PMT14-01824 1
City of Menifee Permit No.: PMT14-01824
29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Alteration
MENIFEE Date Issued: 07/22/2014
1
PERMIT
Site Address: 28941 OLYMPIA WAY, MENIFEE, CA Parcel Number: 337-384-007
92586 Construction Cost: $20,000.00
Existing use: 1 &2 Family Residence Proposed Use:
Description of FIRE DAMAGE REPAIR-DRYWALL, INSULATION, ELECTRICAL,TRUSSES
Work:
Owner Contractor
CYNTHIA SMALL PADGETT'S CLEANING &RESTORATION INC
28941 OLYMPIA WAY - 535 NEW JERSEY STREET
MENIFEE, CA 92586 REDLANDS, CA 92373
Applicant Phone: 9093072769
MENIFEE, CA License Number:679028
Fee Description QtV Amount($1
Building Permit Issuance _ 1 27.00
s'ectlot�S�gt-spa�clied�k i ra ��� � 9� � 29`°,,7
Plan Review Building 129 0.00
GREEN FEE 1 1.00
$405.14
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications or from preventing builiding operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise stated, a permit for construction under which no work is commenced within six
months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA_Bldg_Permit Template,mt Page 1 of 1
City Of Menifee
LICENSED DECLARATION
I hereby affirm under penalty or perjury that 1 am licensed under provisions of ❑ I, as owner of the property an exclusively contracting with licensed
Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professions
Professions Code and my license is in full�fo're � Code:The Contractor's License Law does not apply to an owner of a property
License C���ss �k5 � Lice e No "d who builds or improves thereon, and who contracts for the projects with a
Expires ;/:3( Signature licensed contractors)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION D LARATION ❑ I am exempt from licensure under the Contractors'State License Law for the
J�ffeby affirm under penalty of perjury one of the following declarations: following reason:
e and will maintain a certificate of consent of self-insure for workers' By my signature below I acknowledge that, except for my personal residence in
compensation, issued by the Director of Industrial Relations as provided for by which I must have resided for at least one year prior to completion of
Section 3700 of the Labor Code, for the performance of work for which this improvements covered by this permit, I cannot legally sell a structure that I have
permit is is �rf' .�a �' built as an owner-building if It has not been constructed in its entirety by licensed
Policy# "1G?S- contractors. I understand that a copy of the applicable law, Section 7044 of the
❑ 1 have and will maintain workers' compensation Insurance, as required by Business and Professions Code,Is available upon request when this application is
section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:http/Iwww leoinfo ca cov/calaw html.
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier �J
C e CoN, _ Property Owner or Authorized Agent Date Expires d-as- /
(-5 Policy# (A�by.qrk�igAQ(1'e
Cy�� p 7�'�$�� b ❑ By my Signature below, I certify to each of the following: a the property
Name of Agent Phone# h owner or authorized to act on the property owner's behalf. I have read this
(This section need not be completed if the permit is for application and the information I have provided is correct. I agree to comply
one-hundred dollars($100)or less) with all applicable city and county ordinances and state laws relating to building
construction. I authorize representatives of this city or county to enter the above-
, ❑ I certify that in the performance of the work for which this permit is issued,I igg;;�
rposes.shall not employ any persons in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers'compensation provisions of Section 3700 of the Labor Date
Code,I shall forthwi comp) with those provisions.
7 City Business License#
Date; �pplicant; A
WARNING: FAILURE TSECURE WOR S' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDING
($100,000), IN ADDITION TO THE COST OF COMPENSATION, ES OCCUPANT HANDLE A HAZARDOUS MATERIAL ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES [I NO EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS
I hereby affirm that under the penalty of perjury there is a construction lending
INFORMATION GUIDE?
agency for the performance of the work which this permit is issued (Section WILL THE INTENDED USE OF THE BUILDING BY THE
3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE
Lender's Name DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
� 6 FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address 11 N0 DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR
GUIDE LINES
OWNER BUILDER DECLARATIONS
I hereby affirm under penalty of perjury that I am exempt from the Contractor's PRINT NAME:
License Law for the reason(s)indicated below by the checkmark(s)I have placed DYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable item(s) (Section 7031.5. Business and Professions Code: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A
Any city or county that requires a permit to construct, alter, improve, demolish, 0 SCHOOL?
or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the I HAVE READ THE HAZARDOUS MATERIAL
provisions of the Contractor's State License Law (Chapter 9 (commencing with
Section 7000)of Division 3 of the Business and Professions Code)or that he or S INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from licensure and the basis for the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREMENTS
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than ($500).) CODE, SECTION
E S MATERIAL 50 25533AEPOW�WG AND 25534 CONCERNING
El I, as owner of the property, or my employees with wages as their sole
compensation, will do( ) all of or( ) porting of the work, and the structure is P OPE TY OW 1 O H IZED ENT
not intended or offered for sale.(Section 7044,Business and Professions Code; AI
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
CITY O MENI EE PLCK No: i No:
29714 Haun Road Date: Date: 1 —O
Menifee, CA92586 —7 14 LJ 1 �aa�/
Phone: (951)672-6777 Amouryt Amou t
Fax:(951)679-3843 1�'G1 �{So�
ck#: ck n:
Building Combination Permit tC 53
To Be Completed By Applicant
Legal Description: .y-,s �3 � LO T., 1 2 � Planning Case: F: L: Rt: R
P2 erty Addles:CJ�.. C LY J Assessor's Parcel Number. _ QD
8 337 - 3g
P rojec�enant Name: Unit#: Floor#:
c5/H.4 C,f...
Name: Pha el
Property GN
� S µ sF q?3 3 e Fax No.
Owner Address: Q . Unit Number ZiCd e
Email AddZsJ "
Name: (,<N SOS Phone N�32 V$ Fax No.
Address: I Nu t7 G �U 6l
Applicant r S!S / A�S� \� p,. Unit Number Zip Code
Email Ad�Ql / I NV[C (2tY1/.V
Nam OC
S rl hJ Cf` fT rU�J Qon No.
ContractorOil
Fa
lklbr
S�ar� Zip Code
A� Cal OtZ3
Contractors Illy Business Licen a No. Contracte s t(ttali
�� OOfornia License No.
�jj� Classification:
Number or Squares: �� 1✓ U
Square Footage
Description of Work: F/ eG/ Cost of Work:$ _14 ab�
Applicant's Signature �C
Date:
By;C To Be Completed ity Staff Only_ _
Indicate As R-Received or WA-Not Applicable
5 Completes sets of fully dimensioned,drawn to sale plans which include: r set of documents which include
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Geo Tech/Soils Report(on cod only)
❑ Plol/Site Plan ❑ Roof Plan
❑ Mechanical Plan ❑ Title 24 Energy(on 8 %,x 11)
❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan El Structural Calculations
❑ Single Line diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan I ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration' Addition' MeanslMethods
Work Type: Repair' Retrofit' Revision to Exish'ng Permit' Required? YES NO
Proposed Building Use(s): Existing Building Use(s):
#Buildings: Lmd
s: i!Stories: Will the Building Have a Basement?
Y of N
Bldg. Code Occupancy Group In
Indicate if Indicate all Geo-tech. Haz. Zone
At Project ruction Sprin'lered YES or NO that a Coastal Zone
Completion: apply:s): C Of o YES or NO Noise Zone
Required? Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commis Arch.Review Board Landmark Comm. Planning Comm.Zoning Administrator
Pee Exempt: City Project Plan.Vehicle Charger Landmark Seismic Retrofit SPcial case.envy.
OffcialA ,,oval
Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing
For Staff use Only
Buildin9lSalety Permit Sperialisl Cly Plarmi q C- I F FP
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY