1620 W. Wilmot Ln.
V ALUA TION: 4,300.00
I OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that' am exempt from the Contractor's :Jcense 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 subjects the applicant to a civil penalty of not more than fjve hundred dollars
($500).
o /, as owner of property, or my employees with wages as their sole compef'sation, 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 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 purpose of sale).
o I, as the owner of the property, am exclusively contracting with licensed coo tractors 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 for such projects with
~ontractor(s) licensed pursuant to the Contractor's License Law).
U I am exempt under Sec. ,8& 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
.~s permit is issued.
'~l 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 Numbec WC0701040200001
BUILDING PERMIT NO. BLD2005-02464
TYPE OF PERMIT CITY
Reroof
DATE: 8/8/2005
JOB ADDRESS: 1620 W WILMOT LN
LEGAL DESCRIPTION: N TR 12884 LOT 6
APPLICANT: YOLANDA HUAPAYA
OWNER INFORMATION:
CLIVE SHAPIRO
1620 W WILMOT LN
ANAHEIM, CA 92802
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 23 squares with 50-year composition shingles
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765- 4626
CENSUS CODE: 555
QUARTER SECTION: 59
ARCHITECT/ENGINEER1NFORMA TION:
;'
PROCESSED BY: JNJ
This section need not be completed if the pennit is for one hundred dollars ($1 00) or less.
o '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 ifl should beco e subject to the worker's compensation
provisions of Section 3700 of the L b Co e, I sh fort i comply with those provisions.
Date: 8/8/2005 Applicant:
WARNING: FAILURE TO SECUR
UNLAWFUL, AND SHALL SUBJE
FINES UP TO ONE HUNDRED 1H S D DOLLARS ($100,000), IN ON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 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 ag~ncyfor the
performance of the work for which this permit is issued (Sec.3097.Civ.C):
Lender's Information:
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 building construction, and
hereby author a rep sentiv s of his city to entar upon the above mentioned property for
in cti pu ses.
Dale: 818/2005
Signature of Applicant 0
shall expire by limitation n beco null and void if the building or
work ol passed final inspection 36 a from the date of permit issuMCe. A
new permit is required to commence or continue work.
LICENSED CONTRACTORS DECLARATION
1 hereby affirm un er penalty of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000) f OJ ion 0 e Business and
Professio e.
8/8/2005
Date:
NUMBER
643700
TYPE
EXPIRATION DATE
6/3012006
C39
ConstrucJon Tvpes:
V N, ,
Fees paid for Permit:
Total:
235.33
.
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainiWaste Pipe)
Electrical Ground Electrode/Ufer
SetbacklFormslTrenches (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 (Compaction/Membrane Rein!.)
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
Roof (Sheathing/Diaphragm/Frame) ~ 7y/-"
Masonry (Reinf./Bond 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 785-5126
Fire Dept. Final 765-4040
Water Engineering 765-5268
Sub list/Business license 765-5194
Zoning 765-5139
Building Final (Last Inspection - Only
After Above Complete)
INSPECTOR
PARTIAL INSPECTIONS
Building Inspections
Mechanical Inspections
Plumbing Inspections
Electrical Inspections