626 S. Peregrine Pl.
TYPE OF PERMIT
Reroof
CITY
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BUILDING DIVISION
2bo S, ANAHEIM BLVD,
(714)765-5153
INSPECTION REQUEST LINE: ,
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 11~
BUILDING PERMIT NO, -BLD2004-04062
DATE: 11/5/2004
JOB ADDRE,SS: 626 S PEREGRINE ST
'LEGAL DESCRIPTION: N TR 1987 LOT 45
APPLICANT: LEW FERGUSON
OWNER INFORMATION: CONTRACTOR INFORMATION:
Guy Guyer MCCORMACK ROOFING CO
626 S Peregrine St 4091 E LA PALMA AVE #T,"
Anaheim, CA 92806 ANAHEIM, CA 928070000;
" ' , BUSINESS PHONE: 714 63~,5543 '
JOB DESCRIPTION,ear off existing and Install 25 squares of metal shakes: IGBO # 4361,
" I '
VALUATION:, 8,400,00 :'i
I OWNER-BUILDER'DECLARATION-
'1 hereby affirm under penalty 'of- perjury that I am exempt from the Ccntrc:.ctor.'J:, ~iceTlse, Law for the fol1owi(\g, rcason (Sec. 7001.5 Business and
Profes~ions Code: any city or county which requires a permit to con;5t~.uct, a~~r(imprQve, oeroolish Qr repair any structure, prior tq its issuance, also
requires the applicant for such'permit tofrle Rsigned statement that De is lic.~ilsed pursuant to_ th~ provisions of the Contractor's Licen~e-Law- (Chapter
'9)(commencin!';J with Section 7000:0f Division 3 of the Business and pr9fess-:in..'s Code} or that ne is exempt ~herefrofTI ar.d thebasis for the alleged
e:1(emptio.n. Any violation of Section 7031,5 by any applicant.for a permit Sl1~j,;:cts the applicant to a civil penaity c~ not more th~r. five hundred dollars
~OO~.' . .
0' I"as owner of p~operty, or my employees with wages as their sole com~~nsatlon, '\vill do the work, and the structure is -(1ot intended or offered for
sale (Sec. 7044 Business and Professions Co(le: The Contractor's License':1!aw dop.s nQt aRplyto an owner of property who builds o rJmprove.<;.
thereon, and who does such work himsp.lf or herself or through his or'_hf:r Oy4jl) ,erPploY6€s, provided that such improvements ale. not intended or _'
offered for sale. If; t"'.owevl9r, the building or irnrxovement is sold withone y:.;1..~:of ,;cmr:etio!1, the owner-bllilder will have the burden of proving thot he
didnotbuildorimpr<?ve'fcrthelJu~posecfsale). _ ',' . ,:. ":1_ ' .,'.'. .
o I, as the owner of the property, amexdus!vely contracting with licel1se~PJi'Jtr:-lctors to C0r13trl)ct the'project {See. 7('144' 8usi:iess-13nd Professions
Code: The Contractor's License Law does not apply_to on ownl9r of property':uho cuiid3' or li11prCVes therp.on, ar.d who oontr8cts forzuc.'-1 piOjects w:t11
~ontractor(s) licensed pursuant to the Gonttactor's License Law). : i
U .1 am exe!f1pt ~nder See,. ,B & P.(:. for thi~ re<;lison: ,___
Date: OWner:
( WORKER'S COMPENSAT!ON DECL4.RATIOt~
.1 hereby affirm under pen;;llty,of perjury one of-the following dE3clarations: ,;
o I have and will n1a'int~in a' certificate of ronsent to se-IF-insure for worker~~ cOr7wen~ation,
as provided for by Section 3700 of the Labor Code', for the performance ofth:~ work for \''.'hicll
this permit is isSued:' . _ 1: I
o I have'and willmnintain worker's compensation insurance, as reqtJi.red !:\'?'Secticn 3700 of I
the ,Labor Code, for the performance of the work for which this permit is it-~!.!e;d. MY'Norker's
Compensation insurance carrier and polic.y are: I
Carrier: AMERICAN INTERNATIONAL GROUP Polic.y Number. W-~7572.'i6
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: EMA
1
,~
LiCENSED CONTRACTORS DF.OC!-ARATION I
I hereby affirm under, penalty of perjury that I AIr!
!icensed urxier prcvisiOnsof chopter 9 (Commflr.cing
with S~ction 7000) of ivsion 3 of the Busfneoss ,and
~~'~:~;os~:nscode... ~_' .~_ '.
D8ts-: contra-c~
. -
This section need not be ,comple,ted-ifthe ~rmit isfor one hundred dollars ($10lo\ or less. I
o I certify that in the'perfonn~nce of the work far Which this permit is iSSU~::t I shall 'nc.t .1
emptoy any person in any manner so as to 'become subject to the worker's 4l1lpensaticn laws
of Califomia. and agree t~at if I should become subject to the worker's comrJ,f'!sation
provisions of Section 3700 of the'Labor"Code hall fort ith co ply Witll tt0::;e pIC'visions.
NUMBER
643700
TYPE
EXPIRATION DATE
6/30/2006
C39
Date: 11/5/2004 Applicant
WARNING: FAILURE'TO SECURE WORKER'S COMPENSATI
UNLAWFUL: AND SHALL SUBJECT AN EMPLOYER TO CRIMIN ENA1,TIES.ANDCIViL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN A[)D:TION XOTHE
COST CF COMPENSATION, DAMAGES AS PROVIDED cOR IN SECTIOI~ 3706 OF THE
LABOR CODE, INTEREST AND ATTO~NEY'S FEES, '--3,
I CONSTRUCTION LENDI~JG AGENCY .!.
I hereby affirm,'Jilderpenelty of perjury that there is a con~tructi.on lending:.;gen~yfpr the
p~rrorin:'\nc:eofthe'Ncrk for _"Yhictl thi~' permit is issued (Sec. 309Z..Ci...:J;t _ ~,L' _
.bander's Informafion;- . , . . .j':;'
Construdon 1 ypes:
VN
I '
I
1
Oat. 11/5/2004
Fee:s paid for Permit:
Totai':
235,67
Agent
The permit shall expire by lim' a and become null and void if the building or'
work has not passed final inspection 365 days from the date of permit issuance, A
ne~ permit is required to commence or continue work.
INSPECTION RECORD
. INSPECTION. . . . ; DATE INSPECTOR
Temporary Power Pole .
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/lifer .'
SetbacklFormsfTrenches (FootingS) "
Do 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 (Compactionl",embrane.Refiif.:
Underpinning (Floor Joist/Girders)
Do not 'cover or conceal the work.below until the
following applicable items have Qeen signed: '
1 st Floor Shear ' ' , "
FiresPrinkler (Rough)
2nd Floor Shear ' .. , ^
RoOf (Sheathing/Diaphragm/Frame). , /dOi;'. / In.fi
Masonry (ReirlfJBond BeamlPre-Grout) I 'f d.
Rough Plumbing (Top Out) .
Rough,Mechanical
Rough 8ectrlcallurv wall)
Rough Electrical "
Framing . (Only afterPlbg., -Elec.. rvlecl1., af'!d Fire,)
InsulatIon (SoundlEnergy)
Do not tape or plaster until the following applicable
items hav.e been sigr:'led: ,- . . .
Drywall. '... . , '. .
Penetrations (Fire Rilted) Electrical
Penetrations (Fire Rated) Mech8l1ical
Penetrations (Fire Rated) Plumbing . . .
Interior Lath ' . ,
Exterior Lath . , ,
, GENERAL ITEMS .
Exterior Plaster (BroWn Coat) I
T -Bar Electrical
T-Bar Mechl!nical
T -Bar Structural ' , ,
Sewer ,
water Engineering Backflow , ' '
Water Seniice
FINAL INSPECTIONS'
Electrical Fimil
. Date.
Inspector
Plumbing Final
Mechanlcai Final
Gas Test
Engineering/Grading Final 765.6126
Fire Dept. Final "~5-4040
Water Engineering 765-5268
Sub ListlBul!iness License 765-519
Zoning 765-,5139 '
'Building Final ILast Inspection' Only
After Above Complete)
PARTIAL INSPECTIONS
Buildinqlnspections
Mechanical Inspections
l:',
Plumbimi Inspections
Electrical Inspections