02070187 CI sun OF
c DIVISION
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS- PERMIT N0,
10140 N BLANEY AV 02070187
OWNER'S NAME: APPLICATION SUB DATE
MC AFEE JIMMY J AND PATRICIA A 07/29/2002
1 PHONE: SANITARY NO. CONTROL NO.
0 O ARCHITECTENGINEER: BUILDING PERMIT INFO
Q U BLDG ELECT PLUMB MECH
a d -`"�._ I L= LI U LJ
Z y i LICENSED CONTRACTOR'S DECLARATION w Job DesGri tion
0 z-0 I hereby ahTrm m
that I am licensed under provisions of Chapter 9 Nerneming P
pL t_w with section 7")of Division 3 of Business and Professions coda.and my license REPIPE/WATER SERVICE
< in lull force an R
are a 6 License Clasx Lic.a
3 a I- Date Cnntromtr
F=0 w CH ll le Mm DECLARATID
F g I understand my plans snail be used E public TI Na
r
E:o O Licensed Professional
OWNER-BUILDER DECLARATION
to 1 hereby affirm that 1 am1. exempt s an the Contractor's Licence law for Ilm
s- a following reason emiot ]onsma Business end Professions Code:Any city or county $5000
is F o poor
which req a permit I t t aloe p demolish or fil repair any structure
r°1 pct wsmm.mmaalso rcgo do,lheappl 1f hractormkenue aw(Cocmcm _. ......-___.
a.3=s..Ipohei.fartn-dpumuanllolbepofDivi nof 3 CnButim Lccnse Law(CounterCade)
.�v,' Valuation
a man heel a �N szs q Vaio)and the b. 1 f the 1 rltod asand imi.Any
code) L;g 11*-i t3'ISE 2Ff;GF7�F,tiW ;'.'e l�f'�'3'i�1`^,:
or Nat he Is exempt Nererrom and the basis fns the subjects
th a chem%ltd.Any l pennon
-.I of Section than byany ehundrpi eddoso llars apermit subiecw the applicammacivil penalty- Occupancy Type
for not,more man five hundred etnan(asoo). 202APN L2FLOOR PLUMBING`
01,as owner of the property.or my employees with wages as their sole compensation, ini _
-
will do the walk,,add la s(runure'is nor intended.1 offered for sale(Scc.'T 4, --' --- -
(Bustsesa'and Profexa'o s Cod The Conum m s License Law does not apply to an 502 - FINAL
P 1]lYl gri FYSILet>�Il�R�Y- " ,
owner of property Who Wild,or improves N thereon and who does such work himself
m
or through his own employm,I y dcd I h- provemenm are not uncorked or 507 FINAL PLUMBING
�pff tend fm sale,If,however the nodding imlimvement is sold w thin one year of
completion,the owner W rider will have the burden of proving that he did not build or
improve for purpose of sale.).
O r f iA pmpcnY am cxdux IY t t BN f d cony tors to
t tract thel j r(Sec ]041,Busne d Pr fess ons Cod )The Contractor s u 6s Wry my I ;-_� .,L( f r .i. [.!
License Law does not apply to an owner of propany who Wilds or improves Merton,
i = ._etre ht c ntrmts.for a ch.p 1 m w N casomicwr(s)f mad pursuant to.thc _
7. _. ._. - __._ .__._
co --
Connector,License seU
01 m t acr6 - F - B&PCI misrcason Aur, 0
In ""
'...netDate .. .,
WORKER S COMPENSATION DECLARATION BU'LDlpf^BY\.l
,. Ihereby iffirm und Klmfy, �perjury,me of for,following dtions.
❑ I home aial Momenta Cnrtificzfir V Crisem So If for Wmker's
Compensation, u provided for by Section 37W of the Labor Code for the
Penormance•ef the work for which Nis permit`s issued,
O 1 h and will Maintain Workers Comparoattiol'iniumit as required by Section
37W of'he Labor Clyde for the Performanceof b walk.f loch If,permit.is
isstad My Wok C a l q Imsu e lfarrier
d Policy numbe '
lo
1 -
Camil'ri'ttn�'Policy No '�>'{9(r17C-Vkll-2VR'� .... __ I
Y tjl`))`CERTFlCATION OF EXEMPr10N FROM- O— N R t . I t1.i,. 1 r s rs5�ti.•t 1,�L'i iy+-r�r,; \Ut ui_f c.l ,
d ...
.r COMPENSATION INSURANCE'•'':'^a a
c. t
`(r I(Thi3 ctin'nced not he completedf the perit is for ohundred arsd doll '�s l' s .'I .: Cr_ 'rl. Tf 1 •..•�...
fslao)tnen.) mneun
'.
„1 I. .. ..
sh 1 cert .j'ait Ise petoom y of 0 k f hi h th
mmed'I
''A II t mploy any Pero i y e to become s b)n to Ne'Wtrkcn :�1'.r l. ti,h, a L` r
Compcnsauod Isws of C li�onim.Dalen
.iNOTpp! a1,-_-,
1 NOTICE TO APPLICANT If aft making this C n fc m the
Exemption.you ho Illmost
y N0
z be wi o 11 abeWork,,,C p t i p ons or Ih Lab Cod 'you must n�
O --fbi-----comply with such provisions or Nrs pcnnu shall W domed revoked.
ofNe work for which hON�TRUCDON N. aaAGENCY
tYa-t711-11. 8 agency fortheperfrm-ce ._:.1. r
.'..sued(S 1111 Civ C.)
'
y:M -Lenders Name- .. ,a-•--- 1._..- i,. . .
Uk}=T+._[TZ0F„aal) cmNLoeeM I 1 Asedg d
cert y th o1 h d this application-a d some that the W a information is
ocplyw II city oil .only ds nand stem I misting
rcenfN scity r mer ortmWd g rdh by authO I sewive
nice,
mand
p pony,f
in pen
'Pct 0.i (We)agree -ts e dem' y d keep har s the C ty f C peri ifiS signors,
Vi
liabilities.jildilarenta,cut.and xpeases h ch y in any y ace gain 1 said
UZ
City in gene of the g ing of[hispe n1. ^
APPLICA\T ONCE ST AV A\D WILL COMPLY WITH ALL\ON-POLVf'- I ^Z7
.Sb�kh RE(d'1' r „-r 29-0, Issued by: Dale
sig atI ' is3nUC trac�` .•v Doe .
• IM
HAZARDOUS' ATERIALS DISCLOSURE 1 r e Re-roofs
wnlne fi2antmnrrcbild Typeof.Roof..
PP gm p t.t rtorhaMl hazallometedal
fd f d by th C panni Mu ip.l Cas Ch Chapter 9 12 d d He lth d Safety
r .1
'Cod sect a7537(a) �) , 1 t . ' 4 )1.111",
rOYes Y i tVl 's ONO :� - , rtle6 x�5 d - { 1 l kPxL 3 5 (Fl
._ All roofs shall,be inspected prior.to any rcofing,matenal being installed..
WII the e 1 f b Id gOccupant ,yup t p - n h If a roof is installed without firs[obtaining an'mspechon' I agree to remove
emtb d air cot aril as
- tllned byN Busee A Qa1tyM g< t'
all new materials for inspection Applicant understands and will Comply with
all non
point source regu]ations .I:,, ,
w y.
Oi q y al requirements
a oderil:1, 6 95 Of hm
s 25585 553.)and der Chapter I 6.95 o Thal
ac I of the rc ire t b h crlm6 Nat it s MY responsibility In t notify the '_' - .. __. . _ .. .- _.
lh sedNeh raid r �td
C hfo aHe Rh&Sa(t Code Sent
If Ne Wtld gdm north try hae t
sI W t p - to issuance oneC Rfcat ' f
rm(cr1. Si nature of A licant
Cf ka 7 2`F OZ — g -- PP.-- - - Dae
t
0 oAll roof coverings to be Class "B"or better
p8 lit
- OFFICE— -- - - -