6923 E. Shorecrest Dr.
TYPE OF PERMIT CITY
Reroof
DATE: 11/2/2005
JOB ADDRESS: 6923 E SHORECREST DR
LEGAL DESCRIPTION: N TR 8514 LOT 36
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 217
BUILDING PERMIT NO. BLD2005-03509
CONTRACTOR INFORMATION:
MCCORMACK ROOFING CO
4091 E LA PALMA AVE #T
ANAHEIM, CA 928070000
BUSINESS PHONE: 714630-5543
JOB OESCRIPTION:Tear off existing and reroof 19 squares with Gerard Metal Shakes leBO ESR1491
APPLICANT: YOLANDA HUAPAYA
OWNER INFORMATION:
MINORU YOSHIOKA
6923 E SHORECREST DR
ANAHEIM, CA 92807
ARCHITECT/ENGINEER INFORMATION:
VALUATION:
5.400.00
PROCESSED BY: JNJ
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 am exempt rom the Contractor's License Law for the following reason (Sec. 70 1.5 usiness and
Professions Code: any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also
requires the appficant for such permit to file a signed statement that he is licensed pursuant to the provlsions of the Contractor's License Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged
exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars
($500).
D I, as owner of property, or my employees with wages as their sole compe:isa.tion, will do the work, and the structure is not intended or offered for
sale {Sec. 7044 Business and Professions Code: The Contractor's License laW dOes not apply to an owner of property who builds or improves
thereon, and who does such work himself or helSelf or through his or her own employees, provided that such improvements are not intended or
offered for sale. If, however, the bulJding or improvement is sold with one year: of completion, the owner-builder will have the burden of proving that he
did not build or improve for the pUlpose of sale).
o I, as the owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts tor such projects with
a contractor(s) licensed pursuant to the Contractor's License Law). '
o 'am exempt under Sec. . B & P.C. for this reason:
Date: OWner:
I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
o I have and will maintain a certificate of consent to self-insure for worker's compensation,
as provided for by Section 3700 of the Labor Code, for the performance of the work for which
I" permit is issued.
I have and will maintain worker's compensation insurance, as mquired by Section 3700 of
t Labor Code, for the performance 01 the work tor which this permit is issued. Myworker's
Compensation insurance carrier and polir:;y are:
Carrier: AMERICAN INTERNATIONAL GROUP Pofrcy Number. WC0701040200001
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penatty of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000) f Divsion 3 of e Business and
Profession e.
11/2/2005
Date:
This section need not be completed if the pennit is for one hundred dollars ($1 00) or less.
o I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the worker's compensation laws
of Califomia, and agree that if I should b ome subject t the worker's compensation
provisions of Section 3700 of the r e, all 0 with comply with those provisions.
NUMBER
643700
TYPE
EXPIRATION DATE
6130/2006
C39
Date: 11/2/2005 Appllca :
WARNING: FAILURE TO SEC REW
UNLAWFUL, AND SHALL SUBJ~CT A EMPLOYER TO CRI I AL P NALTIES AND CIVIL
FINES UP TO ONE HUNDRED """OUS ND DOLLARS ($100,00 ), IN DDITION TO THE
COST OF COMPENSATION, DAM AS PROVIDED FOR IN CT ON 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency 10r the
performance of the work for which this permit is issued (Sec.3097.Civ.C):
Lender's Information:
Construcion Types:
V N, ,
I certify that I have read this application and state that the above information is correct. I
agree to comply with all city ordinances and state laws relating to bu ilding construction, and
hereby horize represe rves of this city to enter upon the above mentioned property for
"n cti rp s.
Date: 11/2/2005
Fees paid for Permit:
Total:
170.24
ent
d become null and void if the building or
days from the date of permit issuance. A
continue work.
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (Drain/Waste Pipe)
'Electrical Ground Electrode/Ufer
ISetbacklFormslTrenches /Footinas)
I Do not install subfloor or pour floor slab until the
I following applicable items have been signed:
IPlumbing (Water Pipe/Sorinkler Valvesl
Mechanical (Groundwork)
IElectrical (Underground Conduitl
'Pre-slab (Compaction/Membrane Reinf.)
Underpinning (Floor JoistlGirders)
Do not cover or conceal the work below until the
following applicable items have been signed:
1 st Floor Shear
Firesprinkler (Rough)
2nd Floor Shear II
Roof (Sheathing/Diaphragm/Frame) izM I~-; .I A.\J ..w"5l,L I
Masonrv (Reinf./Bond Beam/Pre-Grout) III
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Efe., Mec. And Fire)
Insulation (Sound/Energy)
Do not tape or plaster until the following applicable
items have been signed:
Drywall
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing
Interior Lath
Exterior Lath
GENERAL ITEMS
Exterior Plaster (Brown Coat)
T -Bar Electrical
T -Bar Mechanical
T-Bar Structural
Sewer
Water Engineering Backflow
IWater Service
FINAL INSPECTIONS DATE INSPECTOR
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Cross Connection Control (714)765-4280
Engineering/Grading Final 76S-5126
Fire Dept. Final 765-4040
Water Engineering 765-5268
Sub ListlBusiness License 765-5194
Zoning 765-5139 I
Building Final (Last Inspection - Only '~is
After Above Complete) -Jf..J.lcW<,) tt-l
I
PARTIAL INSPECTIONS
Buildin!! Inspections
Mechanical Inspections
PlumbinCl Inspections
Electrical Inspections