1675 Sumac Ln.
TVPEOFPERMIT CITY
Reroof
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 57
BUILDING PERMIT NO. BL02005-02984
DATE: 9/16/2005
JOB ADDRESS: 1675 W SUMAC LN
LEGAL DESCRIPTION: N TR 2177 LOT 13
CONTRACTOR INFORMATION:
MCCORMACK ROOFING CO
4091 E LA PALMA AVE #T
ANAHEIM, CA 928070000
BUSINESS PHONE: 714630-5543
JOB DESCRIPTION:Tear off existing and reroof 18 squares with 30-year composition shingles and 1 squares of BUR
APPLICANT: YOLANDA HUAPAYA
OWNER INFORMATION:
DANIEL EGO
1675 W SUMAC LN
ANAHEIM, CA 92802
ARCHITECT/ENGINEER INFORMATION:
VALUATION:
2,600.00
PROCESSED BY: JNJ
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt rom the Contractor's Ucense Law for the following reason (Sec. 7031.5 Business 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 applicant for such permit to file a signed statement that he is licensed pursuant to the provisions 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 subj(.cts the applicant to a civil penalty of not more than five hundred dollars
($500).
o I, as owner of property, or my employees with wages as their sole compensation, 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 herself or through his or her own employees, provided that such improvements are not intended or
offered for sale. If, however, the building 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).
D 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\o\rho builds or improves thereon, and who contracts for such projects with
a contractor(s) licensed pursuant to the Contractor's License Law).
o I am exempt under Sec. J B & P.C. for this reason:
Date: Owner:
I WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
o I have and will maintain a certificate of consent to selHnsure for worker's ()ompensation,
as provided for by Section 3700 of the Labor Code, for the performance of the work for which
this permit is issued.
~I have and will maintain worker's compensation insurance, as required by Section 3700 of
the Labor Code, for the performance of the work for which this permit is issued. My worker's
Compensation insurance carrier and policy are:
Carrier: AMERICAN INTERNATIONAL GROUP Policy Number. WC0701040200001
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under provlsi ns of chapter 9 (commencing
with Section 7000) of ivsion of t e siness and
Professions
9/16/2005
Date:
C39
This section need not be completed if the pennit is for one hundred dollars ($100) or less.
o I certify that in the performance of the work for which this permit is issued, I shan not
emptoy any person in any manner so as to become subject to the workers compensation laws
of Califomia, and agree that if I should become subject to the worker's compensation
provisions of Section 3700 of the La or Cod I shaYYorth it amply with those provisions.
Date: 9/16/2005 Applicant: J!.,..
WARNING: FAILURE TO SECUR WO
UNLAWFUL, AND SHALL SUBJE TAN PLOYER TO CRIMINA P NA TIES AND CIVIL
FINES UPTO ONE HUNDRED TH SAN DOLLARS ($100,000), IN DOl ON TO THE
COST OF COMPENSATION, DAMAG S PROVIDED FOR IN SECT 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm und~r penalty of perjury that there is a construction lending agp"ncyfor the
performance ofTtie work for which this permit is issued (Sec. 3097 .Civ.C):
Lender's Information:
NUMBER
643700
TYPE
Construcion Types:
V N, ,
I certify that I have read this application and state that the above information is correct. I
agree to oompJy with all city ordinances and state laws relating to buUding construction, and
herebyauth rize representives of this city to enter upon the above mentioned property for
in .on u po
Dale: 9/16/2005
Fees paid for Permit:
Total:
170.20
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/Uter
SetbacklFormslTrenches (Footings)
Do not install sublloor or pour lIoor slab until the
following applicable items have been signed:
Plumbing (Water Pipe/Sprinkler Valves)
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (Compaction/Membrane Reinf.)
Underpinning (Floor Joist/Girders)
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 " ---
Root (Sheathing/Diaphragm/Frame) l..\ _1.1 ,/L ~
Masonry (Reint.lBond Beam/Pre-Grout) . \ .
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele., 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
Water Service
FINAL INSPECTIONS DATE
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040
Water Engineering 765-5268
Sub ListlBusiness License 765-5194
Zoning 765-5139
Building Final (Last Inspection - Only
After Above Complete)
INSPECTOR
PARTIAL INSPECTIONS
Buildina Inspections
Mechanical Inspections
Plumbing Inspections
Electrical Inspections