2823 E. Standish
TYPE OF PERMIT CITY
Heroof
ElM
BUILDING DIVISION
200' S. ANAHEIM BLVD.
(714)765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626 '
CENSUS CODE: 555
QUARTER SECTION: 134
BUILDING PERMIT NO. .BLD~~~5-01558
DATE: 5/24/2005
JOB ADDRESS: 2823 E STANDISH AVE
LEGAL DESCRIPTION: N TR 4096 LOT 34 '
APPLICANT: LEW FERGUSON
OWNER INFORMATION:
Jack Santivanez
2823 E Standish Ave
Anaheim. CA 92806
CONTRACTOR INFORMA'nON:
MCCORMACK' ROOFING CO
4091 E LA PALMA AVE #T
ANAHEIM, CA 928070000
BUSINESS PHONE: 714630,5543
JOB DESCRIPTION:Tear off existing root and replace with 24 squares of metal'tile ICBO# NER423.
VALUATION: 7,200.00
ARCHITECT/ENGINEER INFORMATION:
PROCESSf:D BY: MSM'
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury t at I am exempt from the Contractor's License Law for the.fo low;1)g reason ~Sec. 7031.5 Busin.ess and
Prefas.sians Code: any city or county whICh requires a permit to c,onstruct, altelr, improve, demolish or repair any structure, prior to'its iS$uance, also
requires the applicant for such permit to file a signed statement that he is Iicen,sed pursuant to thei provisions of the Contractor's License Law (Chapter
9)(cdmmencingwithSection 7000.0f Division 3 of the Business and Professions Code) Dr that he is exempt therefrom and the basis for the alleged
exemption. Any violation of Section. 7031.5 by any applicant for a permt subj~cts the applicant 10 a civil penalty of not more than five hundred dollars
~~ " I .
o J, as owner of property, or my employees with wages as their sole compehsatJon, will do the work,. and the structure is not intended or offered for
sale (Sec. 7044 Business and Professions Code; The Contractor's Ucense Law does not apply to an owner of property wh.o builds or improves
thereon, and who does sl,!ch work himself or herself or through his or her own ~mployees, provided that such improvements. are not intended Or .
off.ered for sale. If, however, the building or improvement is sold with one ye.ar of completion, the. owner-builder w.i11 have the burden of proving that he..",
did not build or improve for the purposeof sale): 1 .
o /, as .the owner of the, property, am exclusiv.ely contracting with lic.ensedcontractors to construct the project (Sec. 7044 Business and Professions
Code: .The Contractor's License Law does not apply to an owner of property Who builds or improves thereon, and who contracts for such projects with
~ontractor(s) licensed pursuant to the Contractor's License Law),_ . i
U I am exempt under Sec." ,,8 & P.C. for this reason:
'Date: Owner:
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury pne of the following deClarations: :
o I, have and \NiH maintain a certificate of COr:'lsEmt to self-insure for worker's~ompensatjon,
as provided for by Section 3700 of the Labor Code, for the performance 01 the work for which
ih'~~~~~~ .. 1 o.
j have ,a,nd will maintain worker's ~ompe~satjon i, nsurance, 'as required by Section 3700 of
Labor Code, for the performance of the work for which this perm~is issuE'!d,~ Myworker's
Compensation insurance.carrier and policy are: '
Carrier: AMERICAN INTERNATIONAL GROUP Policy Number. WC0701040200001
This section need not be completed if the pennit is for one hundred dOllars ($1 00) ("'.'ess.
o I certify that in the performance of the work for which this permit is issued,l,shaH not.
employ any person in any manner so as,to becom.e sl:lbject to the worker's compensatiol'llaws
of Califomia, alid agree that if I should become bject to thewarker's-.comp'en'sation
provisions of Section 3700 Of the Labor od hall forth ' co ly with. those provisions. >
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed onder provisions of chapter 9 (commencing
with Section7000) of Divsion 3 of the' Business and
professio~c. '~ ~' ,
5/24/200 _6" -l. /,C., ~,~
Date: contract~. .
NUMBER ,EXPIRATION DATE
643700 6130/2006
TYpE C39
Date: 5/24/2005 Applicant:
WARNING: FAiLURE TO SECU WORKER'S COMPENSATION
UNLAWFUL, AND SHALL SUBJ' CT AN EMPLOYER TO CRIMINA LTIES AND CIVIL
FINES UPTO ONE HUNDRED 'THOUSAND DOLLARS ($100,000), IN ADDI1l0N TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. .
CONSTRUCTION LENDING AGENCY
I hereby affirm _under penalty of perjury that there is a construction lending agency for the
p~rformance of the work for which this permit'is issued (Sec.3097.Civ.C):
Lender's Information:
Construcion Types:
VN"
Fire Sprinklered?
NO
..
I certify that I have react this application and state that the above information is correct. I
agree to comply w~h all city ordinances and state laws relating to building construction, and
~. e by.auth<?rlze representives of this city to ~nter upon th~ above mentioned prope-rty for
n IOn pur s..~. 0
, /L . Date: 5/24/2005 '
Signature of pplican or Ag t
The permit shall expire by Iimitatio become null and void if the building or
work has not passed fi nal inspection 365 days from the date of permit issuance. A
new permit is required to commence or continue work.
Fees paid for Permit:
Total:
235,55
INSPECTION RECORD
. .. .
INSPECTION DATE INSPEt;TOR .
Temporary Power Pale
Plumbing (Draln/Waste Pipe) .
Electrical Ground Electrode/Ufer . ..
SetbacklFormsrrrenches (Footings)
Do not install subfloor or pour floor slab until the
fOllowing applicable. Items have been signed:
Plumbing (Water Plpe.Sprinkler Valves)
MeChanical (Groundwork)
Electrical (Underground Conduit) . .
Pre-slab (CompactiofllMembrane.Reinf,
Underpinning (Floor JOist/Girders) .
Do. not cover or conceal the work below until the
following applicable Ilems have been signed: .
1 st Floor Shear .
Firesprinkler (Rough) . . ..
2nd Floor Shear ..
Roof (Sheathing/Di;lphragmlFrane) . .
Masonry (ReinfJBoild BeanlPre-Grout)
Rough Plumbing (T<!p Out)
Rough MeChanical ..
!. Rough Electrical jury vvalll
Rough Electrical .
Framing .(On~ after Plbg.. E:lec..Mech.. and Fire) .
Insulation (SoundlEnergy) .
po not tape or pla$ter until the following applicable .
Items. have been Signed:, .
Drywall . .
Penetrations (Fire Rated) Electrical. .
Penetrations (Fire Rated) MeChanical
Penetrations (Fire Rated) Plumbing
Interior Lath . .
Exterior Lath .
. GENERAL ITEMS .
Exterior Plaster (Brown Coat) . .
T -Bar Electrical
T-Bar Mechanical
T -.Bar Structural .
Sewer . . .
Water Engineering Backflow .. .
Water Service
FINAL INSPECTIONS. ............. . C-Date . Inspector .
Electrical Final . . .... .
Plumbing Final.
Mechanical Final .
Gas Test .. .
EngineeringfGrading Final 765:5126 .
Fire Dept. Final 765-4Q40 .
... . .
Water Engineering 765-5268 .
. . .
Sub List/Business Lic~,"se 765-519 ..
Zoning 765-5139 I I .
Building Final ~asl Inspection- Only 7ltcJ. S J'MJ ..,.jSU:
Iter Above Complele) .
PARTIAL INSPECTIONS
Mechanical Inspections
Plumbing Inspections.
Electrical Inspections