe,tnspected prior[o_apy roofing material being installed.
. _
I
Will the applicant
future building` p t e equipment devices which If a roof is installed without first obtaining an'inspectton •I'�agree'do'remove
emit haamdous air anal r nt,as defined by the Bay Mea Air Quality Management
District? all new materials for inspection. Applicant understands and will comply with
Dyes 0 No f all It source regulations,
I have read the haamdouv teriils req bcomad undo Chipter.695 of.the
Cal(crinin Health&Safety Code.Sachem 25505.25533 end 25534 1 understand that
i(ihe Wt ffirdoequL cm"Yhmx enam,thatlis MYmap.
erdiwfyne - -"" "" '-'-”'
ads t of n Ocala he
Oc anc
p eaaux 'ortni=s a Le r r`ni Signature of Applicam Date
aunp oda ,U All roof coverings to be Class"B" or better
r
-OFFICE--
. . ... . , .. . .-