522 N. West St. (2)
TYPE OF PERMIT
Re(oof
DATE: 1f712005, '
JOB ADDRESS:, 522 N WEST S1
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CITY ~~' 'i~~i~J.tEIM
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BUILDING DIVISION
200 S, ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REOU,EST LINE:
(714)765 - 4626
CENSUS CODE: ' 555
QUARTER SECTION: 62
BUILDING PERMIT NO. BLo2005-00039
LEGAL DESCRIPTION: VINEYARD LOTS LOT 6-7 SLY 75 FT NL Y
1
1
CONTRACTOR INFORM,\TION:
MCCORMACK ROOFiNG CO
4091 E LA PALMA AVE#T ~
ANAHEIM, CA 92807 OO~
, BUSINESS PHONE: 714 6'!0~5543
J06DESCRIPTION:Tear off existing roof and replace with 36 squares of 50 ,~ar composition shingles ICBO# 5546,
~ .
VALUATION: 6,400.00 . lPROCESSEDBY: MSM
I OWNER.BUILo!::,! DECLARATION "
J hereby affirm under penalty of. perjury that'l am exempt from the Contradcu's. License L~w for tp,e following reason (Sec.?0315Businessand
professions. Code: any city creou. ntYW.hlCh requires a permit to con.stru .ct, ,. '~teri jrppro,,v.e., ~e.mo.IiSh 0 r.re.pa.i.r. an, ystr uc.t.u.r. e,.pr!O, r to'.its'issua.ne'e,., aIS..C........ '
requires the appli98ntfor such permit to file a signed statement that he ~5nC' n~'--d pUrSUQo1:Jo .t.he provisions t;lfthe Contracor's license Law (Chapter
9}(commencing with .Sgction 7000 of Division 30f the Business and Prores.c;: ns Code)'or that he is e)fempt therefrom.'and the !:::S&!$ for the'alleged;-..,',;.
<';;(;o),tlon. Any violation Of, Section. 7031.~ by a ny a~~icant for a permit SLi'~~l:.C,:~,t.::;: the '"S,' .p,p licant to.a ,?v,.H ~.,enatty a,fn"ot. m. .",ie rr._!3~.n"fi;.:V. ellunore.d", dollar, . "
'0 I, as owns.r of.i)rotlerty, of my employees with. wages as their sole corrl:,~l)sation, wilt do_ the work. and the stru(jture is notin~e;,.!i~j or offered for:'
sal~ (Sec. 7044 Business and professions Code: The Contractor's U:::ensa-aVo/ does not 9Pply to an owner of prbperty viho builds or improves ,
the;reon, and who does such "..ork himself or herself or through hrs or ber 'o.'-'.ti _employe~s, pro'/:ded tj)atsllch improvements_ 2're not 'j(ltended .or .'
offered for sale." If, 'how~ver, the ,building or improvement is sold with oh~ y;f;;ar of .~m;JiI;!;OF'!, the ownel'-buil,der w~llhave't,!e burden of. provin.!J that he
didnotbuildorimprovefol'the_purposeofsale).. _' .'-"1., .... ... _,-' "'::-' ' .. ..,. ,'::
o . I,' as the owner of the property, am exdusively contra ding with Iice0'3~q<oontr3ctcr$ to COr.diUtt ,the pjQj~ct (Ssc, 7044 Busir;~$and Professions
Code: The Contractor:'s License Law does not apply to a.... owner of prrJp~r:~~who builds or improvos theretm;andw,ho oontracts for.suCh projects. with- .
- ~~ontractor(s) licensed pursuant to the Contractor's License Law}" l .. -' ",'-., ., .-',':' .
1___ I am exempt under See, . ,B&P.C.forthlsreaso-r.: __~.~'L;__~_ . ... ,.- -', ,'. .,'. '- '.
Date: . Owner:, . il' '
L WORKER'S COMPENSATION DECLARATION -"--:-' '--1 LICENSED CONTRACTORS OEClARATiO,,'tl
i hereby affirm unde~.penaltYOf pe~ury on~ O,f the following declaratio~s:... ~.. . , '. I I hereby affIrm under penalty of perjur'j tl")at I arYl
rJ I have and wi!lmaintain 2 certificate of consent to self-insure for work€j~: compensation, licensed und.;r pro-vis:Oli::; of chapter 9 (commenCing
as piOvided for by Section 3700 of the Labor Code, for the performanCe bf U:;,;: 'Nork tot" which with Section 7 00) of O\\<$ion ~~ of the 8U5ine~s :and
~hj .permit is issued. . .. . Y Pl'QfesSiOns lOde. , ,. ...::J _
. .;1 have and WilInia. intain.wo .rker's' compensatio.n lnsur~nce> asrequireo,' !~,v. :S'ectir)j) ,3700 of 1/7/200 ~~Zf
t Labor Code,. for the performance of the work for whIch this permit is ~ss,,:iW, My \~'orker's Dare: Contractor
mpensatiOn. insurance q3:rrier and policy are: ,'. ; , . ,
rrier: AMERICAN INTERNATIONAL GROUP Policy,Number. WCO?OFl<l'J200001 NUMBE EXPIRAT'ON DATE
, . ' . . ': ." .' 643700 6/30/200&
This section,~ed not be completed if the pennit is for one hundred do:~ars ($tp.;j)-?r," less..' , . TYPE C39
o I certify that in the performance ofthe work for which thiS perrriit isiie_~+,t,"r shalloot '
employ any person in any manner so as to become subject to the worker's' c/:;mpensation laws
of Califomia, and agree that jf 1 should become subject to theWOrKl;Ir's- _colT!p:r'n~"ation
prOvisi?hS of Section 3700 o.fthe Labor co~ ,f s~au fa~hwithcomPiY''N!th.t~05e provisions.
Date: II? 12005 AppJican , -' -
WARNING: FAILURE TO SECU WORKER'S COMPENSAT N CO 'itiAGE is
UNLAWFUL; AND SHALL SUBJE AN EM'PLOYER TO CRIM RM:LTIES AND CIVIL
FINES UP TO ONE HUNDRED OUSANo DOLLARS ($100,000), !N Aiff;lTION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3'fC06 OF THE
LABOR CODE; INTEREST AND ATTORNEY'S ,FEES. -
I . CONSTRUCtiON LENDING AGE'NCY ,\c;' 1,
I hereby .affirm under penalty of perjury -that there is. a construction Ie-d.j,!r.g~,;e:"lcy for the
'~CIfur;liaflQ; '-'; {hti! ....::;;r:-.-fQi' 'R!'-.i.J;:i.:lh:;V~i"nit-;sh,~~d ~Sec.3fr;j-7;GN.(;J~. ,;--..' - ~"
Lender's'lnformation:' ,
APPlICAII!T:LEW FERGUSON,
OWNERINFORMA TION:
Lilriy J Crotchet!
522 N West SI
Anaheim, CA 92801
ARCHITECT/ENGINEER INFORMATION:
Construcion Tv.:,es: .
VN, ,
Fire SiJrinklered7
NO
l__~
. .-. . -' - ~
.-----
, '..~ .,
. :-{ ,~,.,. ",
I certify that 1 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 COMtruction, and
here yauthoriz representlves of this city to enter upon the above mentioned' property for
i sp ion ~s.
Fees paid for Permit:. '
Total:
310,19
~
Signature of A ica or Agent
The permit shall expire by lim ation and become null and void if the-,building or
work has not passedflnal inspection 365 days from the date of permit issuance. A
new permit is required to commence or continue work. '
'-'>
Uare: 1/7/2005
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INSPECTION RECORD
. INSPECTION .. DATE INSPECTOR
Temporary Power Pole . .
Plumbing (Orain/Waste Pipe) , ,
Electrical, Ground Electrode/uter . ,
SetbacklFormslTrenches (Footings) ,
Do not install subflOQr or pour floor slab untilthe
following applicable items have. been signed:
Plumbing (Water Pipe.Sprinkler Valves) , . ,
Mechanlcal(Grounclwork) , , "
t:lectrical(Unaerground Conduit) "
Pte-slab (Compaction/Membrane.Reint., ,
Underpinning (Floor Joist/Girders) . , ,
Do not cover or conceal the work below until the
following applicable items have been signed: . ,
1st Floor Shear. . , .. '
Firesprinkler (Rough) ,
2nd Floor Shear, , i/~
Roof (She~inalDiaohraamlFrane) J~-()';
Masonry (ReinfJBond BeanlPril'Grout)
Rough Plumbing (Top Out)
RlIugh Mechanical ,
l<Ougn t:IectrlC8I(UFy wall)
Rough Electrical
FramIng (Onlyaft~r Plbg" Elee.. Mect'l.. and Fife! ,
Insulation (SoundlEoergy) . .
Do. not tape or plaster 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 Mechan.lcal ,
T.Bar Structural .
Sewer'
Water Engineering Backflow
Water. Servic<>
FINAL INSPECTIONS . ' . Date Inspector
Electrical Final . ' , .... ,
Plumbing .Final ' , , . .
,
Mechanical Final.
Gas Test , :
" ,.'
EllgineeringlGrading Final 765-5.126 . ,
.,' .
Fire Dept. Final 765-4040
Water Engineering 765-526~ ' .
, :
sub List/BuSiness License 765-519.<
Zoning 765:5139 , . . "
Building Final ~ast Inspection- Only 'vdr 'j~J7
: fter Above Complete}
PARTIAL INSPECTIONS .?/
BUildi~nSDection~
p., .'/ .?u, ~ldf~
~'1 -<.A,p.
-- -W6~/
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MechanicallnsDections
, Plumbina InSDections
ElectricallnsDections