1531 S. State College Blvd.
BUILDING PERMIT NO. BLD2004-03936
TYPE OF PERMIT
Tenant Improvement (Limited) . CITY
DATE: 11/8/2004
JOB ADDRESS: 1531 S STATE COLLEGE BLVD
LEGAL DESCRIPTION: P BK 56 PG 25 PAR 1
APPLICANT: MARK HILLGREN
OWNER INFORMATION: CONTRACTOR INFORMATION:
Properties l Seawafd
923 N Main St
Orange, CA 92867
JOB DESCRIPTION Handicap modifications to existing restrooms BLOG A
VALUATION: 5,000.00
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REOUESTLlNE:
(714) 765 - 4626
CENSUS.CODE: 437
QUARTER SECTION: 107
ARCHITECT/ENGINEER INFORMATION:
ERNEST STUART
1100 SOUTH COAST HIGHWAY
. LAGUNA BEACH, CA 92651
PROCESSED BY: KBT
OWNER-BUILDER DECLARATION
I herebY a l~m unper'penaltyof perjury that I am exempt from the Contractor:~ .L.icense law for thefol/owlng reason (Sec. 031.5 Business and
Professions Code: any city or county which requires a per/:?it to construct, alter, improve, demoli.sh or repair any structure,.prior to its issuance, also
requires,the applicant .for such permit to file a signed statement that he is lic::n-?eo pursuant- to the provisions of the Contractor.'s license law (Chapter
9)(commencing with Section 7000 of Division 30f the Business and ProfesS:iQr1s-Code) or that he is exempt therefrom and the basis-for the alleged
exemption. Any violation of Section 7031.5 by"any applicC!nt for apermit.subjects the applicant to a dvit penalty of not.more than five hundred dollars
($500). .' . .
o I. ~s owner of property, or my employees with 'wages as their sole comp~nsation, will do the: work, and the ~tructure isJ~t lntend.ed or offered for
sale (Sec. 7044 Business and Professions Code: The Contractor's. Llc.ense_J,aw does not apply to an owner of property who bui~s or improves
. thereon, and who does such work himself or herself or through his or her ov<~_:employees, provided that such lmprovemen~s'are not intended or
offered for-sale. If, however, the building or improvement is sold with one ye:y of completion, the owner-builder will have the burden of proving thafhe
_~tbuildorimproveforthepurposeofsale). .' t'\ . . .' " .
J?::..l~: as the owner ofthe property, am e sivety contracting with licensed !::ontradors to construct the project (Sec.' 7044 Busin8$s and Prof~ssiorn?
Code: -The Contractor's license Law d s no apply to an owner of property who buads or improves. thereon, and who oontracts for such projects with
,aJ(ontractor(s) licensed pursuant tot Contra tor's license law).' .
U I a\l1 ixe. t 1I"'f Sec. " B & .C r ll1is reason:
Oat. \ \ . . . Owner:
WORKER'S C MPENSATIDN DECLARATION . I
I ~ereby affirm under penalty of perjury on~ 'Of the following declarations:
O. I have and' will maintain a certificate of oon~nt try 'self~insure:- for worker':~ compensation,
as provided for by. Sedion 37QO of the labOr Code, for.the performance cfth~ work for whidl
this permit is issued.. "
o I have andwill maintain worker's compensation insurance. as required'b~' Section 3700 of
the LaborCo.de. for the performance of-the work for which this 'permit is iSsUEd. Myworker's
Comp.ensation inSurance earrier and poliCy are.: .
Carrier:' PolicY Number.
This s~tion need not be completed if the pennit is to,r .~J'1e ~unctred dollars ($1 On:,. or less.
fti, ,I certify that in the performance of the work fOr ~hicn'this permit is issued" I Shall not
~Ioy any' person in any manner as become subject to the 'worke'(S,compens'ation laws
of Califomia, and agree that if Is ouldb me subject;to the worker';; comp€,;l~atlon .
provisions.of Section 3700 oft L~tyrCo e, s all !orthWith onmply ~1l1 t?ose provisions.
Date: 11/8/2004 APplicant:)(_ '. .
WARN ING: FAILURE TO SECURE WORKER'S COMPENSATION C\:lVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL RENALTlES ANO CIVIL
FINES UPTO ONE HUNDRED THOU~AND DOLLARS ($100,000), II{ADDiTION TO THE
COST OF COMPEN~ATIPN, QAMAGE~ A~ PROVIOED. FOR IN SECTION.3706 OF TfjE
. LABOR CODE, INTEREST AND ATTORNEY'~ FEES. ., .
CONSTRUCTION LENDING AGENCY
'- hereby affirm under penalty Of perjury-that there is a constructi911_ lendin,g eger\cy for the
performance of the work for which this permit is is"su~d (S~c.309t,Civ.C): . ._r . ,
-L~dfir'slnf"J-rn:!2tiQn: . '. _;_.'''-c __.'''_ 0..::_-
va read this application and state that the above information is correct. I
with 'all city ordinances and state laws relating' to bu i1ding construction, and
representfvesofthis city to enter upon the abo~e mentioned' property for
-----
Date: 11/812004
Signature of Appli'cant or Agent .
The permit shall expire by limitation and become null and void if the bliilding or
work has not passed final inspection 365 days from the date of permit issuance. A
new permit is required to commence or continuework. .
LICENSED CONTRACTORS DECLARATION. I
~ I hereby affirm under penalty of perjury that I am
licensed under provisions 0'( chapter 9 (commencing
with Section 7000) of Oivsion 3 of the BUSiness' and
Professions Code. '
11/8/2004
Date:
Contractor
NUMBER
TYPE
EXPIRATION DATE
Con'strucion l"Voes:
VN" .
Occupancy Groups:
S2" "
Fire $prinklered"!
YES
.
--.--- - ."-----~.'-----........-._".-'
Fees paid for p'ermit:
Total:
. 381.811
INSPECTION RECORD
'. . . DATE. . INSPECTOR
. INspeCTION
Temporary Power Pole , . . .
Plumbing (Drain /Waste Pipe) .
Electrical Ground Electrode/Ufer
SetbacklFormsfTrenche$ (Footings) . .
Do not install subflqor or pour floor slab until the
following applicable items have been signed: .
Plumbing (Water Pipe.Sprinkler Valves) .' ..
Mechanical (GrouildWork)
Electrical (Underground Conduit) . .
~-slab (Compaction/Membrane.Keinf.
Underpinning (Floor Joist/Girdeni) .
. lJ() not cover or conceal the wo"cbelow ul)til the
. following aPRlic"ble items have been signed: . .
1st Floor Shear.
FireSprinklllr (Rollgh) . .
2nd Floor Shear .'
RoOf (Sheathing/Diaphragm/Frame)
Masonry (ReinfJaond BeaniJPre-Gl'Cl\It) .
Rough Plumbing (Top Out) . .
ROllgh Mechanical. .
. Hough E1ec:tricallDI'Y Wall}
Rough Elecirical
Framing . (Only aher Plbg. -Elec.. Meetl" and FIre)
Insulation (~ndlEnergy) .
Do not tape or plaster until tn<> 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 Coal)
T -Bar Electrical
T'Bar Mechanical .' :. ..
T -BarStru.:tural '. . . .
Sewer .
Water Engineering eackflow. . .'
Water Service- .
'.
FINALlNSPECTIONS. . Date . '. Inspector'
Electrical Final '. .
Plumbing Final
Mechanical Final .' .
Gas Test '.
.
Engineering/Grading Final 765-5126 .
Fire Dept Final 7654040
Water Engineering 765-5268 . .
Sub List/Business License 7ti5-S19 .
Zoning 765-513.9
Building Final .~ai'l inspection- Only' . . .
fier Abov~ Complete)
PARTIAL I.NSPECTIONS
Buildina Inspections
'. .
. .
Mechanicallnspections . .
'Plumbina Inspections
'Electrical.'nsDections
Pt.RMIT EXPIRED
INSPECTION
NOT COMPLETED
DATE: \ \ \\'\~