7840 Samantha Cir.
TYPE OF PERMIT CITY'
Reroof
ElM
BUILDING DIVISION.
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 200
BUILDING PERMIT NO. BLD2004-04319 .
DATE: 12/112004
JOB ADDRESS: 7840 E SAMANTHA CIR
LEGAL DESCRIPTION: N TR 8831 LOT 99
CONTRACTOR INFORMAnON:
MCCORMACK ROOFINQICO
4091E LA PALMA AVE #Tl
ANAHEIM, CA 92807 DODO!)
BUSINESS PHONE: 71463(\.5543
. JOB DESCRIPTION: Tear off existing and reroof 22 squares with ,50 year composition shingle"
. . . I
VALUATION: 6.800.00 . t. . PROCESSED BY: SAM .
." ~,'
I OWNER-BUILDER:DeCLARATION . . _---1.
I hereby affirm under.penalty of perjury that I am exempt from the Contractcn~ License Law for the foHowing reason (Sec. 7031.5. Business and . .
. Professions Code: any dty or county which requires a permit to construct, al6r: improve. demolish or repair any structure, prior to its isSuance, also.
requires the applicantror such permit to file a signed statement that he i.s Iicd~~d pursuant tq the provisions of the Contractor's License Law (Chapter
9)(commenving with Section 7000 of Division 3 of the Bljsiness and PmfessiJtrisCode) or that he is exempt therefrom and the basis for the alleged
exemption. MY violation' of Section 7031.5 -by any applicant for a permit sUDj:Ccts the applicant to a dvi! pen:dty of not more than five hundred dollars
($500). . Ii, . . .
o I, as owner Of property. or my employees with wages as their sole com~:msatiol1~ wi!!' de the work, and the structure is not intended or offere<;jfor
sale (Sec.'7044 Busiryessand Professions Code: The Contractor's license6:!w doe~ not apptyto an owner of property who builds or improves ..'
thereo(1, and who does such work himself or herselfor throygh hia.or her ow{;;erhployees, provid8d ttlat such_improvements are not intended or
offered for sale, If"however, the building or improve'ment issoid with one Yt"'l~f of completion, theowner..builder will have the .burdon of p~oving that he..
did not buDd or improve for the pUIlJtlSe df sale}. , _ ':.- . .' '-,
o I, as the ,~ner of the property, am exclusively contra ding with ii~eflS?c.\t'Ontr.-ilct.ors to construct the pruject (See. 7044, Busines$ and Professions
Code: The Contractor's license Law does not apply to an owner of p,:opelty{;-;bo cuilds or improves thereon, and who contracts for such 'projects with
CLQontractor(s) licensed pursuant to the Contractor's License Law}. .r, .
I I _ " -,' i
.---I.lamexernptunderSec. ' ,BS_P.C.~Oi"thisreo:l.3on: _~}': ,
~t~: Owner:.. , . ' .,~,-
L WORKER'S COMPENSATION OECLARATlot-L_:'ii:.._ -~
I hereby affirm und_~r penalty of-perjury oneot the following declarations~ . '~_;"
o I have and will maintain a certfficateof consent to self-insure for wo:"kef!.!I~{':6J11pp.nsation.
as provided for by Sect.ion 3700 of the Labor Code:- for ~he performance of m:; y..'oik-for which
this permit is issued~ . , , __ ,t.-
'. ~l1ave ,a nd w11l maintain wcrker's,compen:sc;tion insurance, as required b~\'Jh~ction 3700 of
,{he Labor Code, for the performanc~ of the work .for w. hich this permit is isswM, My worker's
Compensation insurance carrier and policy are: . V, <
Carrier: AMERICAN INTERNATIONAL GROUP Policy Number. W-37572fl6 .
. .' :'1-
This secti90 need not be completed if the pennit is for one hu~dred dollars ($ t OUl:~i tess.
o i.certify that in the performance of the work for whi9h this permit is iSSLl€l.f;.'( shall flot
employ any person in any manner sa as to 'become sl,Ibject to the worker's, compensation laws
at California, and 'agree that if I should become subject to the worker's corr.pe~$.atjOI1
'proviSions of Section 3700 -of the labor CQ . sha'n it amply with th(l,~e prOVIsions.
( ~.
APPLICANT: LEW FERGUSON
OWNER INFORMATION:
Cynthia SWarner
. 7840 E Samantha Cir
Anaheim, CA 92807
ARCHITECTIENGINEER INFORMATION:
LICENSED CONTRACTORS DECLARATION i
t. hereby affirm under penalty of perjury that I am .'
licensed under provisiOns of ~hapter 9 (commencing
with Section 7000 Oivsion oft e Business and
ProfeSSions C
1211
Date:
NUMBER
643700
TYPE
EXPIRATION DATE
613012006
C39
Date: 12/112004 AppJi
WARNING: FAILURE TO SE EWORKER'S COMPENSATi
UNLAWFUL, AND. SHALL SUBJECT AN EMPLOYER TO CRt
FINES UPTO ONE HUNDRED THo\JSAND DOLLARS ($100, l ADDITION TO THE
COST QF.COMPENSATION, D.AMAGES AS PROVID.ED FOR .IN SECTION F06 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
1 CONSTRUCTION LENDING. AGENCY
I hereby.affirm under penalty of perjury that there is a construction lend!ng ag{:ncyfor the
,;2t3.'1!?f!!l~D~_..otlllf.u.~"n"k fQ.!~~!.C+-.,,~t"~a :.., i:--.... ~__.l .~r.- ~c_ ':H-'Q;"'~~r_;"o.-'"
Lender's fnformation: . -
Construcion Types:
VN. .
(,certify that I have read this application arid state that the above information'is correct. I
agree to oomply with all city ordmances and state laws relating'to buDding con<;truction, and
hereby ~uthorize tepresentiv ~f t 's city, to enter upon the above ~ent;oned property for
inspection p sas. - .
'. . Date: 121112004
Signature of Applica or Ag nt
The permit shall expire by Iimitat d 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 required to commence or continue work.
Fees -paid for Permit:
Total:
235.51.
INSPECTION DATE INSPECTOR EI.eetrieal Final
Temporary'Power Pole . . Plumbing Final .
. Plumbing (DrainIWaste Pipe) .' . Meehanieaf Fina.1
Electrical GroLlnd ElectrodelUfer
SelbacklFormslTrenches (Footings) . Gas Test . .
Do.not install subfloar or pOllr floor slab. until the Engineering/Grading Final
following applicable items have been signed: .
Plumbing (Water Plpe.Sprinkler Valves) Fire Dept. Final 765-4040
Mechanical (Groundwork) Water 'Engineering 765-52
Electrical (Underground Conduit) Sub List/Business License
.Pre-slab (Compaction/Membrane.Raint. '. . . .
. Underpinning (Floor Joist/Gilders) Zoning 765-5139
Do not cover or conceal the work below until the Building Final \l-asl.lnspecti
'following applicable ilems have been signed: . Iter Above C
1st Floor Shear . , _/ PARTIAL
Firesprinkler (Rough) dina Inspections
2nd Floor Shear . . I A/I
Roof (Sheathing/Diaphragm/Frame) 111'31 -, 11ft...! ----- .
Masonry (RainfJBond BeamlPre-Grout) i' . .
.
Rough Plumbing (Top Out) .
ROLlgh Mechanical .
Rough l:Iectncallury wall) .
Rough Electrical .
Framing (Only after Plbg.. E!ec.. ~..~ech.. and Fire)
Insulation (SoundlEnergy) .' Mechanicallnspectio
po not tape or'pla~ter until the following i1Pplicable
Items hav.e been signed: . .
Drywall -' . .
PenetrationS (Fire ~ated) Electrical
Penetrations (Fire Rated) Mechanical, . .,
Penetrations (Fire Rated) Plumbing .
Interior Lath" .
Exterior Lath . Plumbin~ Inspection
. GENERAL ITEMS '.
Exterior Plaster (Brown Coat) .
T -Bar Electricat .'
.T-Bar Mechanical . . .
T-Bar Structural
Sewer . .
Water Engineering Backflow Electrical Inspection
Water Service .
INSPECTION RECORD
FINAL INSPECTIONS
Date
Inspector
765-5126
68
765-519
on- Only
omplete) ,
ns
s
S.