917 S. Marjan St.
TYPE OF PERMIT CITY
Reroof
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765.4626
CENSUS CODE: 555
QUARTER SECTION: 124
BUILDING PERMIT NO. BLD2005.01616
DATE: 5/31/2005
JOB ADDRESS: 917 S MARJAN ST
LEGAL DESCRIPTION: N TR 3796 LOT 19
CONTRACTOR INFORMATION:
MCCORMACK ROOFING CO
4091 E LA PALMA AVE #T
ANAHEIM, CA 928070000
BUSINESS PHONE: 714630-5543
Tear off existing material and reroof 31 squares with 50 year composition shingles and fill in space sheathing.
( .- 'RE\lIS~b
OWNER-BUILDER DECLARATION
J hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5 Business and
Professions Code: any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business and Professiors Code) or that he is exempt therefrom and the basis for the alleged
exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars
($500).
D I, as owner of property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for
sale (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 does such work himse~ or herself or through his or her own 8mployees, provided that such improvements are not intended or
offered for sale. If, however, the building or improvement is sold with one year of completion, the owner-builder will have the burden of proving that he.....
did not build or improve for the purpose of sale).
D I, as the owner of the property, am exclusively contracting with licensed contractors 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
a contractor(s) licensed pursuant to the Contractor's License Law).
D I am exempt under Sec. , B & P.C. for this reason:
Date: Owner:
I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
o I have and will maintain a certificate of consent to self-insure for worker's <;ompensation,
as provided for by Section 3700 of the Labor Code, for the performance of the .....ork for which
this permit is issued.
%1 have and will maintain worker's compensation insurance, as required by Section 3700 of
the Labor Code, for the performance of the work for which this permit is issued. My worker's
Compensation insurance carrier and policy are:
Carrier: AMERICAN INTERNATIONAL GROUP Policy Number. WC0701040200001
APPLICANT: YOLANDA HUAPAY A
OWNER INFORMATION:
George R Perry
917 S Marjan St
Anaheim, CA 928060000
ARCHITECT/ENGINEER INFORMATION:
JOB DESCRIPTION:
VALUATION:
9,600.00
PROCESSED BY: ENO
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under rovisions of chapt r 9 (commencing
with eeti 000 f Oi . n 3 of e Business and
Profe i
This section need not be completed if the pennit is for one hundred dollars ($100) ()f' less.
& certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the worker's compensation raws
of Califomia, and agree that if I should bee e subject to the worker's compensation
provisions of Section 3700 of the Lab r all f rt ith comply with those provisions.
,
NUMB R
643700
TYPE
EXPIRATION DATE
6/30/2006
Date: 6/27/2005 Applicant:
WARNING: FAILURE TO SECU VERAGE IS
UNLAWFUL, AND SHALL SUBJ ENALTIES AND CIVIL
FINES U P TO ONE HUNDRED OUSA D DOLLARS ($100,000 I ADDITION TO THE
COST OF COMPENSATION, AM S PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST D ATTORNEY'S FEES.
ONSTRUCTION LENDING AGENCY
I hereby affirm under pen Ityof perjury that there is a construction lending agel'lcyfor the
performance of the work for which this permit is issued (Sec.3097.Civ.C):
Lender's Information:
Construcion Types:
VN, ,
I certify that I have read this application and state that the above information is correct. I
agree to comply with all city ordinances and state laws relating to building construction, and
hereby aut ize re re nti s of this city to enter upon the above mentioned property for
insp u 0
,
Date: 6/27/2005
Fees paid for Permit:
Total:
310.51
Signature of ppli nt rAge t
The 't shall expire by limit i nand ecome null and void if the building or
wor s at passed final inspecli 365 ys from the date of permit issuance. A
new Dermit is reauired to commenc ontinue work.
FINAL INSPECTIONS DATE
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
neering/Grading Final 765-5126
Dept. Final 765-4040
r Engineering 765-5268
Lisl/Business License 765-5194
ng 765-5139
ing Final (Last Inspection - Only
Alter Above Complete)
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR Engi
Temporary Power Pole Fire
Plumbing (Drain/Waste Pipe) Wate
Electrical Ground Electrode/Ufer Sub
Setback/FormslTrenches (Footings) Zoni
Do not install subfloor or pour floor slab until the Build
following applicable items have been signed:
Plumbing (Water Pipe/Sprinkler Valves)
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (Compaction/Membrane Reinf.) Buil
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below until the
following applicable items have been signed:
1 st Floor Shear
Firesprinkler (Rough)
2nd Floor Shear ~ -
Roof (Sheathing/Diaphragm/Frame) I7-ZL -a r~
Masonry (RelnfJBond Beam/Pre-Grout) I Mec
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele., Mec. And Fire)
Insulation (Sound/Energy)
Do not tape or plaster unlilthe following applicable
items have been signed: Plu
Drywall
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing
Interior Lath
Exterior Lath
GENERAL ITEMS
Exterior Plaster (Brown Coat) Elec
T -Bar Electrical
T -Bar Mechanical
T-Bar Structural
Sewer
Water Engineering Backflow
Water Service
INSPECTOR
PARTIAL INSPECTIONS
dina InSDections
hanicallnSDections
mbina InSDections
tricallnSDections