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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