415 N. West St.
TYPE OF PERMIT CITY
Reroof
DATE: 11/212005
JOB ADDRESS: 415 N WEST ST
LEGAL DESCRIPTION: COWAN TR LOT 2 E 148 FT N 75 FT- EX
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714)765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 62
BUILDING PERMIT NO. BLD2005-03505
APPLICANT: YOLANDA HUAPAYA
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
BART ZIEGLER MCCORMACK ROOFING CO
PO BOX F 4091 E LA PALMA AVE #T
DEL MAR, CA 92014 ANAHEIM, CA 928070000
BUSINESS PHONE: 714630-5543
JOB DESCRIPTION:Tear off existing and reroof 25 squares with 30.year composition shingles
VALUATION:
5,600.00
PROCESSED BY: JNJ
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's License 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 licenSl~d 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 five hundred dollars
($500).
o I, as owner of property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended pr offered for
sale (Sec. 7044 Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his Of' her own employees, provided that such Improvements are not intended or
offered for sale. If, however, the building or improvement is sold with one year of completion, the owner-builder will have the burden of proving that he
did not build or improve for the purpose of sale).
o I, as the owner of the property, am exclusively contlacting with licensed contractors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's License Law does not apply to an owner of propertywtlo bunds or improves thereon, and who contracts for such projects with
a contractor(s) licensed pursuant to the Contractor's License Law).
o I am exempt under Sec. , B & P .C. for this reason:
Date: Ownsr:
I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declara.tions:
o I have and will maintain a certificate of consent to self-insure for worker's compensation,
as provided for by Section 3700 of the Labor Code. for the performance of the work for which
B$ permit is issued.
. I have and will maintain worker's compensation insurance, as required by Section 3700 of
Labor Code, for the performance of the work for which this permit is issued, Myworker's
ompensation 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 provisions of chapter 9 (commencing
with Section 7000) f Di ion the Business and
Professio e.
11/212005
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 perfonnance 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 me subject to the worker's compensation
provisions of Section 3700 of th or 0 e, I all f rt with comply with those provisions.
NUMBE
643700
TYPE
pale: 11/212005 Appliea t:
,WARNING: FAILURE TO SEC RE RKER'S COMPENSA
UM':"AWFUL, AND SHALL SUB ECT EMPLOYER TO CRIM PEN LTIES AND CIVIL
FliIIES,UPTO ONE HUNDRED OU AND DOLLARS ($100,000), IN AD ITION TO THE
COST OF COMPENSATION, DA S AS PROVIDED FOR IN S 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 for the
performance of the work for which this permit is issued (Sec.3097 .Civ.C):
Lender's Information:
Construcion Types:
VN, ,
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 buUding construction, and
hereby au orize representVes of this city to enter upon the above mentioned property for
io rpo s.
Dale: 11/212005
Fees paid for Permit:
Total:
244.93
orA nt
ecome null and void if the building or
days from the date of permit issuance. A
ontinue work.
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION
DATE
INSPECTOR
Temporary Power Pole
Plumbing (Drain/Waste Pipe)
Electrical Ground ElectrodelUfer
SetbacklFormslTrenches (Footings)
Do not install subfloor or pour floor slab until the
following applicable items have been signed:
Plumbing (Water PipelSprinkler Valves)
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (CompactionlMembrane Reinf.)
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below until the
following applicable items have been signed:
1st Floor Shear
Firesprinkler (Rough)
2nd Floor Shear
Roof (SheathinglDiaphragmIFrame)
Masonry (Reinf.lBond BeamIPre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele., Mec. And Fire)
,
/
'117:110:5 J A .n,,""v..J
/ I
Insulation (SoundIEnergy)
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 INSPECTOR
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Cross Connection Control (714) 1ll5-4:280
EngineeringlGrading Final 765.5126
Fire Dept. Final 765-4040
Water Engineering 765-5268
Sub List/Business License 765-5194
Zoning 765.5139 /
Building Final (Last Inspection - Only I%i,
After Above Complete) J AIJDW SV-I
,
PARTIAL INSPECTIONS
Build;n!! Inspections
Mechanicallnsoections
Plumb'n!! Insoections
Electricallnsoections