HomeMy WebLinkAbout10-71 CITY OF DIAMOND BAR ,
`"---�F�— DEPARTMENT OF COMMUIVITY&DEVELOPMENT SERVICES �������
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� 21825 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027�-- � P�iESS
` ��'��', BUILDING PERMIT APPLICATION ",... ^^^n FIRMLY
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, ¢ ADDRESS 23 5l,� 1�ri.ospe�t V a Il�r'D� APPLICATIO / PERMIT p/C
p DATE �/��q/�v NUMBER� '��I #,/
°r APN �e �LOT TRACT �SSUE TYPE OCC
, DATE O CONST.� GROUP S F/L
p OWNER _ Ld R!� �1..�-1.�'
o ADDRESS 13 S�0� �2tis PEc•r J�4tt�Y 'prz ZONING SEfBACKS
Z CITYO�Bwcv�- �C�`A� ZIP'.R17�S TEL.Rn9S(tI 1y0�3 FRONT RW ❑
o APPLICANT L.�� FCs2�uSON TEL.714?�7yn4d REAR p
Z SIDE/SIDE STREET RW ❑
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p PROPOSED USE � DUE�2 �yLST� O�uE LA��/erL Go+rtP�
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z DESIGNER N�l� �-��sr��� ����`' CA`��� �d Y� ��`�
a ADDRESS NO.DWEL. NO. � NO.
cn UNITS ON� STORIES � BEDROOMS
� CITY ZIP TEL.
�
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/AOD/REM
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p I HEREBY AFFIRM UNDER PENAL7V OF GE0.NRY THA7 1 AM EXEMPT FROM THE CANTRACTORS LI- G8t8J9/C9fpOR
W CENSEUWFORTHEFOLLOWINGREASON(SEC.7031.5BUSINESSANDPROFESSpNSCODE:ANYCI7YOR (n �
C-) COUHfYWHICHREOU�RESAPERMITTOCONSTRUC7,ALTER,IMPROVE.DEMOLISH,ORREPAIRA1JY57RUC- w �
w TURE.VRqR TO ITS ISSUANCE,ALSO HEOUIRES THE APPLICANT FOR SUqf PERMIT TO FILE A SIGNED w Patio/Deck
� STATEMENT THAT HE OR SHE IS LJCENSED PURSUANT TO 7HE PROVISIONS OF THE CAMMCTOHS LF LL
� CENSE UW(CHAPTER B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF iHE BUSINESS AND PRO- POOUSPB
Q FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- � c�-�
V TION.ANY VIOLATION OF SEC710N 703t.5 BY ANYAPPLICANT FOR A PERMIT SUBJECTS 7HE APPLICAN7 TO Z Re-Roof rJ�L U v
� A CML PENALTV OF NOT MORE THMI FiVE HUNDRED DOLURS(i500�.):
� ❑I,ASOWNEROFTHEPROPERTY,ORMYEMP�OYEESWI7HWAGESASTHEIRSOLECOMPENSA710N, 0 Commercial =
Z WILL DO THE WORK,AND 7HE STRUCTURE IS NOT tMENDED OR OFFERED FOR SALE(SEC.70�1,BU51• J
� NE55 AND PROFESSIONS CODE:7HE CONTRAC70RS LICENSE lAW DOES NOT A7PLV TO AN OWNER OF � �
VROPERTY�NTIO BUILDS OR IMFROVES THEREON,AND NM110 DOES SUCli WORK HIMSELF OR HERSELF OR
Q THROUGH MS OR HER ONM EMPLOVEES,PROVIDED 7HA7 SUCH IMPROVEMEHTS AqE NOT INTENDED OR m
Q OFFEREDPoRS�LL.EIF,HOWEVERTMEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCAMPLE- �
Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF VROVING THAT HE OR SME DID NOT BUILD OR �
� IMPROVE FOR THE PURPOSE OF SALE).
w ❑I,ASOWNEROFTHEPROPEHTY,AAIE%CWSNELYCONTRACTINGWI7HUCENSEDCONTRACTORS -
Q TO CONSTRUCT THE PROJEC7(SEC.70an,BUSINESS AND PROFESSIONS CODE:THE CANTRACTORS LI- V81UetlOfl ADJ.AREA
W CENSE lAW DOES NOTMPLY TOAN ONMER OFA PROPERTV NM1iO BUILDS OR IMPROVES THEREON,AND
� WHOCAMMCTSFORSUCHPROJEC7SWITHACONT{UCTOR(S)LICENSEDPURSUANTTOTHECOHTRAG pUANT17Y DESCRIPTION FEE
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�� O I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
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� - �C
DATE_ OWNER f' �
O W I
�Q LICENSED CONTRACTORS DECLARATION w
CL i:iEREBY AFFIRM UNDER PENALTY OF VERIURY 7HA71 AM LICENSED UNDER 7ROVISIONS OF CHAP7ER I
d :'(i%)UMENCING WITH SECTION 70W)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CADE,AND �
i���-� ::Y UCENSE I51'1 FULL FOHCE AND EFFECi m
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V DATE O 1 / ilq � )O CONTHACTOR NCw2)VLC�C � d
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� WORKE9S'COMPENSATION DECLARATION a
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� 1 HEREBV AFFIRM UNDER PENALTY OF PERIURV ONE OFTHE f-0LLOWING DECLARATIONS: Z
Z _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' _
¢ COMPENSA710N,AS PROVIDED BV SECTION 370o OF THE LABOR CADE,FOR 7HE PERFORMANCE U
Q OF 7HE WORN FOR NM1iICH THIS PERMIT IS ISSUED. � _
Qw �I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION -
3700 OF THE LABOR CODE.FOR THE PERFORMANCE OF THE WORN FOR WHICH TH�S PERMIT IS �
¢ ISSUED.MY WORN RS'CAMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION ����
� CARRIER lGF IA� '57►4"I PLAN REVIEW
Z POLICY NUMBER n r3� S'P O���=O ELECTRIC
Q
0 (fHLSSECfIONNE�NOTBEODA4�ETmOFTEPERMT6PoqONEHIN]fiED�OLLAfiS(f10D)ORLFSSI PLUMBING
Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR NMICM THIS PERMIT IS ISSUED,I MECHANICAL
C} SHALL NOT EM7LOV ANV PERSON IN ANV MANNER SOAS TO BECAME SU&IECT TO THE
N WORKERS'CAMPENSATION LAWS OF CALIFORNI�AND AGREE THAT IF I SHOUID BECAME INSPECTION FEE
� SUBJECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION37000FTHEUBOR '�/
� CADE,I SHALL FORTHWITH COMPLV WI7H iHOSE PROrVISIONS. SSUAN CJ �
� L�u>\"tlL�ou-f�� ' �
p DATE:O� IO pppLICANT:
J WARNING:FAILURE TO SECURE WDRKERS'COMPENSA710N CAVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C
LL SUBJECT AN EMPLOYER TO CRIMINAL PENA�TIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLURS(Slao.o0o),IN ADDITION TO THE COST Of COMPENSATpN,OAMAGES AS PROVIDED FOR IN �E RMIT
¢ SECTION 3708 Of hiE LABOR CODE,INTEfiES7,AND ATTORNEYS FEES. '+ O CJ
�RETENTION FEE: �
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
�o �,�.'z 1
I HEREBY AFFIHM UNDER PENAITV OF PERIURV THAT THERE IS ACONS7RUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30Y7,CIV.C.�.
Z
W
� LENDER'S NAME
F- LENDER'SADDRESS
¢ I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT 7HE ABOVE INFORMATpN IS CARRECT. TOTAL FE ES � �, �� �
w I AGREE TO CAMPLV WITH ALL CITY AND COUNTV ORDINANCES AND STATE UWS RELATING TO BUILDING
� CONSTRUCTION,AND HEREBY AUTHORIZE FEPRESENTATNES OF 7HIS COUNTY TO ENTER UVOH THE
� ABOVE�MEMIONED PR07ERiY FOR INSPECTION PURPOSES.
Z COMMENTS
� C.�c.��S � �e�Co u.S��
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m E (PRINT) /�� � � �
¢ r� �
� SIGN TURE OF PERMRTEE OATE `^
= RECPT.NO.�_PAID BYy �' VALIDATION
~ WHITE—De Ament Co YELLOW—Finance
pa py, Copy,P�NK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's�Copy
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FfGS!FURMSlSTEEL • �, :�NA REG2t��TS
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ELECTFiIC GROUNt� � ;:�NDER F�OOR DUCT . ,
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C�ROUND PLUMB{NG �i�NDER FLflC�C�iJD�?�f ; �
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SIAB GRAD� ' ; ;�IREPLACE Ft�UNDATION �
_.._,.._.........._._.. ... _. ___...... . _...... _ _.._._.. _.. _..._.. _...... __... . _..... .._... _ _.._. _.._ _........ _.. ..
TEMF PC3VJER �FI�EPLACE BOND BERM .
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WATEi� SERV{CE -- . - - � -- �YfiID FiT. B>7ND BEA'tA — � ---- . -
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RQQF�SHEATHlNG ; ; � 'S FT. BO'��'BEk�4
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RC}UGH HEATIhlG 'BEf�CHIhG
ROUGH ELEGTRIC � � --- - !RD�GH GFiRUIN�
ROUGH P�UtV�BlNG i FiNISI-1 GRADih;G
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SHOb�lER;TUB TEST ; ; POQ�.ELECTRtC
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EXT. LATHISIDING ;POQL FENCING
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WALL INSULATION ;�OOL�INAL
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CE±UNG I'�SULATlQN ;�iEF SITE�MP�_
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SEVI�EF3 i�ll�iA!�NG.
SEPTICTANK — --Y-------------- ;LAi�GSCA4�E!l�'�RlG.--- ----
SEEP PITtL.L ------ — — 'Ot�SITE IMPS.— —
GAS AIR l�EST �FitvA[_ZONiNG
FlNAL COi�ST. ;F9RE J�'�T. Fit�r`1L
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f=1NA�E�ECTRIC � 'QEV. FEES PAlfl�� -
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FINAL PLU��BiNG s�NEf�GY •
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- --�,�� f s y CITY OF DIAMOND BAR � .
✓� � � DEPARTMENT,,OF COMMU1vITY&DEVELOPMENT SERVICES
a� 21825 Copley Drive,Diamond Bar,CA 91765 •
�`�'�'� � (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 ,� PRESS
���� ` ��'�^', � BUILDING PERMIT APPLICATION FIRMLY
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} JOBSITE . APPLICATION PERMIT p/C ,''r
o ADDRESS a =� � , t t_' - �t , i�.- DATE � A i1 NUMBER �'l`� ,,..�t # .•""���'
o ISSUE a OCC
°r° APN LOT TRACT DATE i� '' �{ �t: " ONST. `t�• " GROUP :� �
� OWNER 3' 'f d �t;ti 6 �
O
" ADDRESS ,'4 -', r,,' '• , .. . , e e r! •. ,'1,, ZONING SETBACKS
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Z CITY : •
� � ^ , ZIP i 't �: TEL. s , FRONT RW ❑
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p� ADDRESS s . s . ".� e ,_ � c, 6: . . �
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w ARCH/ENG/ ._Y''. '�c .. �,�r- �� �� � `u � '
z DESIGNER a'- �1T -�""'" .'�
w NO.DWEL. NO. NO.' �
a ADDRESS
UNITS STORIES BEDROOMS
� CITY � ZIP TEL.
�
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SPR/ADO/REM
O
� p I HEREBY AFFlHM UNDER PENALN OF PERNRV THAT I AM EXEMPT FROM THE CANTRACTORS LI- G8f8QB/CBfPOR � - �
W CENSELAWFOR7HEFOLLOWINGREASON�SEC.7o3t.58USINE55ANDPROFE5510NSCODE:ANVCITVOR (n
. U COUNTyWHICHREOUIRESAPERMITTOCONSTRUC7,ALTER,lA1PROVE.DEMOUSH,ORREFAIRANY57RUC- � � �
w TURE,PRIOR TO ITS ISSUANCE,AL50 REOUIRES 1HE APPLICANT FOR SUCH PERMI7 TO FILE A SIGNED w Patio/Deck .
� � S7ATEMENT hiAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF 7HE CONTRACTORS LI- � .
CENSE UW(CHAVTER B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PR6 Pool/Spa
0 FESSIONSCODEjORTHATHEORSHEISEXEMPT7NEREFROMAND7HEBA5I5FORTHEALIEGEDEXEMP- (�
V TION.ANV VIOLATKKJ OF SECTION 7037.5 BY ANV APPLICAN7 FOR A PERMIT SU&IEC75 TNE APPLICAN7 TO Z Re-Root .
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNORED DOLURS(fSOD).):
0 ❑I,ASOWNEROFTHEPROPERT/,ORMYEMGLOVEESWITHWAGESASTHEIRSOLECAMPENSATION, � COff1ff10fC18I --
. Z WILl00 THE WORN,AND THE STRUCTURE�5 NOT INTENDED OR OFFERED FOR SALE(SEC.7ot�,BUSI- J
N NESS AND PqOFE5510N5 CODE:THE CONTRACTORS LICENSE LAW DOES NOT AVPLV TO AN OWNER OF � , �
PROPERTY WFiO BUILDS OR IMPROVES THEREON,AND NTiO DOES SUCH WORN HIMSELF OR HERSELF OR
Q' THROUGH HIS OR HER ONM EMPLOYEES,PROVIDED 7HAT SUCH IMPROVEMEMS ARE NOT 114rENDED OR m .
w OFFEREDFORSALEIF,HOWEVER7YiEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCAMPLE- '
0 TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVINCa THAT HE OR SHE DI�NOT BUILD OR
Z IMPROVE FOR THE PUPPOSE OF SALE). �
� ❑1,AS ONR7ER OF THE PROPERTV,AM E%CLUSIVELY CONTRAC7ING WI7H LICENSED COMMCTORS
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Q TO CONSTRUCT THE PRQIECT(SEC.70�t,BUSINESS AND 7ROFESSIONS CODE:THE COMMCTORS LI- V8IU8IlOf1 .y �` ADJ.AREA
W� CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND -- .
� WFIOCONfMCT5FOR5UCFiPRQIECTSWITHACOMMCTOR�S�UCENSEDPUHSUANTTOTHECOMRAG pUANTITY ��DESCRIPTION FEE
Y TORS LICENSE LAW.�. � . �
0 ❑I AM E%EMP7 UNDER SEC. - B.8 P.C.FOR THIS REASON�� � Q ' ' _
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DA7E •��OV.TJER F-
Z � .��f:�� . W
� LICENSED CONTRACTORS DECLARATION W
� .�I HEREBY AFFIRM UNDER PENM.TY OF PERJURY THAT I AM UCENSED UNDER PROVISIONS OF CHAPTER � ' ' '
� '"i(COMMENCING�WRHSECTtON7000jOFDNI510N30FTHEBUSINE55ANDPROFESSIONSCODE,AND Z ' � � ' '
'X• 'MY UCENSE IS.M FULL FORCE AND EfFECT. ' m �
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a� WORKERS'COMPENSATION DECLARATION � '
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� N I HEREBY AFFIRM UNDER PENALTY OF PERJURV ONE OF THE FOLLOWING DEClAMT10N5: Z �
Z _I HAVE AND WILL MAIN7AIN A CER7IFICATE OF CANSENT TO SELF-INSUFE FOR WORNERS' _ � . . .
a CAMPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE U
� OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. W �
W i �
� I HAVE AND WILL MAINTAW WORNERS'CAMPENSATION INSURANCE,AS REOUIRED BY SECTION
O 370o OF THE LABOR CODE.FOR THE PERFORMANCE OF THE WORK FOR WHICH TH�S PERMI715 . i.. ��1 .
ISSUED.MY WORNERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION ' - � ` �
J � .
j CARRIER 4"�S:+ , ..� ! PLAN REVIEW �
, Z POLICY NUMBER -`1 i' ^� � � ELECTRIC t
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0 (n+�ssFcrnr+NE�rio78Eoor.�t�ooF7r+EaEw.+rs�oraE�a�moaiuuRiao)oaLEss� PLUMBING
� Z . 1 CERTIFY THAT IN THE PERFO{iMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED.1 MECHANICAL �
C} SHALL NOT EMPLOV ANY PERSON IN ANY MANNER 50 AS TO BECAME SUBJEC7 TO7HE
� �WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME �INSPECTION FEE
� SU&IEC770 THE WORKERS'COMPENSATION VROVISIONS OF SECTION 3700 0F THE UBOR _ ��t� ,
� CODE,1 SHALL FORTHWITH COMPIY WITH TFIOSE PROVISIONS. ISSUANCE"����-�
p DATE: r ��.�I' APPLICANT. C y..., �� .� : ' ��SMIP:-�"q. � � " � ' 'j,•i
W
J WARNING:FAILURE TO SECURE MIORKERS'COMPENSATION CAVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C '
� ' SU&IECT AN EMPLOVER TO CRIMINAL PENALTIES AND GVIL FINES UP TOONE HUNDRED THOUSAND ENERGY.PERMIT " �
� DOLLARS(5700,000),IN ADDITION TO THE COST OF CAMPENSATION,DAMAGES AS PROVIOED FOR IN
¢ SECTION 37oB OF hiE LABOR CODE,INTERE57,AND ATfORNEYS FEES. RETENTION FEE:�"': �� ���
� O- CONSTRUCTION LENDING AGENCY . . PRE-ALT FEE: � �
pC � ..F.J
� I HEREBV AFFIRM UNDER PENALTY OF PERIURY THAT THERE IS ACONS7RUC710N LENDING AGENCY �„!�+
. FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS VERMIT IS ISSUED(SEC.3087,CIV.C.�. � � ,
Z
W
� LENDER'S NAME - .
F— LENDER'SADDRESS
� I CERT�FV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATqN�S CARRECT. TOTAL FE ES � / f
� IAGREETOCOMPLVWITHALLCT'PNDCAUN7VORDINANCESANDSTATEUWSRELATINGTOBUILDING �t{ �� i�. '
�. CANS7RUC710N,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENrER UPON 7HE � ' ,
Z ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. ' COMMENTS '
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m PERMIT7EE NAME(PRINn � .
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p I HEREBV AFFIRM UNDER PENAL7Y OF PERIURY THAT I AM EXEMPT FROM 7HE CONTRACTORS LI- G8fe9B/CefPOR
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Z ❑I,ASOVlNEROFTHEVROPERTY,ORMVEMPLOYEESWI7H]NAGESASTHEIRSOIECOM7ENSATION, � COmf110lCIel -
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OC �1 HEREBY AFFIRM UNDER PENKTV OF PERIURY 7HA71AM LICENSED UN�ER PROVISIONS OF CHAPTER � .
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X MY LICEHSE IS IN NLl FORCE AND EFFECT. m
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� ISSUEO.MY WORKERS'COMPENSATION INSURANCE CARRIEF AND POLICY NUMBER ARE: CONSTRUCTION � ^'� •
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Z I CERTIFV THAT IN THE PERFORMANCE OF THE WOHK FOR WHICH THIS 7ERMIT IS ISSUED,1 MECHANICAL �
(,�} SHALL NOT EMPLOY ANV PERSON IN ANV MANNER 50 AS TO BECAME SUBJECT TO THE '
� WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGPEETHATIFISHOULDBECOME INSPECTIONFEE
? SUBJECT TO THE WORKERS'COMPENSA710N PROVISIONS Of SECTION J7o0 OF THE LABOR � � .
CADE,I SHALL FORTHWITH COMPLY WI7H 7HOSE PROVISIONS. ISSUANCE
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p DATE: ' APPLICANT: ' ' ' .
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DOLURS(5100.000),IN ADDITION TO THE COST OF CAM7ENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION 3708 OF THE LABOR CODE,MTEREST,AND ATTORNEY'S FEES. RETENTION FEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: }
� 1 HEREBY AFFIRM UNDER PENALTY OF PERIURV THAT THERE IS A CONSTRUCTION IENDING AGENCY ' �
FOR THE VERFORMANCE OF THE WORK fOR WHICH 7HI5 PERMIT IS ISSUED(SEC.3097,CIV.C.J.
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? LENDER'S NA1AE
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F- LENDER'SADORE55
W 1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE hUT THE ABOVE MfORMATION IS CORREC2 TOTA L F E ES . ,
� I AGREE 70 COMPLY WI7H ALL CITY AND COUNTY ORDINANCES AND S7A7E UWS REUTING TO BUILDING '
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Check a License or Home Improvement Salesperson (HIS) Registration - Contractors Stat... Page 1 of 2
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C��partrr��r�� c�f ��r�suc��r 1�i�a�r� �"�'�
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Contractor's License Detail - License # 643�00 �
�%f�- DISCLAIMER:A license status check provides information taken from the CSLB iicense database.Before
relying on this information,you should be aware of the following limitations. •
CSLB complaint disclosure is restricted by law(B&P 7124.6). If this entity is subject to public complaint disclosure,a link
for complaint disclosure will appear below.Click on the link or button to obtain complaint and/or.legal action information. ..
Per B&P 7071.17,only construction[elated ciVil judgments reporteii to the CSLB are disclosed.
Arbitrations are not listed unless the contractor fails to comply with the terms of the arbitration. I
_ Due to workload,there may be relevant information that has not yet been entered onto the Board's license database.. I
� License Number: 643700 Extract Date: 01/29/2010 ' •
J M A C INTERNATIONAL INC
. dba MC CORMACK ROOFING&WINDOW CO.
Business Information:
1260 N HANCOCK STE 107 -
ANAHEIM,CA 92807
Business Phone Number. (714)777-4040
Entity: Corporation
Issue Date: 04/30/1992 � ----- --------------------------- --
Reissue Date: 06/22/2000
Expire Date: � ^ 06/30/2010
License Status: This license is current and active.All information below should be reviewed.
CLASS DESCRIPTION
Classifications: C39 ROOFING
B GENERAL BUILDING CONTRACTOR
� CONTRACTOR'S BOND
This license filed Contractor's Bond number 88368 in the amount of$12,500 with the
bonding company
Bonding: AMERICAN CONTRACTORS INDEMNITY COMPANY.
Effective Date: 01/01/2007 .
Contractors Bondinp History
BOND OF QUALIFYING INDIVIDUAL
https://www2.cslb.ca.gov/OnlineServices/CheckLicense/LicenseDetail.asp 1/29/2010
�
Check a License or Home Improvement Salesperson (HIS) Registration - Contractors Stat... Page 2 of 2
A I
� 7. The Responsible Managing Officer(RMO)JAMES KEVIN MC CORMACK certified
� • that he/she owns 10 percent or more of the voting stock/equity of the,�orporation.
A bond of qualifying individuaf is not required. .
Effective Date: 08/29/2002
. . BQI's Bondinq History
. An employee service group holds the workers compensation insurance.
Policy Number: MBS-SIP-00079-09 � �
Workers'Compensation: . Effective Date: 03/10/2009:
Expire Date: 02/28/2010
. Workers'Comoensation History
' ' Miscellaneous .� - .
DATE DESCRIPTION � °
Information:
� 06%22/2000 LICENSE REISSUED TO ANOTHER ENTITY
� Personnel List Salesperson List - , '
" Conditions of Use � Privacy Policv _
. Copyright O 2010 State of�California
https://www2.cslb.ca.gov/OnlineServices/CheckLicense/LicenseDetail.asp 1/29/2010
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, . � Roofzng 8y Window Co. �. �� , ,
• Lic i 643700 . /. . 1260 lp.Haacocl�, Suite 107 .
� • -Anaheim, CA 92807...
� (714) 777-4040 / (949)�347-1400 / 1626j 2541644
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To Whom It Ma Concern: � �`
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This memorandum is confirmation that Lewis Fer�uson is authorized to obtain building
permits and license(s) and ior renewals on behalf of Mc�ormack Roofins Co.
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', Thank you,
state-ca county-orange Date �� ��- �� � �
� personally appeared•Tf��C-� K-- �C�(�1�1RC�-
' whose name is subscribed & acknowedged
I J es . McCormack to me thaf ,1-!�,_.Y,� executed the same in
Pr s� ent authorized capacity & that by H; ssignature
on the instrument
. Seal . Notary Pub(ic
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. , I. S. JAYASW,q�
• � � "* Commisslon # 1618758
_ 2 •r,m Notary Public- Calliomic �
Oronge Counry -
My Ccmm.Exoires Nov a,2009
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: ' www.mc�ormackroofing.cam
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