1457 W. Westmont Dr.
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 44 squares with Gerard Metal shakes ICBO #1491
VALUATION: 8,600.00
I 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 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 subje~ts 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 comper'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 herself or through his or her own tJmployees, 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). .
o /, as the owner of the property, am exclusively contracting with licensed cchtractors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's License Law does not apply to an owner of propertyw:,o 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. , B & P.C. for this reason:
Date: Owner:
I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of pe~ury one of the following declarations:
o I have and will maintain a certificate of consent to selHnsure for worker's compensation,
as provided for by Section 3700 of the Labor Code, for the performance of the \{ori< for which
this permit is issued.
~ have and will maintain worker's compensation insurance, as required by Section 3700 of
r~ Labor Code, for the performance of the work for which this permit is issued. Myworker's
Compensation insurance carrier and policy are:
Carrier: AMERICAN INTERNATIONAL GROUP Policy Number. WC0701040200001
BUILDING PERMIT NO. BLD2005-03610
TYPE OF PERMIT CITY
Reroof
DA TE: 11/14/2005
JOB ADDRESS: 1457 W WESTMONT DR
LEGAL DESCRIPTION: N TR 5427 LOT 32
APPLICANT: YOLANDA HUAPAYA
OWNER INFORMATION:
HENRY V CRAWFORD
1457 W WESTMONT DR
ANAHEiM, CA 92601
ElM
BUILDiNG DiVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
iNSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 53
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: JNJ
This section need not be completed if the permit is for one hundred dollars ($100) or less.
o I certify that in the perfonnance of the work for which this permit is issued,l 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 become subject to the worker's compensation
provisions of Section 3700 of the a or Co ,I sh J forthwi mply with those provisions.
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000) Divsi n 3 0 t Business and
Profession e.
11/14/2005
Date:
NUMBER
643700
TYPE
EXPIRATION DATE
6/30/2006
C39
Construcion Tvpes:
VN, ,
Date: 11/1412005 Applicant
WARNING: FAILURE TO SECU E W RKER'S COMPENSATION C VE G IS
UNLAWFUL, AND SHALL SUBJ~T A EMPLOYER TO CRIMINAL P N LTIE AND CIVIL
FINES UPTO ONE HUNDRED OUS NO DOLLARS ($100,000), IN AD T1 TO THE
COST OF COMPENSATiON, DA AS PROVIDED FOR IN SECTION 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 Informa.tlon:
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 aut ize represen ive f this city to enter upon the above mentioned property for
in ion $eS.
Date: 11/14/2005
Fees paid for Permit:
Total:
394.57
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporarv Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/Ufer
SetbacklForms/Trenches (Footings)
Do not install subfloor or pour floor slab until the
fallowing applicable items have been signed:
Plumbing (Water Pipe/Sprinkler Valves)
Mechanical (Groundwork)
Electrical (Underllround Conduit)
Pre-slab (CompactionlMembrane Reinf.l
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 I
Roof (Sheathing/Diaphragm/Frame) ri'" VI ~f~
Masonrv (Reinf.lBond Beam/Pre-Groutl
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 INSPECTOR
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Cross Connection Control (714)7854280
Engineering/Grading Final 765.5126
Fire Depl. Final 765-4040
Water Engineering 765-5268
Sub List/Business License 765-5194
Zoning 765-5139 I
Building Final (Last Inspection - Only 1/06~
After Above Complete) .J "oJo.....,;5U-(
I
PARTIAL INSPECTIONS
BUil.din: Ins;;ctions
5/z. ~ J l.Jo,.)Sd.!- ~Ik..-s &1L.
MechanicallnSDections
PlumbimllnSDections
ElectricallnSDections