1360-1380 S. Vernon St.
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8UllD:~G PERMIT NO. 8l[)2003'01915A~;c;gf~l:;~\ '. .
:TYPE OF PEP~ . '~,I./ .tgk.'H ElM
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LEGAL DESCRIPTION' SEC 23 T 4 R 10 POR SE1i4 NE1/4 AS
BUILDING DIVISiON
200 S.ANAHEIM BLVD.
(714) 765.5153
INSPECTION REQl)EST LINE:
(714) 765 . 4626
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. CENSUS CODE: ". 437
QUARTER SECTION: 106
APPLICANT: MIKE LINDSTROM .f
OWNER INFORMATION: CONT'RACTOR INFORivlclnON:
Market C YoVngs . SCHOLTEN ROOFING $<JRVICE
2164 N Batavia 5t 23401 MADERO #C I.
Orange. CA '92865 MISSION VIEJO, 92691 OOO~ GA
JOB DESCRIPTIONr and r BUR '\
VALUATION: 120,000.00 1.:' PROCESSED BY: GAQ
I. . '. . .' '. i . OWNER-BUllDERRECLARATION .. .... '_.J
I hereby affirm under penalty of perjury that Lam :ex<9rnpt,fmrntt1e c.ontrac~Q('~{ tic~nse Law for the following reason (Sec. 7031.5 BuSIness and.
Professions Code: any city or county which requires a ,perrtl~ 'to construct. alt;&:r. i!nprove, demoll,sh or repair any struc.ture, prior to it.c; issuance, also
requires.the applicant-for such permit to file a signed statement that he;s Jical.:;e,1 pursuant to the provisloFlsof tt"leContractor's license Law (Chapter
9)~co~m~1icjng with Section 7000 of Division 3 of the' 8usiness~nd Profess~hr Code) or th::l:t he is :ex,ompttherefrom and the b.~s,is for theallegsd
exemption., Anyvialatian af Section 7031.5 by any,applicant fer a ~errr.it subi~'1";~~: t:~e app1bant tO.1 dv'~ per.o.lty of not more than five hundred dollars
(S500}"" '.' '. . ' ". "'. ' '\ ...p ,:1\,<., " .
o . I, ~s owner of property. or"my emploxe.e~ V/I!h wages as theit Sole com~;,~,~ation; will do the work, ::md. the structure ,is not lntended'Jr ~ffer~d fQr
, sale (Sec. 7044 Business8!"ld Profess,ions Code;,. The Contractor's.UcenGEf:..:.h:/dces n~t3i'ply to an owner of prop~rtl.'Nho builds or imp(0VeS "
thereon, and who does such work hi~elfor herse'_~ or through his e>r her c''';rjp::nplOy~e.s; pro~'lded th2t such im::l;'Q.....ements are not in ter'ded or '
offefea for sale. If, however, the ~i!dlng or improvement is sold with one 'j~r->of oomplC:.:ti(lq, thp owner~bui/der w.!l h~ve iha burden of prov!n!;) _that he
did not build or improve for the purpose ofS3le)., _ ,
o !, -as the owner'~fthe property, am ex.q~_$ive~cn)"ltfficting withli::::er.sec: ;i;1lract.o:-s to 'construct the project (S'ec. 7044 Business and Proresslo(1s'
Coda: -The Ccntractor'$ ' License LaiY do~s.'hot apply'to an owner 01 property .~'> !)u~d$ or improv~s thereon, ::>nd who contracts for such_proj~ts with
a contracto.(.s) licensed pursuant bthe Contractor's Ucen~ taw).
o -f ~m exempt u'nder Sec. ,.. _ ,B & P .C. fqr lhis reason:
'D<3te: . Owner:
r~" WO'RKER'S COMPENSATION DECLAFlATION(
Ih~ret\y aftlrm under penalty of perjury one of th~ following declarations: ~
o ,I hove Clr.d will maintain a certificate of consent to seif-insure forworker';}~~cmp~ns;3tion,
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. as provided for CJy Section 3700 of th~ Labor Code, for the perform;:mee cfthe~~'{O(k forwhid"l
~hlS ermit is'issued. , '. . i
I h3ve and wlll maintainworker~s compensa. tion inswance, a:s requ;red'i:f{!.:;;ec~icn 3700 of
the abor Code, for the performance ot the work, for which this permit is !ssue';~ l'','!ywQrker's '_
Compensation I"surance carlier and pohb)"are: l' . I
Carriel: STATE FUND , PcHcy Number. O.:!.6-?t~:i'f:0005~.ag
This section need not be completed if the pennit is for one hundred dollars ($100) O( ;ess. I
o I certify that In the performance of the work.forwhlch this permt is iS~U~(J~ I Shol! not
employ any person ~n any manner so as to become subject to the wo I r:'s CO"':JErisation la'.vs
of Califomia. and agree that if I should become subject to the work 's ..::omP:'Er:sat;on .
provisions of Section 3700 of the Labor Code, I shall forth~/ h co ply Ith tr.u~,~ preVISIons. Construcion Tvpes'
< '. ::J'VN, ,
Date: 5/19/2003 . Applicant: ,FIre Spnnklered?
WARNING: FAILURE TO SECURE ORK' '5 COMPEN ATION COVEBAGE '15
UNI.AWFIJL, AND SHALl, SUBJECT (\N e:I.>1PkOYER_'tQ CRIM1NAL.Pf:.!;Jj,L'.JF~_.e..c;Q,f.IVJL, ' ," ,_. ,
FIN. E. S' UP'TO ONE HUNDRED TIiOUSANO DOL.L ARS ($100,000.. )',iN ,A.D.'.'.)I,.,. lO.N '''0 THE. 'j
COST Of COMPENSATION, DAMAGES AS P.ROVIDED FOR IN SECTION "'lOB OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. . '. . :. J . .
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1,.;Ji' CONSTRUCTION LENDiNG AGENCY-,:',: ';: '---:-~,"
'hereby affirm under penaltY of perjury that there is a-construction lending agE.ncy for the
. performance. of the work for whicttthfs permitis issued (Sec.3097 .Civ.C):
Lender's Information:' .
ARCHITECT/ENGINEER INFORMATION:
I."
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LICENSED CONTRACTCRS t>ECLARATIO~~
I h'ereby affirm under pendlty of pe,rjll ;thatl am
. licensed under provisions of ctlapter 9( mmenqing
. i.".vith Section 7000) c1' Divsiori 3 c the Jsiness and
? ro fess!on~ ~e.
5/19/2003
Date:
COiltrac1or'
NUMBER
389884
TYPE
TYPE
EXPIRATION DATE
513112004
B
HIC
NO
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I certify'.tr,at 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 com:truction, and
hereby authorize representive of' en upon the above mentioned property for
inspection pur -
Fees paid for Permit:
Total:
1,131.08
Date: 5/1 9/2003
Signatur
The. per it shall expire Ij 'mila Ion and become null and void if the building or
work has. not passed tinal insp 5 days from the date of permit issuaoce, A
new permit is required to. commence or continue WOrk.
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- INSPECTIt:>N RECORD
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, " INspeCTION :' DATE INspeCTOR
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Electrical-Ground Electrode/lifer
SetbacklFormslTrenches (Footings)
Do not install subfloor or pour floor slab until the
following applicable items have been signed:
Plumbing (Wl!ler Pipe.Sprinkler. Valves)
Mechanical (Groundwork) , ' ,
Electrical (Undergrol!l'ld Coilduil) ,
, ,Pre-slab (Compaction/Membrane.Keinf.
Underpinning (Floor JoilltlGirders) "
Do_not tover or conceal the work Del,ow until the
following applicable items have been signed: ' ' ,
1 st Floor Shear ' ' ,
f'jresPrinkler (Rough)
2nd Floor Shear " , " 1// ,
Roof IShealhlngiOiaphragrn'Frame) II ~/- ~.
Masonry (ReinfJBoild BeamfPre.Grout)
Rough Plumbing (Top Out) ,
Rough Mechanical , ,
i Rough f1ectriCal (ory wall)
Rough Electrical
FramIng (Only after Plbg., Elec., Mem.. and Fire) , ,
Insulation (SoundlEnergy) : ,
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 J ' '
T-Bar Mechanical ' 1'1'- Ill') if/IA /17-
T -Bar Stl'lJctural ,
Sewer , -
Water Engineering Backflow
Waler Service
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FINAL INSPECTIONS
Electrical Final
Pluntbing Final
Mechanical Final
Ga$ 1'es,t
Engineering/Grading Final 765.0126
Fire Dept. Final 165-4040
Water Engineering 765-5268
Sub List/Business License 165-519
Zoning 165-5139
Building Final (Last Inspection. Only
_ _ - Alter Above Complete)
Inspector.
Date
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MechanicallnSDections
Plumbina InsDections
ElectricallnSDections