4003 E. Mapletree Dr.
BUILDING PERMIT NO. BLD2005.01850
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TYPE OF PERMIT C' ITY
Reroof
DATE: 6/16/2005
JOB ADDRESS: 4003 E MAPLE TREE DR
LEGAL DESCRIPTION: N TR 4689 LOT 14
APPLICANT: YOLANDA HUAPAYA
OWNER INFORMATION:
Phillip D Royster
4003 EMaple Tree Dr
Anaheim, CA 92807
ElM
BUILDING DIVISION
200 S, ANAHEIM BLVD,
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 157
CONTRACTOR INFORMATION:
MCCORMACK ROOFING CO
4091 E LA PALMA AVE #T
ANAHEIM, CA 928070000
, BUSINESS PHONE: 714630-5543
JOB DESCRIPTION:Tear off existing, roof and replace with 32 squares of 50 ye~r composition shingles ICBO# 5443. .
VALUATION:
7,900,00
PROCESSED BY: MSM
'OWNER-BUILDER DECLARATION
I heret;ly affirm under penalty of perjury that I am'exempt from the ontractor's License Law for the following reason (Sec. 7031..5 usiness and
Professions Code: any City or county which requires a permit tocdnstruct, 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 proviSl~ons of the Contractor's License Law (Chapter
9)(commenci(1g with'Section 7000 of Division :3 of the BU,siness and Professioi1S Code) or that he is exempt therefrom and the basis for the alleged '.
exemption. Anyviolation of Section 7031.5 by any applicant for a permit subjkts the applicant toa civil penalty of not more than five hundred dollars
~~, . I, ,'.
o I, a,s'owner of property, or my employees with wages as their sole compe:nsation, will dp the w~rk, and the structure is,nat-intended or offered for
sale (Sec. 7044 Business and Professions Code: The Contractor's License L<;iw does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her own;employees, provided that ~uch improvements are not intended or .,~,
offered.forsale~ If, ho~ever, the building or improvement is sold with one yea.t of completion, the owner-builder will have the burden of proving that he
did not build or improve (qr the purpose of_sale). . ' ; . . . . ,
o I, as the owner of t\1e property, am exclusively coniracting with licensed epntractors tbconstructthe project (Sec. 7044 Business and Professions
Code: The Contrac.tor's License Law does not apply to an owner of prope_rtyv,ho builds or improves thereon; and who contracts for such projects with
acontractor(s)lice~ed pursuant to the Contractor's License Law). \
o I am exemptund~r.Sec. . , ,B & P.C. for this reason: '
Date: Owner:
I
ARCHITECT/ENGINEER INFORMATION:
WORKER'S COMPENSATION DECLARATION
Date: 6/16/2005
p~ its null and void ifthe building or
work'has passed final inspection 365 om the date of permit issuance. A'.
new permit is required to commence or continue work.
I hereby affirm under penalty of perjury o~e of the following declarations:.
D Ihave'and win maintain acertificate of,con'sent to self-insure for worker'scompensation,
as provided for by'Section 3700 of the Labor Code, for the pertormance of the work for which
~. perm iUs issued. , . .
i, I have and will maintain worker's compensation insurance, as required by Section 3700 of
th Labor Code, for the performance of the work for which tHis permit is issued. Myworker's
Compensation insurance carrier and policy are: ~ i
Carrier: AMERICAN INTERNATIONAL GROUP Policy Number. WC0701O,10200001
This'section need nOt be completed if the pennit is for one hundred dollars ($1 00)01' less.
o 'I c~rtify that in the p~rformanceofthe work for which this permit is iSsued: I sharr not
employ any person in any manner so as. to become subject to the worke(s conpensation ~aws
of Califomia, and agree that if I should becom SUbject to the worker's compensation
provisions of Section 3700 of the bar. de I all, f hwit ,mply with those provisions.
Date: 6/16/2005 Applicant:
WARNING: FAILURE TO SECURE
UNLAWFUL, AND SHALL SUBJEC N E ND CIVIL
FINES UPTO ONE HUNDRED 11-1 U AN DOLLARS ($100,000), IN ADDI TO THE
COST OF COMPENSATION, DA AGlE S 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
performance of the work for which this 'permit is issued (Sec.3097.Civ,C):
Lender's .Information:
I
LICENSED CONTRACTORS DECLARATION
I hereby a Irm under penalty of perjury thaI I am
licensed under pro 'sions of,chapter 9 tcommencing
withSection,700 'Divs' n'30f e Business and
Professio .' e
6/16/2005
Date:
NUMBER'
,643700
TYPE
C39
EXPIRATION DATE
6/3012006
Constn.icicm Tvpes:
V N, ~
Fire Sprinklered?
NO
Fees paid for Permit:
Total:
310.34
INSPECTION RECORD
INSPECTION . DATE. . INSP.ECTOR
Temporary Power Pole .. j
Plumbing (Draln/Waste Pipe) . . ,
Electrical Ground Electrode/uter.
setbacklFormsfTrenches (Footings) .. ,
Do not install sub floor or pour floor slab unt; I the
following applicable items have been signed: .
Plumbing (Water Plpe.Sprinkler valves) ,
Mechanical IGI"O!Jndwork) . .
Electrical (Underground Conduit) I
Pre-slab (CompactioniMembrane.Reinf. . .,
,
Underpinning (Floor Joist/Girders) . . .... I
Do not cover or concea./ the WO~ belOW until the . I
following applicable items have been signed:: . .
1st Floor Shear . . !
Fin.sprinkler (Rough) . . . . ,
2nd Flo.or Shear .. . . . I
Roof (Sheathing/Diaphragm/Frame) o,y-05 rlJt'~ (( I
Masonry (ReinfJBond BeamlPre-Grout) I
Rough Plumbing (top Out). ... I
Rough Mechanical .. ,
Rough Electrical I Dry wall) . I
Rough Electrical. ... . .. .1
Framing . (Only after PIIig., Elec., Mech,. aM Fire) . I
Insulation (SoundlEnergy) , . . .. i
Donat tape or plaster until the following applicable . ,
items have' been signed: .:" . I
Drywall I
Penetrations (Fire Rated) Electrical I
Penetrations (Fire Rated) Mechanical . I
Penetrations (Fire Rated) Plumbing . . . . j
Interior t.ath .. .. . I
Exterior Lath i
GENERAL ITEMS ' . j
Exterior Plaster (Brown Coal) I
.T -Bar Electrical . . , I
T -Bar Mec/larilcal . ' . .. I
T -Bar Structural ' , I
Sewer . . I
Water Engineering Backflow . . . i
Water Service . I
-
- .
.
.
FINAL INSPECTIONS . Date, Inspector .
Electrical Final .
Plumbing Final ,
Mechanical Final. .
Gas Test ., . .
Engineering/Grading Final 765-5126 . .
Fire Dept. Final 765-4040
Water Engineering 765-5268 .
Sub list/Business. License 765-519 .
.
Zoning 765-5139 . . . . . .,
Building Final ~.st Inspection. Only . €ft~!o5 ~j\'\lo~1
fter Above Complete)
PARtiAL INSPEC'tIONS . .
Buildina'lnslJections.
, MechanicallnslJections
Plumbina Inspections
ElectricallnSDections .
TYPE OF PERMIT
Residential Remodel
DATE' 4f8/2005
JOB ADDRESS: 4003 E MAPLE TREE DR
LEGAL DESCRIPTION: N TR 4689 LOT 14
ElM
BUILDING DIVISION
. 200 S. ANAHEIM BLVD.
(714) 765 - 5153
. INSPECTION REQUE;;STLINE:
(714) 765 - 4626
CENSUS CODE: . 434
QUARTER SECTION: 157
BUILDING PERMIT NO. BLD2005-00966
CONTRACTOR INFORMATION:
BURGIN CONSTRUCTIONINC
2323 N TUSTIN AVE #122
SANTA ANA, CA 92705 0000
BUSINESS PHONE: 714558.1094
JOB DES.CRIPTION:Kitchen remodel. Replace 500 square leet of drywall. .
V ALUA TION: 10,000.00
I OWNER-BUILDER nECLARATION
I hereby affirm under penalty of .perjury that.1 am' exempt from the Contractor's Ucense Law for the following reason (Sec. -7031.5 Business and
Professions Code: ~ny .city or ?ounty which requiresa permit to construct, alter, improve, demo'lish or repairany structure, prior. taits 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.Licens~ Law (Chapter
9)(c.bmmencirlg with Section 7000 of .Division 3 of the Bus.inessand Professior,s 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 subje.bts the applicant to a civil penalty of not more than five hundred dollars
~~. ..
o I, as: owner"of prqperty, or my employee~ with wages 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 app\yto an._owner of property who builds or-improves ,
thereon, ~nd who does such work himself or herself <?r through his or her own \9mployees, provided that such improvements are not intended or. '..
. offered for sale. If, however, the building or improvement is s~ld with one yea~ of completion, the owner-b!Jilder will have the burden of proving that he,
did not build or improve for,the purpose of sale). . /.. ".' .
o I, as the owner of the property, am. exclusively contracting with licensed C9ntractors 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, an/:l who contracts'for such projects with
~ontractor(s) licensed pursuant tothe Contractor's Lice~se Law).' _' }', _
U lamexemptunder$ec.. i,B&'FJ.C.forthlsreason: . ." ..' .
Date: Owner:
I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalJy of pe~ury one of the following declarations:
.0 I have and will maintain' a certificate of consent to self-insur~ for worker's iompensatron,
as provided for by Section 3700 of the Labor Code, for the performance of the_work for which
~i permit is issued. . '.' ,,~
';,1 haV. e and will maintain worker.'s compensa .tion insuraf1ce, as. required !JYS. ect.ion 3<'.00 of 4/8/Z0q5
e Labor Code;for the performance of the work for which this pe'rmit is issue('~ Myworker's Date:
ompensation insurance carlier and policy are: I .
Carrier: VIRGINIA SURETY COMPANY, INC. Policy Number. 005-00022,452 .
. This section need not be completed if the pennit is for one hundred dollars ($1 00) 6r less.
o "I certify th'at..in the performance of the work f which this 'perm' is issued. I shall no.t
employ any person in any manner so as to 'b m. subject to kers cOr:lpensation laws
,of Califomia, and agree that if I should bee e bject to th w 's compef\sation
provisions of SeCtion 3700 otthe Labor e shall forth It ply with those provisions.
APPLICANT: BRAD BURGIH
OWNER INFORMATION:.
Phillip D Royster
4003 E Maple Tree Dr
Anaheim, CA 92807
ARCHITECT/ENGINEER INFORMATION:
. PROCESSED BY: MSM
I
Contractor
NUMBER
716244
TYPE
TYPE
EXPIRATION DATE
5/31/2005
B
C5
Date: 4/8/2005 Applicant.
WARNING: FAILURE TO SECUR ORKER'S C PENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EM PLOYER TO CRIM INAL PENALTIES AND CI VIL
FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,0.00), IN ADDI110N 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 ther~ is a construction lending age'ncyfor the
performance oj the work for which this permit is issued (Sec.3097.Civ.C):
Lender's Information: .
Co'nstrucion Tvpes:
V N, ,
Fire Sprinklered?
~, ,-N""
-",<
NO
A
state that the above iniormation is correct. I
state laws relating to buildi)1g construction, and
enter"upon the: above mentioned property for
Date: 4/8/2005
Fees paid for Permit:
Total:
125.53
Signature of Applicant or Agent
The permit shall. expire by limitation and become null and void if the building or
work has not passed final.inspection 365 days from the date of permit issuance. A
l)ew permit is required to commence or continue work.
INSPECTION RECORD
INSPECTION , " DATE INSPECTOR
Temporary Power Pole ' , , ,
Plumbing (DrainlWaste Pipe) " ,
Electrical Ground Electrode/uter , ,
SetbacklFormslTrencheS (Footings)
00 not install Subfloor or pour floor slab until,the "
following applicable items have been signed:
Plumbing (Water Pipe.Sprinkler Valves)
Mechanical, (Groundwork) , ' ,
Electrical (Underground Conduit) , ,
Pre-slab (Compaction/Membrane.Reinf.
Underpinning (Floor Joist/Girders) , ,
,00 not cover or conceal the work below until tne
following applicable items have been signed: '
1 st Floor Shear "
F1resprinkler (ROugh) ,
2nd Floor Shear " ' , .
Roof IShealhlng/DiaphragrnlFrame) , .
Masonry (ReinfJBond BeamlPre-Grout)
Rough Plumbing (Top Out) ~I , ~ ,
Rough Mechanical " ' ~I' 6 '" I \'W(.r
Rougn t:Iec:trlClIIlLJry Walll , " , </ 0 ., J_I
Rough Electrical ' " " 1
Framing (Only after Plbg . Elec. Mech and F,rel 1!l{lo( E -- I
Insulation (SoundlEnergy), l'i/Ot"'"1", ,'\;,.J;U I
Do not tape or plaster until the following applicable I
items have been signed: , , I
Drywall . . ' , ,r(~""" ;>;("'" A'TI
Penetralions (Fire Raled) Electrical I
Penetrallons.(Fire Rated) Mechanical ,
Penetrations (Fire Rated) Plumbing ~ I
Interior Lath' 'I~ I
Exterior Lath ',' I "
GENERAL ITEMS I
Exterior Plaster (Brown Coat) , I
T -Bar Electrical , ' ' , I
T -Bar Mechanical I
T .Bar Structural ' ," " I
Sewer , , I
Water Engineering Backflow I
Water Service , I
,
,
,
I
r FINAL INSPECTIONS
Electrical Final
Plumbing Final'
Mechanical Final
Gas Test
Date' Inspector,
, ftxJ..
Engineering/Grading Final 765-6126
, '
,Fire Dept. Final 765-4040 '
Water Engineering 765.5268
'S'ub List/Business License 765~519
Zoning 765-51,39
tlo '
PARTIAL INSPECTIONS
"BUildin;':~ections, "
1Uio? '~fk U.eII
Building Final (Last Inspection, Only
, ' , After Above Complete) ,
MechanicallnSDections
?,
'Plumbi';il~ections '.," ,',,' '~
1l1W(t4 & " .' '{/;-"-' -' al~~()uJ-(}(Lt"
ElectricallnSDections