475 S. Paseo Bandera
TYPE OF PERMIT
Reroof
CITY
--Y.
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BUiLDING DIVISION
200 S,ANAHEIM BLVD,
(714) 76q - q153
INSPECTION REQUEST L1N!;:
(714) 765 - 4626
, CENSUS CODE: 434
QUART!=RSECTION: 186
BUILDiNG PERMIT NO., BLD2004-02403
DATE: 6/10/2004
JOB ADDRESs: 475 S PASEO BANDERA
,LEGAL DESCRIPTION: N TR 86nLOT 10
, , '
CONTRACTORINFORMA;lON:
MCCORMACK ROOFING ,~O
'4091 Eo LA PALMA AVE #T
ANAHEIM, CA 92807000G :
BUSINESS PHONE; 714630,5543-
JOB DESCRIPTION:Tearaff shakes an,d install 24 sqvares,a( Deera Metal Tii"i 1.5Ibs.
VALUATION: ,8.lori.00, ' !;' '1 " : PROCESSED BY: ODC
I " " .,' ," " . ' ' OWNER-BUILDEP..,~'ECLARATION' " '". . ,
I hereby affirmiJnder penalty of perjury that I am exempt from the Contractor'f, Lic~nse_ Law:for the following reason (Sec. 703_1.5 BUSIness and
Pro,fessions Coda: any,city or county which req'uires a permit'to cOr:lstruc(a!hl;i, iMprove, demolish or repair any structure~ prior to its. 'issuance, also
requires the app::canf for such perrl.l:t to file a signed statement that he is i,~q~';'lsedpursuant to the provisions of t~ '~ontractor's'Lice!lSe Law (Chapter
9)(commencing with Section .700.0 of Division Sof the Business and Profes,"$1(Ts Code) o~ that'he i,sexempt therefrom 'and the basis for the alleged- .
exemption. Any violation of8ectio(l,('.031.5.byany applicantfor a permit sut::....ctsthe applicant toa civil penalty of not more than five hundred dollars _
($500). .' . '. . .. .l.... ., "
o ,I, as owner of property, or my employees with wages as their sole ,cornp{nsation" will do the work,- and the structure is nQtinten:ded or offered for
sale (Sec. 7044, Bus~ness a~d Professions Code:, The Contractor's.License Ll:~W d()es.not apply to an owner of property who builds or improves
thereon, C':lnd who does such work himself or herself or thr()ugh his or herowi1iemployees, provided that su:ch improvements are not intended or- __ .
Otf,eied .for sale. -If, however, the building o~ improvement issold witt:! one ye}t of completion, the owner-builder'w.ill have the burden of proving, that'he
did not build or. improve for the purpose 'of sale). V.'." ' , -.
D I, asthe owner of the property, am exdusively contracting with licen$ed :Jontractors to construct the proje.ct (Sec. 7044 Business arid Professions
Code: The Con:r,;;ctor's License-~w does_n6~ apply to an D:wner of properti'i~'h~ bUi!dS 9r.improvesthereori,-aryd Who contracts for such 'proJects with
, [jon~r~ctor(s) ~lccnsel;l pursuant to the'Co.ntractor'sLicense~a,^,), - , :!'l' , .' :: ','
, _ I am ~x.empt t.!nder Sec., -----,..._ ,B & P.G. for this.reason: ,~' ".'", - _ :,'
Date: Owner: !"
I. WORKER'S COMPENSATION DECLARATION ! - . LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of pe~ury one of-the following declarations:_', t I herebyatfirm ul1der penalty of perjury that ,I am
D I have and w(1I maintain a certificate of Consent to self-insure for worK~rt:; compensation, licensed un~er:.provlsionsof chapteF 9 (commencing
as provided for by Section 3700 of the Labor Code, for the Pa(formance of t~.~.. 'Nork for which "Yith SectiOn '700P)' of ivsion 3 of.the'Business and
th~ Permins issued., r Professions Code '.4 . ., '.
. D-, I' have and will maintain wo~er's 'compensation,insurance, as required t-Jr SectiOn 3700 of 6/10/200 ~,
.the. Labor Gode, for the..perforr:nance of the work forwhict:l this permit is.issl;~:d. Myworker's Date: Contracto
Compensation insurance carrier and policy are:. '_ _ ,,' '
Garrier.: AMERICAN INTERNATIONAL GROUP Policy Number. W-3757;,36 .
This section need natbe Completedil the pennii is lor one hundred dollars($10Clllr iess.
o I certify that ,in the perfo~ance of the work for which this'permit is-''Issu~:d,.I-shall not
employ any, person in a ny manner so a$ to become'subject to the worker's cilmpens.atiori laws
of. Califomia, and agree that if I should become subject to the wOrker's'comt::l,nsatfon", '
provisions of Section.37GG of the labor Cod' all.forthvi' co ' 1Y,~.ith tl'pseprovisions.' '
, - _..J. ,
APPLICANT: LEW FERGUSON'
OWNER iNFORMATION:,
'Stephen' Blythe
475 S Paseo BC'!ndera
Anaheim, CA 92807
ARCHITECT/ENGINEERINFORMA TION:
NUMBER
643700
TYPE
TYPE
C39'
Hie
EXPIRATION DATE
6/30/2004 .
Daie:' 6/10/2004 , Applicant. .
WARN ING: FAILURE TO SECURE WORKER'S. COMPENSATIO Er<AGEIS
UNLAWFUL, AND$HALl SUBJECT AN EMPLOYER TO CRIMiNAL PENALTIES AND' CIVIL.
FINESl)pTO ONE HUNDRED THOUSAND DOLLARS ($100,OOQ).-INADDITJON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN S,ECTION 3766 OF.THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. ' , "
I CONSTRUCTION LENDING AGENCY ../
I hereby a~irm under penalty.of perjury th3t there is a _constructi6nlehding:.i~Jenc'kf~r the~~:_;._
:::'::!. :"G((I'5!..!J,re "l!ihe '!~..:.:"k for ..mal ti";;:.. j.Jt::S-fliiii:S ;~&:i~C1 (i)ec. .509(~-Cr\(C l: - -':- -- - ;'"-, ",,,,,",,,-~_:
..Lender's Information:
Construcion Types~
VN; , .
Fire Spririkfered?
NO
I certify that I have re,!i~ .this application and state that the above informationjs ~orrect. I
,agree to comply with, all city ordinanc'es and state laws' relating to bUilding construction: and'
. ~ereby .authorize rep ntive~s 01 ~, . -Go, '; enter upon the above rnentioneclpraperty lor
inspectIOn rpq .. . . . .. ' . '
. " Date:, 6/1 0/2004
Signature of Applicant or ent
The permit sh3l1 expire by limitation a orne iwlland void if the building of
work has not passed final inspection 365 days' from the date of permit issuance. A
new r;'ermit is required to commence or continue work.
, . Fees paid _for Perm,it:
Total: '
195.62
INSPECTION RECORD
.' .' .
INS.I'ECTlON . . . . . DATE. . INSPECTOR
Temporary Power POle'- . .' . . '. . '. . ..'
..
Pl\.lmbing(DrainiWastePipe) . . .
Electrical GrOund ElectrodellJfer ". . .., . . . '.' .
&,tbacklFor'mslTrenChes (Footings) . . "C . .,. '.
DC> not install .sub floor or pour floor Slab until the .
followin.gapplicabl~ itemsh;:!,ve been sign,ed-:' "
Pl\.lmblng (Water Pipe.Sprinkler ValVes) .' . .
Mech3nlcal (GrOUndwork) '. ..' . .- '. .. '.
Electl"lcaI (Undergr.ound Condu it) .
Pre-.slab (Compaction/Membrane.Reinf. ". '..: .'
Underpinning (Floor Joi.stlGlrders) '. . . .' .....
.
1.!Xl nbt cover or.conceal the work below until the . - ....
:following applicable iteins hav," been signed: ..... c":
I
1.stFloor Shear .. .'. . . . ....<r
Firesprinlder(ROUgh) . . . . .
2nd 'Floor Shear . . .. .. ... . . .. ." - II
ROof ($hilathinglDiaphr..gmlFrame) . t ......kS~6 '#'- '. ,
~'.'
MasonrY (Reiilf./Bol\d BeamlPr'e-Grout) I /y
Rough Plumbing . (Top Out) ." . . - .'
.
Rough Mechanical' . . . . . ...
. .
I Rough t:Iectrlcal II) g
. .
Rllugh Electrical '.' .'
Framing" (Only after Plbg.. EI~..r.;lech and-Fire) .. '.. . !
InlSUlatlon(SoundlEnergy) .
po not tape or plaster until tne foUowiAg applicable . . .,'
It.ems toave been signed:.. . . . .' . i.
DrYwall '. ... '. . . - . .
Penetrations (Fire Raled) Electrical ..
Penetrations (Fire Raled) Mechailieal . .
PenetratiOns (l=ire Rated) PI unlbi ng.
.Interior.Lath . .- . . .
Exterior I,:ath .' ..
. . . '. - GENERAL ITEMS
Exterior PllIster. (Brown Coat) '. .. .
'T -Bar Electrical .... .... .'.
T-Bar Mechanical
T -Bar Structural . .' . '. ".
Silwer' . . . . I.
Water Engine\lring Backflo"" . . . .
Water Sei'Vice '. .
'.....
Date . Inspector
.FINAlINSPECTlONS .
Electrical.Final
Plumbing Fin'"'
Mechanical Final
Gas Test
!=ngineeringlGrading Final 765-5126
Fire Dept. Final 765."4040
Water En'gineering 765-5268'.
. .
SilbListlBusiness License .765-5.19
Zoning 765-5.139
. Building Final ILast Inspection. Only
. . )\fter Abov.e Complete).
. . .... . PARTIAL INSPECTIONS'
BuildhlQ Inspections
,. .". .
. .
. Mechanicai Inspections
Plurnbinalnspections .'
Electrical Inspections