664 So. Westford
TYPE OF PERMIT CITY
Reroof
ElM
BUILDING DIVISION
200S. ANAHEIM.BLVD.
(714) 765 - 5153
INSPECTION REQUESTLINE:
(714) 765 - 4626
CENSUS CODE:~ . 555
QUARTER SECTION: 169
BUILDING PERMIT NO. BLD2005.01020
DATE: 4113/2005
JOB ADDRESS: 664 S WESTFORD ST
LEGAL DESCRIPTION: . N TR 8116 LOT 31
CONTRACTOR INFORMATION:
MCCORMACK ROOFING CO
4091 E LA PALMA AVE #T
ANAHEIM, CA 928070000.
BUSINESS PHONE: 714630-554:3
JOB DESCRIPTION: Tear off existing and reroof 32-squares with eagle ponderosa.@ 10 Iblsf ICBO #4660
VALUATION: . 8,000.00 PROCESSED BY: JNJ.
I . OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from, the Contractor's'Lic.ense Law for the following reason (Sec. 703t.5.Businessand
Professions Code: any city or county which requires a permit to construct, alter, improve, demo'lishor repair any structure,' prior to its issuance, also
requires the applicant for such permit to file a signed statem~nt that he isiicensed pursuant to the provisions of the Contractor's License Law (Chapter
9)(commencing with Section 7000 of DMsion 3 of the Business and Professions Code) or that he is exempt therefrom and the basisfbr 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). . '. .' .
o I, as owner of property, or my employees with w~ges as their sole compe~sation, 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 \V.ho buildsor improves
thereon,and who does such work.himself or herself or through his or her own employees, provided that such improvements a~enot intended or _
offered for sale; If, however, the building or improvement is sold with on~ y~arof completion, the owner-builder will have the burden of proving that~e
did notbuild or improve for"the pUfPose of sale).
o J, as the owner of th~ property, am exclusively contracting with licensed contractors' to constrl:lct the project (Sec. 7044 Business"and Professions
Code:' The Contractor's License Law ~oes not apply to an oY.Jner of property who builds or improves t.hereon, and who co.ntr'acts for such projects with,
~ontractor(s)'licensed pursuant to the Co~tractor's License Law). '
U I am exempt under Sec." " B.& P.G. for this reason:
Date: Owner:
I WORKER'S COMPENSATION DECLARATION
I berebyaffi~m under penalty of pe~uryone of the following declarations:
o I have and will maintain a certificate of consent to self-insure for worker'sc:ompensation,
as provided for by.section 3700 of the Labor Code, for the performance of the work for which
this permit is issued. .
&r 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 perm'it is issued. Myworker's
Co-mpensation insurance carrier and policy are: .
Carrier: AMERICAN INTERNATIONAL GROUP Policy Number. WC0701040200001
APPLICANT: LEW FERGUSON.
OWNER INFORMATION:
Deni sa D Hunter
664 S WesUord St
Anaheim, CA 92807
ARCHITECT/ENGINEER INFORMATION:
LARRY DGARRETT
7612 BESTEL AVE
WESTMINSTER,CA 92683
LICENSED CONTRACTORS DECLARATION
I hereby a irmunder penalty 'of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000) of Divsion 3,of the Business and
professi~ . ~~
4/13/200 . .
Date: , 'c. ': Contractor '
This section need not be.completed if the pennit is for one hundred dollars ($100) or less.
o I certifyt~at in the perfo.rmanceof the work,fm which this permit is issued, I shall not
employ any person in any manner so as.to become subject to the worker's compensation laws
of CcUifomia, and agree that if J should become subject to the worker's compensation
. proVisions of Section 3700 of the L;or ~~II forthwith comply with those provisions:
Date:.4/13/2005 Applicant . A!
WARNING: FAILURE TO SECURE WORKER'S COMP EN SA N OVERAGE IS
UNLAWFUL, AND .SHALL SUBJECT AN EMPLOYER TO CRIM INAL PENALTIES AND CI VIL
FINES U P TO ONE HUNDRED THOUSAND DOLLARS ($100;000),.lN ADDITION TO THE
COST OF COMPENSATiON, DAMAGES AS PR()VIDEDFOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
t her~by affirm under. penalty at perjury that there isa constructior'llending agei-.::.,':orthe
performance of the work for.which this permit is issued (Sec. 3097 .Civ.C):
Lender's lriformation:
NUMBER
643700 .
TYPE
EXPIRATION DATE
6130/2006
C39
Construcion Types:
V N, , .
I certify' that J have read this application and stat~ that the'above information is correct. I
. agree to comply with all city ordinances and state laws relating tobu~ding construction, and
hereby authorize representives of this city to enter upon the above mentioned property for
inspection purp
Date: 4/1 312005
Fees paid for Permit:
Total:
607.14
Signature of Applic~ t 0 Agent
The permit shall expire by limitation and become null and void if the building or
work has not passed final inspection ~5 days from the date of permit issuance. A
new permit is required to commence or continue work,
. INSPECTION RECORD
INSPECTION : . DATE INSPECTOR
Temporary Power Pole.. ' .
Plumbll1!i (DrainIWaste Pipe)
ElectricalGroun~ Electrode/uter ,
SelbacklFormsfTrenches (Footings)
Do not install subfloor 0< pour floor slab until the
following applicable items have been'signed:
Plumbing (Water Pipe.Sprinkler ~lves)
'Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (Compactlonl.Membr;me.Reinf. . ,
Underpinning (Roor Joist/Girders) .
Do not CQver or conceal the work below until the
following applicable items have been signed:
1 st Floor Shear. .. .
-
Firesprinkler (Rough)
2nd Floor . .'
RooW)l1e aphragrnlFrame) . ~ltlo,\ II- .
Masonry (Reii1f./Bond BeamlPre-GlOUt) .
Rough Plumbing .(Top Out)
Rough Mechanical'
I ROugh ~ect"callury wall) .
Rough Electrical .
Framing (Only after Plbg.. Efec,; rAech., and Fire) ~tll>~ T, . I.
Insulation (SoundlEnergy) , . ,
Do not tape or plaster until the following applical>le
items have been signed: ' .
Drywall . . .
-
Penetrations (Fire Rated) Electrical ,
Penetrations (Fire Rated) Mechanical. ' ,
Penetrations (Fire Rated) Plumbing
Interior Lath . . .
Exterior Lath
. GI;'NERAllTI;'MS . '
Exterior Plaster (Brown Coat) .
T -Bar EleCtrical .
. T -Bar Mechanical
T -Bar Structural
Sewer . -
Water Engineering Backflow .. ,
Water Service
FINAL INSPECTIONS
. Electrical Final
Plumbing Final .
Mechanical Final
Gas.Test
Engineering/Grading Final 765-5126
Fire Dept. Final 7654040 .
water. Engineering 765-5268
Sub-List/Business license 765-519
Zoning 765-5139
Building Final ILastlnspection" Only .
After Above Complete)
f>ARTIAL INSPECTIONS
Buildinci Inspections
Inspec.tor .
Date
. Mechanical Inspections
Plumbina Inspections
Electrical 'Inspections