282 N. Paseo de Juan
TYPE 0;: PERMIT
Reroof
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714)765-5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 190
BUILDING PERMIT NO. BLD2004-04318
DATE: 1211/2004
JOB ADDRESS: 282 N PASEO DE JUAN
LEGAL DESCRIPTION: N TR 8081 LOT 31
APPLICANT: LEW FERGUSON ' .
OWNER INFORMATION: CONTRACTOR INFORM,^inON:
Dennis Emge. MCCORMACK ROOFlrJG1S0
282 N Pasao De Juan 4091 E LA PALMA AVE ifl t
Anaheim, CA 92807 ANAHEIM, CA 9280700001
. . . . BUSINESS pHONE: 714 63ll-:'543 .
. JOB DESCRIPTION: Tear off existing and reroof 20 squares with Ihonier ceda;llite tile 5.6p/p.s.
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VALUATION: . 8,100.00 . . . A;. . PROCESSED BY: SAM .
L . . . . . OWNER.BIJILDER6tCL~RAT'ON .. .
I hereby affirm under penalty of perjury tha~ I am exempt frpm the ContrClcto~.r[jq~nse law for the following reason (Sec. 7031.S-Business af)d
Prpfessions Code: "any city or county which requires a permit to Gon::;lruct, ~~~r;::jr:ri'pr6ve, demoiish or repair any structure. priof to its issuance. alsQ
tequires the applicant for such permit to file asi9ned statement that he!s iic;3~~erl'pursuant to the provisions cfihe Contractor's License Law (C.h:3pter
9)(cor:nmencing with SectIOn 7000 of Division 3 of the Business and Profes;:::t:,;'()()de} or t~.at he is Gxempt therefrom z.nd thei~asj$ f"r the alleged
($;~):ion. Any violation of Section 7031.5 by any applicant for i3. permit su~~~hg-r~-.,r?e applicant t? a civil penalty of not more the n five hundre~ dotlars.
D 'I, as owner of property, or my employees wi.th wages as their sole GomD~jh~at!9n~ win do tne ""..ork, and the structure.-is not intended or offerfJ.d fer
saie (Sec. 7044 Business and ProfesstOr:lsGode:' The Contra,ctor's ucenssl-liX~:.?9B~ not apply to cn owner of pt(,perty: who builds.or improves
thereon, and who does such work himself or herself or through his or he:r owfH':;;Jdovees. provided that such improven-,ents are not intendad or
offered for sale. ',!f, however, the building or imprOVement is sold with one y~/;ftidH;'pje~ion, the owner-bul!der wii!have the burden of. proving t-hat he '.
did not build or improve forthepur'poseotsale). _ . ,:r,,-';', ....: ',:. '...., .'
o I, astl.18 owner .oft~!e. property, am exdusivety contracting with ;jce.i.i~d".f.'l'r,nt(a(.-fcr~ to construct the project (S6!"..', 7044. B.lISin~ss and 'Professions.::
Code: The Contractor's. L.icense Law does not apply to an owner of propert)~'.;h() ;"uild., or irT:~lroves rhereon, and who contracts'for-such -projects with
:[jQlltractor(s) Iir.ensed pursuant to ~he Contractor's uce~se Law).~; .' '.,
I am E::~emptande; Set:. .' , B & P.C. for thiS reason: . __~..;..t"u__
Date: Owner: . 'j ,..',
C WORKER'S COMPENSATION DECLARATiON ~~-IE~=-:-' :] jLICENSED CONTRACtORS DECLARATION]
I hGreby affirm under pe~alty of perjury one of the follOWing declarations:' .}:, ," ! i hereby affirm uncierpeila!ty of perjury th<lt ,I am
D ! ha~e and wi.!! r:;18'!ntain a certificate of oonsent to self-,insure for work.::jr)1:,)br:riPens3tDI"', II . licensed u noer-provisions 'of chapter 9 (commencing,
2~.provid:,! t~j by SectiOn 3700 of the Labo~.Code, for the perf.ormance of t~1AW0r~tor \vhich I ~~~;~~~~~:7~~~n'~Or) Of/, ~. nO of ",e 8usiness aod
thIS permll is lSsLJec. .;~-; , . i ~ , -. ._
'b<t::) haV!3 and will 'na!o-rain worker's ,compen::.ation insurance, as reauired tif$'2(,;(10l'; :;70'0 (.( I i21 j/2QO ~
Ith-;;Labor'Code, forJhe performance ~f the work for \'"hich this permit is iss:::,::'--.:I My\vork.)r's Date: C ntractor
Compensation insurance carrier and policy are: -'to I
Carrier: AMERICAN INTERNATIONAL GROUP Policy Number. W-:)7572:iQ i NL'MBE~ EXPIRATION DATE
This section need not be oompletedifthe pel111it is for o~ ~undred dollr...-s (S10t..1 <)f lASS, I ~~~~o C39 6/30/200E?
o I certify that in the perfonnance of the work for which HilS permit is :ssuel.i. : Sf-.~ij not L -
employ any person m any manner so as to become subject to the work~r's c:o.{lp~n:&:~l:ion lalf"iS
of California, and agree that if I should become subject to the wot.(er's cf'!!lP':~nsation
provisions of Section 3700 o(the La~O~hall fort~,) y with ti'1,;;;pr6~isrons. . ,! 8~iJSlrlJCion Types:
Date: 121112004 Applican~ L r2!: r: >_, ~ ' '" .
WARNING: FAILURE TO SECURE WORKER'S COMP.ENSA' ION COVP',c,G;:: I~,~, i
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRI~ , , , A::CiERAl\ID CiVIL
FiNES UPTO ONE iiUNDRED THOUSAND DOLLARS ($100,oooi, IN ADri,'nON TQ THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIO~!:J70C'OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. .'
L CONSTRUCTION LENDING AGENCY .----.~.-
,/herebyaffirm uflderpenaityofperjurj that there is a con$trUctial1lending,fJ5j..~fI"cyfor,the.., i .
-'p~I}0f':l'ldl'1ttf'-e<i~;-~~;. .wo,,:, ;u:'whrd'F:ttys-p-emiirrs--m-SOeu-@.:;:~~J::"''i;0i'.;::-G1:=.~..A:. '_'____';7.~/:~",...!_:; .,.:'.-'~-----:.r;:--~. ~~~~--':',c"'. .__o..--..,..,......__.___.__c..
Lender's'infbn-nation: '
ARCHITECT/ENGINEER INFORMATION:
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I
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I certify that I have read' this applicatioriand state that the above information I::; correct. I
agree to-comply with all city ordinances and state laws relating to.building con;;~rljction; and
~ere by .authorize repz. se . s .of this dty to enter'u pon the a bove mentioned ploP€; rty for
inS on p. ses. ' .
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. Date: 12/1/2004
Signature Applican. r Agent
The permit shall expire b 'milati and become null and void if the building or
work has not passed final inspection 365 days from the date of permit issuance. A
new permit is req\lired to commence or continue work.
Fees paid for Permit:
Total:
160,92
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INSPECTION RECORD
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: INSPECTION DATE ' INSPECTOR.
I Temporary Pow.er Pole
j Plumbl ng (DrainlWaste Pipe)
! Electrical Ground Electrode/lJler .
CSetbacklFormslTrenches (Footings)
.' 00 not i,nstall subfloor or pour floor slab until the
; following applicable items have been signeci:
1 Plumbing (Water Pipe.SprinklerValves)
Mechanical (Groundwork)
Electri,cal (Underground Conduit) ,
. Pre-slab (CompactiontMembrane.Remf. ,
~. .
~ Underpinning (Floor Joist/Girders) .
>; Do not cover or conceal the work below until the
1 following applicable items have been signeci:
; 15t Floor Shear
t~iresprinkler (Rough) ,
f lnd Floor Shear , .
\;~.. ~/ "i/ I:IJ I .;;Z ~
.; Roof (Sheathing/Diaphragm/Frame) {"A'1
!Masonry (ReinfJBond BeamlPre-Grout)
~.Rough Plumbing (Top Out) ,
; Rough Mechanical '"
S KOugh Bectrical(Dry.vvall) , ,
{ Rough Electrical
i Framing (Only after Plbg..Elec.. Mech, and'Fire)
f Insulation (SoundlEnergy) . ,
j Do not tape or plaster until the following applicable
t items have been. signed: . .'
:. Drywall ., " ~.,.
, !>enetrations (Fire Rated) Electrical "
;.f'ei1etrations (Fire Rated), Mechanical
i ?9netrationS (Fire Rated) PI umbi ng
:iN .
. ."terior Lath
'l<xterior Lath.
, GENERAL ITEMS "
'-
. :'.xterior Plaster (BlOWn Coat)
"~! .Bar Electrical . ,
. '! ..Bar Mechanical ,
.:".~ .~r Structural
,~;ewer
...
,Water Engineering Backfl.ow ' ,
;\later Service .
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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 ~ast Inspection. Onl~k, 'rJ-/l.Q3 ./e1.
fter Above Complete
PARTIAL INSPECT!ONS
Buildina Inspections
Mechanical Inspections
Plumbina Inspections
Electrical Inspections