02080162 OF
CT BUILD NG DIaVIISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
10104 CRESCENT RD LEI ENNIS 02080162
wNER'S NAME: APPLICATION SUB DATE
LEI ENNIS 08/28/2002
7^ 'PHONE: SANITARY NO. CONTROL NO.
cZ, ARCHITECIENGWEER: a BUILDING PERMIT INFO
uBLDG ELECT PLUMB MECH
Z<i I=
0 S�'" LICENSED CONTRACTOR'S DECLARATION
h z I hm ereby afTuthin 1 am licensed under provisions of Chapter 9(commencing .Job Description
„f° with Seellon7000)of Division 3ofthe Business and PmfcssionsCodc.and mylicense CONVERT BATHROOM/ADD ELECT/FURNACE
as o E; L cense force and effect. ��g'Oa�I
re z a License Class Lic.p
1i0 Dam Contractor Sa
FM
3 y ARCHITECT'S DECLARATION
so g 1 understand my plans shall be used as public record., 0 C T 3 0 2002
ip D Licensed Professional
OWNER-BUILDER DECLARATION
= 1 hcmby aRnn that I am exempt from the Counselor's License law for the
z G following reason(Section 7031.5.Business and Professions Code:Any city or county BUILDING $7500
at O which requires a permit to construct,alter,improve,demolish,or repair any strustructureetu
a
3 prix to u m
ume. 1 req th pplinm for.such permit to fl gnW statement
that he islcbMM Paramour to thpiw.'onsofthe Commuou's License Law(Chapter
9 �,<,,�af `
lio g, ith Secu 70(ki fD' son 3uf,he Bumnc dP fsions Code) ', r�)`-y i'3�1FfV Wr.®yrQ aV3IUat10❑1;'1•�
or thm rte is e%elapt therefrom and the basis for the alkg<d exampuon.Any violation -
-.of Station 4031.5 by any applicant torn Permit subjms the applicant m a civil penalty
,nfnot mmethan love hundred dollars(55001. 10JAPN10 P&DATION I.il�M'NO. Occupancy Type
❑I,a owner of the pmpeny,in my employees with wages as their sole compensation,
-wilt do the wml,:and the nmcmre I, or inscribed!or oIerN'for sale(Sec:70al l --
'Baa&is'.hd Professions Cole:The Contractor's license Law does not apply to an 103 - UFER Required Inspections'°"'-i; 'Il.
owner of property Who builds or improves thereon,and who does such work himself 10 4 - REBAR
or through his own employes.provided that such improvements art nm intended a
'olrerrd for sale.IC however;the building-or improvement Wsold within otic ycar of �`---`---'-105--ANCHOR - "'-" --'—"'-"C-0.17"0-1 7.t -------
BOLTS --- - ,t osr''ol_•.::
union,tion.h�ncr-Wilder will have the burden of proving that he did nm toile or 106 - SEWER & WATER
improve f q reuse oLaaleJ.
iv
... -":bf the property.am exclusively contracting with licensed contractors to 2'02-�-�--UNDERFLOOR -PLUMBING
--I�:ii �'-------------
nn navt the project(See.7W ,Business and Profession.Code:)Tele Contractor. 2 03 - UNDERFLOOR MECHANSCAL'
:, 'iris..
Liens Law does not apply m w
an oner,of propcnre
y who builds ar improves theon.
''u't`v P,f.we w:cr
-`r _.and.who.contmepfor.such pmjeels.witba comrxmrrsl.icensea.pursuant.to.the. _-_-_-.._..-204----UNDERFLOOR"--FRAME"--.....-"---'-"-'--
,Copuact t Licenx
L/V`I eempva�c5 "' r 1!
&PCT m,.Mason205 - UNDERFLOORbI-NSULATION
o e 4` a 301 - ROUGH PLUMBING
'WOR S 10 RATION `
-. 302 - TUB & OR SHOWER
-1 hereby arrnn under penalty ofWjmy one of'th ronnw;ngdecmratims: 303 - ROUGH MECHANICAL
D 1 have'vnd will'mairain!a CcniRcateof Consent to self-Insure for Worker's 3 04 - ROUGH ELECTRICAL
Compenxmlon: as pMiidcd-for by Section-3700 .T-,he Labor Cnae, for he 305 - FRAME
pciformance of the work for which this permit i;i,a.
i. .. , s.
r. ❑I haveinl will miu imi Workers
' C`mp"nsoton Insura'nce,as m 9 ` byS �: 306 —
HOEDOWNS
nB 'rth Lwf cJd r at Performance of -Ar which'his
issued:a My W A C pen non 1 ,rncame,grid YoeY rte rc 307 - INSULATI
ON
_..
earn f ae It a'ac K':f, rrdl y .- :;;I ,30.8, t= 'SHEETROCK;
CEItTIFICNIONOFMPTIONFROMWORKERS" - l i.3,09 -s1ERTRaIORi�SLATHt^
COMPENSATION INSURANCES '
kNT$RIOR—LATH - - ""'-'-
r s d nm w cample.ee nn pemth is r hamrcd dollars 'l' ,1 f' u i
vw)or :.,, 311 SCRATCH COAT
( "
w_ a.... ..
Cnm,Ie prYthr th x� conn adtr mm�th tsls. ad. 501 - FINAL EliECTRI CAli`IENERGYe.
t tin ell L spelt d n e t be t ! t a .'
'A 11
Pat t_ 502. -__FINAL .PLUMB I NG-ENE RGY_._.. _ . .._ _
N ETOAPPLICANT If a. .i g aC of ualub p. n'ro lho Id - - "'-
Z bee hl train W Ac Compensation mo ofthiLboCod,you 503 - FINAL MECHANICAli 'ENERGY
nit
Z fnnhw.h compIy w ih h provisions or this t shall bed trained revoked
�Z o n by o ONS a tDlGAGENe yrortn<p< m ;<e ' —504_.-- _FINAL._ ELECTRIC, ENERGY
.
rA aR` >•r ONSTRUCr10NLENDINGAGENCY 505 - FINAL ELECTRICAL
.i.:' J'.. l. t. f•. i
�-,'}. elfin 'rkf( men in pe ustss�ed(s< 3o97c.c1 ' ;, 506 - GAS TEST
__ _._—_.___—_—_.—._-_._.
U
" Lcnd Aadre.
507 ='FINAli PLUMBING - - --'---p tie<nlirrma�in�ere.,"atn�:apvu<a. naneemm.knneawvemfarmzilonis 50 FINAL MECHANICAL
on
'AT+p E. 'soircm:I agrtt.p gomplywi.h all ci.y'an Dump oMinanccs arta zmm laws relating 5 9 - INAL G DE
QT, ¢oWld g . I n dh by turbo e p Tvea fth cyY! t upon
5 0 - INAL ANN NG
E. n: fW) 8 t e tle fy tlA< lis t (Capco gains.
v; elan 1. pgmegs.< SL nae, �: n ay' y way accrue agones said 5 - INAL RKS
U.Z cty,n seq d<enn -
r\PP A'r"T.WDERSTAB .'\oDnhl GIN "'
_ _ _ sd' celeeeLr:nnofa. ' Issued by; Date
istur,ofAriplicant/Contractor...'
!. HAZARDOG$'MATE S DISCLOSURE"I ;._ „ /,,,!; a-roofs
the pplc . tat rc W'Idng <pant tarto handl hax.Wuu 'terW T e Of Roof......
a.d f al byth C peon.Muncpal Cale Ch pt 912 dth Hallh Safety
YP '" - `' - `= _' -' "• -- ,••
coe ovenzss�i,3,� rv,«,✓` ' lr lw s t ' i L'A .!S f� ..'.'i1 sf,i is A' , nil n,
All,roofs shall be inspected poor,to.any roofing matenal being installed.
.;,Will the-pylicant f unum w to n g q t Arta'u p . e awn ti If a roof is installed without first obtaining an Inspection;J'agree''t0 remove
emit ha rd contaminantsdfnc YtheBYA cast tYM' ge no
D" i all new materials_for inspection.,Applicant understands and will comply with
❑Ves
all non-point source regulations !-_rI t ri:'<,i,.' -' P Y -
1 h e Mail(he h t16 s Ieri q remen.s t nd Chapter 6.95 of the
Cablumm Hehith&Safety Csvle a' m2505.355 fid 355331onders.and that
,:ati Wrldingdoes and end has acre '.heti my mspons b,dy to notify. '-- "" "" - ._._ _ ..... ...
us. . or iisuace of nlOcam f. T
� d ac ntyf.he requirements hich •' '
Pa� 9
r _ -
-' "' ° d . Signature of Applicant_ _ Date
"own.pct n.Wr ua agent On a. All roof coverings to be Class B of betfei
OFFICE '-... ._ ..