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Home My WebLink About495 OGLE ST - Building Permits(714) 754-5273 • Fax (714) 7543856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA. CA 92626 BUILDING PERMIT JobAddress: 495 OGLEST Suite: Viciniry: Primary Occ: R-3 Dwellings/ Cong Res <10 Type o( ConsWclion: V-N Parcel Number: 42515212 Zoning: Applicant: DRAKE ANTHONY DUESLER Address: 14291 CLARISSA LANE SANTA ANA,CA Owner: ROHRER, JOHN AND JULIE Address 495 OGLE ST � COSTA MESA, CA, " Contractor: DRAKE ANTHONY DUESLER Address: 14291 CLARISSA LANE SANTA ANA, CA Zip: 92705 Arch : Address: � Phone: License: Phone: 714-350-7905 Zip: 92705 Phone: 949-5158589 Zip: 92627 Phone: 714-350-7905 License: 473546 Eng: -� � . Address:� Status: ISSUED Applied: 04/25/2005 Issued: O6/23/2005 ISSUED BY: IY/VJ Phone: License: i SCOPE OF PERMIT ADD 474 S.F. TO EXISTING S.F.D. WORK TO INCLUDE: CREATE NEW 66SF�ENTRY WAY, ADD A LAUNDRY ROOM, BEDROOM, AND NEW BATHROOM. CONVERT EXISTING 3 BEDROOM, 2 BATH S.F.D. TO A 4 BEDROOM, 3 BATH S.F.D. PLANNING: LOT SIZE = 6,090 SQ. Ff. � RESIDENCE & GARAGE = 2,519 SQ. FT. ' DRIVEWAY = 360 S�..FT. ' LOl' COVERAGE = 2,879 SQ. FT. (47%) OPEN-SPACE = 3,211 S�: FT. (53°/a) � • '- ' . EXISTING REAR YARD COVERAGE = 32% (378 SQ.FT:/A,200 SQ.FT.) ... ,_, FEE SUMMARY Plan Check: $385.94 Permit:��, �$593.75- � SMIP Res:� � - .$4.49 . � SMIP Com: �� $0.00 : . �. Other: '$0.00� , ' Inspection: $0:001 Total: $984.18 Calc Valuation: Claim Yaluation: $44,861.52 so.00 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Califomia st� and related regulations. (Ord. No. 92-28, § 1, 1241-92) EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 1 BO days, or if work is s pended or abandoned for a period of 1 BO days. I INSPECTIONS: In order lor the work authorized under this permit to be considered legal, such work must comply all applicable codes, and all '�, required Inspections and final approval must be obtained. FaiWre to obtain inspections and final approval will result in the explration ot this permi�. FOR INSPECTIONS CALL: (714) 754-5626 24W46 (f✓W) WORKERS'COMPENSAnON DECLARAnON: I here6y atlirm under penelty oi perjury one of the following tleclarations: ❑ I heve entl wlll malnteln e certificate oF consent to self-Insure tor warkers' compensetlon, as provided for by saction 3700 of the Lebor Code, for t�e pertormence of ihe work tor which this permlt is issued. ❑ I have enA will meintain workers' compansation inswance, as required by sectlon 3700 ot the Lebor Cotle, lor Ne pedortnance ot the work for which this permit Is issued. My workers' compensatlon Insurance cerner end poliry number are: Cerner: Palicy Number. (This sec(ion need not be comp/efed il fhe permif is valued et one hundred dollars (5100) or Ieu.J r rtity thet in Ihe peAortnance ot ihe work for which ihis pertnit Is issued, I shall not employ any person in any manner so as to become subJect lo Ihe workers wmpenselion laws of C'fomia, entl agree ihat Ii I should hecom i �ec1 to Ihe workers' compensation provisions of Section 3700 of Ihe Lebor Code, I shall fonhwith comDy with ihese Provi � ns. J� Appl�c9fiL Igne . ! �;;�� /� WAFMI : FAI� �T�LU1R�� E WORKE ' EI A M COVEi7q I FUL AND SHALL SUBJECT AN EMPLOYER TO CRIMIWIL PENALTIES AND CNIL FlNES UP TO IXJE MUNDRED T110U5ANDDOLLARE�5100,00 ,INADDrtiONTOTHECOSrOFCOMPENSATION,0AMn0E5ASPROVIDEDFORINSECTION3lOfiOFTHEUBORCODE,INfEREST,ANDATTORNEY'SFEES. LICENSED CONTRACTORS DECIARAiION: I her�_aflign. t I em Iicensed under provisions at Chapter 9(com�{encing wit� Section 7000) of Division 3 of tlh�8usiness and Pmtessions Cade, entl my license Is in full fo e7ane" �� c. Uc. a �� 4 L I 1 [Gas's'd� �� 7��y S . . - �u : i , m � . ��.�� D� � U .. . � ��e CONSTRUCTION LENDING AGENCY: ❑ I here6y aHirtn thellhere Is e construc�ion lending agency for the performance of ihe work for which this permii is issueC. (Sec. 3097, Clvil Code). Lendefs Nema: Lendefs Address: � Signetura: _ Date: OWNER•BUILDER DECLARATIONS: I hereby aXirtn ihet under penalry of perjury [hat I am EXEMPT FHOM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Busineu end Professions Code: My dry or counry which requires e pertnit to construcl, alter, imprave, demolis�, ar repeir any strudure, D�a� �o its issuance, fllso requires Ihe epplicant for such pertnit to fle e signetl sletemeN thet he or she I5 licensed pursuant to Ihe provisians ot Ihe Contrectors License Law (Chapter B(commendng with Sectbn 7000) of DlWsion 3 of Me Business entl Professiore Cotla) or that he or she is e:empt ihereirwn antl the besls for �he alleged exemplion. My vidation oi Sectlon 7037.5 by eny epplicant far e permfl subjects the epplicent to e civil penelry o1 not more ihan Ma hundred tlollars ($500).): ❑ I, es owner ot the praparry, or my employees with wages as their sole compensetion, WILL DO THE WORK, and the structure is not intentletl or ottered for sele (Sec. 7044, Business entl Professions Code: The Comractors License Lew tloes not apply to an owner of properry who builds or improves thereon, antl w�o tloes such work himsetl or �ereelt or t�rough his or her own employees, pravided that such Improvements ere not intended or oXered tor sale. II, however, ihe 6ulltling or Imprwement is sold within ana year of completion, ihe owner-builder will heve the burden of pmving Ihat he or she ditl not �uild or impmve for purpose of saie.). � ❑ I, as owner of the pmperry, am EXCLUSIVELY COMAACTING WRH LICENSED CON7RACTORS to construct the project (Sec. 7044, Business entl Pmfessions Code: The contrecrors Llcense Lew does not eppty to en owner ol property who builds or Improves Ihereon, and who comracts for such prolect with e comractor(s) license pursuant to the Coniractors License Laws.). ❑ I em exempt untler sec. Business and Prolessions CaOe for Ihis reason: Signature: Date: Owner ID vantied by drivefs licensa. ❑ Yes ❑ No Drivets License No. Expires: Verification oi Ownership by (type at tlocument, i.e. - property tex blll or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certiy ihat no axcavation five (5) or more feet in depih Into which e person is requlred Io descend, will be made In wnnectlon with work euthorized by this pertnit, end Ihel no buildinq sirudure, scaftoldinq, falsework, or tlemolition or tlismantling ihereoi, will be more Ihen �hirry-sia (38) faet high. (Chep. 3.2, Grp 2, Atl 2, Sec. 341, Title e, Celltomia Atlministrative Cade). ❑ As owner-builder, I will no� employ anyone to do work which would require a permit trom the Division of Intlustrial Satery, es notetl ebove, unless such person has e pertnit ta do such work irom the tlivision. Signature: Date: Division of Industnal Safety Permit Number CERTIFlCATE OF COMPLIANCE AND AUiHORVJ1T10N OF ENT{iV: I certiry under penalry of perjury Mat I heve read Ihis applicetion end state that the Informatlon given is correct. I agree to comply with ell state laws entl ciry ordinences relating to building constructlon, end authodze representatives of the Ciry o1 Coste Mese ro enter upon the ebove-0escribed property for Inspection purposes. I agree not lo occuDY or allow occupency of eny building authonzed by this permit until finel inspection. GODE �. 1618 1268 200 201 202 20.3 204 Fizetl System Final Fire Prevention Pool Spa Final Finel ReRooi Flnal Block/Retaining wall Finel Fectory Fire Place Flnel Slpn Flnel Demolltlon a�TE li�e�s COOE� INSPECTIONTYPE 206 Final Mechaniwl 20B Final Plumbing 210 Finel Eleclrical 212 220 Final Fire Preventlon Finel Planninp Approval � J eelE li�e�s 222 Final Site ,()!�� 250 Final Buildinp/Occupancy Z�� 1J `� (714) 754-5273 • Fau (714) 754-4856 • www.cl,costa-mesa.ca.us 77 FAIR DFIVE, COSTA MESA. CA 92626 ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber; Applitant: Address: Owner: AddreBs ConVactor. Address: 495 OGLE ST 42515212 DRAKE ANTHONY DUESLER 14291 CLARISSA LANE SANTA ANA, CA ROHRER, :IOHN AND JULIE 495 OGLE ST COSTA�MESA, CA ,� DR.4KE ANTHONY DUESLER. 74291 CLARISSA LANE SANTA ANA, CA Phone: 714-350-7905 Zip 92705 Phone: 949-515-8589 Zip: 92627 Phone: 774350-7905 Zip: 92705 License:473546 ISSUED BY: Status: ISSUED Applied: O6/23/2005 Issued: O6/23/2005 ' SCOPE OF PERMIT ELECTRICAL PERMIT FOR AN ADDITION OF 474 S.F. TO EXISTING S.F.D. WORK TO INCLUDE: CREATE NEW 66SF ENTRY WAY, ADD A LAUNDRY ROOM, BEDROOM, AND NEW BATHROOM. CONVERT EXISTING 3 BEDROOM, 2 BATH S.F.D. TO A 4 BEDROOM, 3 BATH S.F.D. REP #BOS-00667 , . WORK TO INCLUDE: 10 LIGHTING GIXTS, 30 RECEPT OUTLETS AND 20 SWITCHES. ISSUE FEE Temp service test , Res. a/c package New Res (14 units) New Res (3+units) . � � Pool / Spa Lighting Fixts � - �`� Recept Outlets Switches �� Non Res Appl Res Appl Service to 200a Service to 1000a Service over t000a Motars to thp Motars to 10hp Motors to SOhp $23.50 $0.00 $0.00 $0.00 ' � $0.00 $0.00 $11.00 $29:30 ' � �: $22.00� $0.00 � �$0.00 � $0.00 $0.00 so.00 $0.00 $0.00 $0.00 Quantity 0 p '0 �10 30 20 0 0 0 0 0 0 0 0 FEE SUMMARY �.. Temp Dist System / Lighting � - � Busway /100 ft Standing Section � ' ' � Misc Electrical Equipment � Transformers up to 1 kva/kw . . ................up to 10 kva/k�v ' �. , .....�.:..........up to 50 kvalkw � .....:...........up to 100 kva/kw ..................over 100 kva/kw . Low Voltage Equipment Low VOIt Wiring System / Ckt Misa Conduit � Misc: Conductor Circus ( gen or ride) � Cimus (mech nde or lights) Chnstmas Tree Stand Fireworks Stand Quantity $0.00 0 $0.00 0 $0.00' 0 $0.00 0 $0.00 .' 0 $0.00 "��0 , $0.00 0 $0.00- � 0 � 30.00 . o so.00 0 so.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Califomia statutes and related regula�ions. (Ord. No. 92-28. § 1, 12-21-92) EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 180 days, or iF work is suspended or abando�ed for a period of 180 days. % INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable�coHes, and all requlred Inapectl4ne and tinal approval must be obtalned. Failure to obtain inspections and final approval will result in the expiratior o�his permlt. FOR INSPECTIONS CALL: (714) 7545626 zaae-ae 1��1 WOHKERS'COMPENSATON DECLANATON: I hereby eMirm undar penalry oi per�ury o�e of the tollowing decleretions: ❑ I heve end will maintaln e certificate of consent to sell-Insure tor workers' compensation, as provided tor by sedlon 3700 of the Labor Code, tor Ihe pertortnance oi ihe work for w�lch Ihis pertnit is luuetl. ❑ I have arW wlll maintain workers' compensation insurance, as requiretl by section 3700 of the Labor CoOe, tor the pertortnance of the work for which Ihis pertnit is issuetl. My workers' compensatlon Insuran�a carner and policy number ere: Certier: (This si one Policy Number: or less.) '�,,;o I�cartlfy Ihat in the peAortnance oi the work for which Ihis permi s issued, 1 shall not employ any person in eny menner so es to become sub�ect to the workers' d%�oompensation lews at Califomle, end a ree 1 et If 1 should b � suD�ect ro Ihe workers' campenseUon provisions ot Sectlon 3700 oi the Lebor Catle, I shall lorthwit� comply with these QroN io $� �` _ �� Pet�'f,.-+� �j J WAANINO: FAILURE TO E ORKERS' COMPENSATION ERAGE IS UNIAWFUL AND SHALL SUBIECT AN EM YRU ER�TOGPIAYNqpPENALTIES AND CML FlNES UP TO ONE HUNDRED Tl10USAND D01iARE (51� ), IN ADDRION TOTHE WST OF COAAPENSATION, �AMAGES AS PRWIDED FOR IN SECTION 31W OF THE LABOR CODE, IMEREST. AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARAnON: I hereby attirm Ihat I_a�ensed untler provislons of ChaO�er 8 CONSTAUCTION LENDING AGENCV: Sectlon 7000) ol Divislan 3 ot end my license is in tull ❑ I hereby alTirm ihat there is a cons��+Mion lending egency for the pertortnance of the work for which this permit is issued. (Sac. 3097, Civil Code). Lendefs Name: Lenders AAtlress: Signelure: OWNER•BUILDER DECLARATIONS: Dete: I hereby ettirtn that untler Denalry of perjury thet 1 am E%EMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Buslness and Professions Code: Any ciry or county which requires e pertnit lo canstruct, alter, improve, demolish, or repair any sirucWre, pnor to its issuance, also requires Ihe applicant for such pertnil to lile a slgned statemem thet he ar she is Ilcensed pursuant ro Ne provlslons oi ihe Contrectore llcense Law (Chapter 9(commenGng wit� Section 7000) af DiWslon 3 ot ihe Business end Professions Code) or Ihat he or she is e:empt Iherefram and the basis for the alleged exemption. My vidatian ot SecUon 7037.5 by eny applicant for e pertnit subjacis ihe applicent to e civil penalry o� not more ihan frve hunOretl Oollars ($500).j: ' ❑ I, es owner of the propery, or my 8mployees with weges es thelr sole compensatlon, WILL DO 7HE WORK, antl the structure Is not intenAeA or ottered lor sale (Sec. 70d4, Business and Pmlessions Cade: The Contractors License Law tloes not apply to en owner ot properry who builds or improves Ihereon, antl who does such work himself or herself or through his or her own employees, provitled that such improvements ere not intended or otfaretl lor sele. II, however, ihe builtlinq or imprwement Is soltl within one year of complelion, the owner-builder wlll heve the burden of proving ihat he or she did not build or improve for purpose of sale.). � ❑ I, as owner ol the praparty. em E%CLUSIVELV CONTRACTNG WITH UCENSED CONTRACTORS to canstruct the projeCt (Sec. 7044, BuSiness end Profession5 Code: The contractars License Lew does not epply ta en awner ol properry who bullds or Improves thereon, end who con�rects lor such project with e comracbr(s) licen5e pursuant to Ihe ConlreclorS �icense LewS.). ❑ I am esempt under sec. Business and Professions Code for Ihis reason: Signature: Date: Owner ID veritied by tlnvefs license. ❑ Yes ❑ No Drivefs License No. Venlicatlon ot Ownership by (rypa at tloc�ment, i.e. - pmperry taa bill or tleetl): Expires: DIVISION OF INDUSTRIAL SAFETV PEAMR CERTIFICATION: ❑ I hereby certity ihet na excavetion five (5) or mora teet In dapth Into which a person Is requirad to descenQ will ba mede in connection with work authonzetl by this permit, and that no building struct��e, scattolding, telsework, or demolition or tlismantling thereof, will he more then Ihirty-six (36) feet high. (Chep. 32, Grp 2, A� 2, Sec. 341, Title B, Califomia Atlministreti�e Code). ❑ As ownerbuilder, I will not employ enyone to tlo work which would require e permit irom Ihe Division of Industnel Sefety, es noted above, unless such person has e pertnit to do such work Irom Ihe di�s�on. Signature: Date: Division ot Industrial SaFery Pertnil Number. CEHTIFlCATE OF COMPLIANCE AND A�MORVATON OF EMAV: I certity under penelry ol perjury that I have read this epplication antl state that �he Infortnatlon given is correct. I egree to comply with ell stete laws and city ordinences relating to building constructlon, antl euthorize representetives of Ihe Ciry of Goste Mesa to enter upon Ihe eDove-described property for inspec�ion purposes. I agrae nol lo occypy or allow occupancy oi eny building authorized by this permil until final inspection. COOE 1, pISPECTIONTtPE 1616 FixeC Sysiem Final Fire Preven�ion 7266 Pool Spa Finel 200 Final Re-Roof 20/ FIneI BIocWReteining Well 202 Final Factory fire Plate 203 Final Sign 204 Finel Demolltion 1jejE � �QQf,a INSPECTIONTYPE 206 Final Mechenical 208 Final Plumbing 210 Final Electricel 212 Flnal Fire Prevenllon 220 Final Planning Approval 222 Finel Site 250 finel Bulldinp/Occupancy n 1 Da�e-�� PAg iNIID�LS t2 -o � (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 495 OGLE ST Suite No Vicinity: Parcel Nunmber: 42515212 Applicant: Address: Owner: Address PLUMBING PERMIT DRAKE ANTHONY DUESLER 14291 CLARISSA LANE- . � . . � Phone: 714-350-7905 SANTAANA, CA , .- . � Zip:= -92705- � , ROHRER, JOHN AND JULIE 495 OGLE ST COSTA MESA, CA Phone: 949-5158589 Contractor: DRAKE ANTHONY DUESLER � Address: 14291 CLARISSA LANE Zip: 92627 Phone: 714-350-7905 SANTA ANA, CA. Zip: 92705 License: 473546 ISSUED BY: Status: ISSUED Applied: O6/23/2005 Issued: 06/23/2005 SCOPE OF PERMIT PLUMBING PERMIT FOR AN ADDITON OF 474 S.F. TO EXISTING S.F.D. WORK TO INCLUDE: CREATE NEW 66SF ENTRY WAY, ADD A LAUNDRY ROOM, BEDROOM, AND NEW BATHROOM. CONVERT EXISTING 3 BEDROOM, 2 BATH S.F.D. TO A 4 BEDROOM, 3 BATH S.F.D. REF #B05-00667 , WORK TO INCLUDE: 1 BATHTUB, 1 LAUNDRY.TUBMIASHER, 1 WASH BASIN, 1 WASTE AND VENT � � ' SYSTEM, 7 WAT�R CLOSET (TOILET) AND 1� WATER HEATER RELOCATION. � , FEESUMMARY � . AMT � ; QTY . . AMT QTY " _ � AMT QTY ISSUE FEE � .$23.50 Laundry Tub / Washer � 39.80 1 Sump Pump 50.00 0 Backflow irrigatlon �- �� ' -$0.00 . 0 � � . �- Landscape Irrigation �� $0.00 0 Swimrning Pool , $0.00 0 BackBow Preventer . �$0.00 . 0 - � p-Trap � $0.00 0 � Trap Primer , � $0.00 0 Bathtub . 59.80� 1 PressureRegulator $0.00 0 Urinal $0.00 0 Clanfier System �. �� $0;00 ' 0 -' - � Process Piping (per 10 ft) $0.00 0 , � �Vacuum Brki Bkflow(1-4) $0.00 0 Connect pce,Soda,etc) �`50.00-� 0 , Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 �' 0 �. Septic Tank � � �$0.00 0 Wash Basin $9.80 1 Dishwasher $0.00 �� 0 - Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 -0 - Sewer Connect �. $0.00 0 Waste and Vent System $9.80 1 Drain, Rainwaler $0.00 0 Sewer Private Line $0.00 0 Water Closet (Toilel) $9.80 1 Drein, Roof $0.00 0 Shower - , 30.00 0 Water Heater / vent 512.30 1 Drinking Fountain $0.00 0 Sink, bar $0.00 0 Water Piping (Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink, commercial $0.00 0 Water Re-pipe $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and re�ated regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended:or abandoned for a period of 180 days. INSPEC710NS: In order �or tha work author'rzed under this perm'rt to be considered legal, such work must canply with all cable codes, arW all required Inapectlons and final approval must be obtained. Failure to obtain inspections and final approval will result In the expiration of ihis permit. FOR INSPECTIONS CAIL: (714) 7545626 2d46�<8 (8N0) WORKERS'COMPENSAnON DECLARAnON: I hereby eNirtn under penalty of perjury one of the following tleclaratlons: ❑ I have an0 will malntain e certilicate of consent to self-Insure for workers' compensatlan, es�proviGed for by seclion 3700 oi ihe Lebor Cade, tor ihe pertortnance of Ihe � work for which this permil Is Issued. ❑ I heve antl will maintain workers' compensation insurance, es requiretl by sectlon 3700 of the Lebor Cotle, for Ihe peAortnance oF ihe work for whicli ihis pertnit is issued. My workers' compensation Insurence certier end policy num6er ere: Garner: Policy Number. /Thls section neea nol be comp/efed I! fhe permif is ve/uetl ef one hundred dollars (S 100) or /e55J �ertity Ihat in ihe peAortnance of the work for which this pertnl is i�sued, I shell not employ eny person in any menner so es to become subjecl lo the workers' wmpensation laws of Ce omia, end agree t e, t It I s�ould b e ubject m t�e workers' compansation proNsians of Sedion 3700 ot the Labor Code, I shall foMwlih compty with ihese pr W -- ,,�._.�.�� pp�� srgr�ature;. i ete'6"' �:'=i�0 � t � _'�� I.' T�, WANN . PAIL`VRErTO E KERS' COMPENSATIW MOE IS UNUWFUL M'D SHALL SUBIECr PN EMPIOYER TO CRIA9NP1 PENALTIES AND CML FlNES UP TOONE MUNDRED THOUSANDDOLLARE 1 , �,INADDITIONTOTHEC0.STOFCOMPENSATION,DMAAGE50.SPFOVIDEDFORINSECTION37060FTHELABORCWE,INTEREST,ANDATTORNEV5FEE5. LICENSED CONTRACTORS DECLARATION: I hereby eRirm ihat I am Iicensed under rovisia m«� a�ana��. x 4 ��(``Pt CONSTRUCTION LENDING AGENCY: with Section 7000) oi Division 3 ot the Business and Pmfessions CoOe, end my license Is in full ��ass�» 3 �—v � � oe,� (, -t��dd' ❑ I hereby aflirm ihet Ihere is a consWction lendinp agency for the peAormance ol the work br which Ihis permit is issuetl. (Sec. 3097, Civil Cotle). Lendefs Name: Lenders Address: Signeture: OWNER-BUILDER DECLARATIONS: Dale: I �ereby effirtn t�et under penelry ol perjury that I am EXEMP7 FROM THE CONTRACTORS IICENSE LAW for the tollowing reason (Sec. 7031.5, Business enC Professions Cotle: Any ciry or counry which reQWres e pertnit to construct, alier, improve, demolish, or repair any slrucWre, pnor to its issuance, also reqWres the epplicant tor such pertnit to tile e signetl statement that he or she is licensed pureuant to the provislons ot �he Contredore License Lew (Chepter 9(commencing with SecNon 7000) of Divislon 3 of ihe Business end Protessions Cade) or that he or she Is exempt t�erelrom and the basis for the elleged exemption. Any vlolation oi Sectlon 7031.5 by eny applicanl for e permit su6jects the applican� to e civll penalry of not more then five huntlred tlollars ($500)J: ❑ I, es owner of Ihe properry, or my employees wlth weges as Iheir sole compensetian, WILL DO THE WORK, entl �he structure Is nat In�entletl or ofFered for sele (Sec. 704d, Business end Professions Code: Tha Coniradors lice e Law dces not epply to an owner ot proparry w�o builds or improves thereon, and who does such work himself or hersell or ihrough his or her own employees, pm ed ihat such improvemenis ere not intended or ofleretl for sele. If, however, t�e building or improvemen� Is sold wi�hin one year of completion, the owner-builder wlll �a ihe burden of proving �hat he or she did nol builtl or improve for purpase of sele.). � ❑ I, es owner of the Droperry, am EXCLUSIVELV CONTRA NG WrtH LICENSED CON7BAC70RS to construct tha prqect (Sec. 70a4, Business and Professians CoCe: TTe tractors License Law does not apply to an ner ot properry w�o 6uiltls or impmves t�ereon, end who contracls lor such pro�ect with a crontractor(s) 1 license pu ua to Ihe Contradors License LewsJ. � �� ❑ I em exe pt un r sec. �� Busin and P lessions Code f Ihis rea bwn- I enile0 by tln�ets Ilcens . ❑ Ye� �P o' / ' Dr ve�'s-Lice e;.No. � � \�� Vedficetlon of OwnershiO.�Y (t af document, i.e. - ro er�' nez blll or deed : DIVISION OF INDUSTRIAL SAFETV PERMR CERTFICATON: ❑ I hereby certify thet no exwvation tive (5) or more feet In depth into which e person Is required to tlescentl, will be made in connection with work euthorizetl by Ihis permit, end Ihat no building stmcture, scaflolding, falsework, or tlemolition or dismentling ihereof, will be more then Ihirty-six (36) feat hiph. (Ghep. 32, Grp 2, Art 2, Sac. 341, Ttle B, Califomia Atlminisiretive Cotle). ❑ As owner-builder, I will not employ enyone to tlo work which would require e permil from the Division ot Intlustnel Setery, as noted ebove, unless such person hes e permit to do such work fmm Ihe divisian. Signature: Date: Division of Industnal Safery Pertnit Number: CEHTIFlCATE OF COMPLJANCE AND AUiHORVA710N OF ENfRY: I certity under penalry ot perjury thet I have read ihis epplication and state that ihe infortnation given is correct. I egree to comply wit� ell stete laws flnd dry orOlnences relatlng to builCing construdion, and authodza representatives of t�e Clry of Costa Mesa to enter upon the above-described property tor inspection Durposes. I egrerynpt tq,accupy or allow accupenry of any building euthorized by this pertnit until final inspection. COOE t. INSPECTIONTYVE pd¢ 1616 Fixetl System Final Fire Prevention 1266 Pool SDa Final 200 Final Re-Roof 201 Final BIocWReteining Wall 202 203 Final FecMory Fire PleCe Final Sign 204 Final Demolitlon 7�{,$ �QQ�( INSPECTIONTYGE 206 Final Mec�enical 208 Finel Plumbing 270 Final Elecidcal 212 220 222 250 Finel Flre Prevention Final Planning Approval Finel Site Flnal Bullding/Occupancy QAIE V�ELS • �\