PMT14-02295 City of Menifee Permit No. PMT14-02295
29714 HAUN RD. Type: Residential Alteration
<;;CCIRJA MENIFEE, CA 92586
MENIFEE Date Issued:
08/27/2014
PERMIT
Site Address: 23700 NORMA DR, MENIFEE, CA 92587 Parcel Number: 350-261-032
Construction Cost: $70,000.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of HOURLY INSPECTION FOR FIRE DAMAGE
Work:
Owner Contractor
JOHN LYONS GRIFFITHS CONSTRUCTION&INTERIORS INC
23700 NORMA DR 4076 ALAMO STREET
MENIFEE,CA 92587 RIVERSIDE, CA 92501
Applicant Phone:9513427913
GARY GRIFFITHS License Number: 643658
GRIFFITHS CONSTRUCTION&INTERIORS INC
4076 ALAMO STREET
RIVERSIDE, CA 92501
Fee Description Qty Amount($l
B
Inspections not specified 129 129.07
$156.07
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.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION
I hereby affirm under penalty or perjury that I 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
Professi Mode my license is in f Yfo c d e Code:The Contractor's License Law does not apply to an owner of a property
Licari ss License who builds or improves thereon, and who contracts for the projects with a
ignatur licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION D CLARATI
❑ I am exempt from licensure under the Contractors'State License Law for the
❑ 1 hereby affirm under penalty of perjury one of the following declarations: following reason:
I have 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 issu �jj/��
Policy# v�j built as an owner-building if it has not been constructed in its entirety by licensed
contractors. I understand that a copy of the applicable law, Section 7044 0(the
❑ I 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:htto'//www.leciinfo.ca.gov/caiaw.html.
permit is issued. y w •Pr2rs'c pensation ance carrier and policy number are:
Carrjt /�� Property Owner or Authorized Agent Date
ExpirEs��/s / 7 Polio /
((( ❑ By my Signature below, I certify to each of the following: I am the property
Name of Agent Phone# 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 ord' ances and state laws relating to building
coI structi uthorize re as of this city or county to enter the above-
El I certify that in the performance of the work for which this permit is issued, I ident p erty for io urpo
shall not emolov 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 provisio f Section the Labor rope er uthor' gent Date
Code,I sh II forthwith om ly with those p S.
City Business License#
4AppIIWA NING: FAILTO SEC4WCALTIES
ORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVGE IS UNLAWAND SHALLSUBJECT AN EMPLO TO CRIMINAL AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDING
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DYES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES El 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 ❑YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address ❑NO DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR
OWNER BUILDER DECLARATIONS GUIDE LINES
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, ❑NO 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
provisions of the Contractor's State License Law (Chapter 9 (commencing with I HAVE READ THE HAZARDOUS MATERIAL
Section 7000)of Division 3 of the Business and Professions Code)or that he or DYES 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 25505 25533 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARD MATERIAL R
compensation,will do ( )all of or( ) porting of the work, and the structure is R WN H IZED T
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property
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 OF IMENIFEE PLCKNo: _ PppwT14-0
29714 Haun Road Date: Date:
Menifee, CA 92586 ;
Phone: (951)672-6777 Amount: Amount: a7
Fax:(951)679-3843 Ck#: Ck#: 156.
Building Combination Permit
To Be Completed By Applicant
Legal Description: Planning Case: F: L: Rt: R
Property Add Jc e.
r A o '
�I7LL /��
Project/Tenant Nam ) _ / �- 62
U d#: Floor#:
Name: /�� P
Owner hone No. Fax No.
Property Address: Unit Number Zip Code
Email Address:
Name: Fax No.
Applicant Addres Unit Number
EmailA dress
Name: Phone No. Fax No.
Contractor Address: - City State Zip Code
ontractor's ity usmess Ltcanse o. Contra r' a icense No. Classi8calio
Number of Squares:
Square Footage
Description of Wor Cost of Work:
Applicant's Signature Date
To Be Completed By City Staff only
Indicate As R-Received or N/A-Not Applicable
5 Completes sets of fully dimensioned,drawn to sale plans which include: 1 set of documents which include
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Geo Tech/Soils Report(on cd only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8'A x 11)
❑ Structural Calculations
❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Single Line diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration' Addition' Meansifvlethods
Work Type:1 I IHRepair' Retrofit' Revision to Existing Permit'l Required? YES NO
Proposed Building Use(s): Existing Building Use(s):
#Buildings: #Units: #Stories: Will the Building Have a Basement?
Y of N
Bldg.Code Occupancy Group Indicate Indicate if YES or NO Indicate all Geo-tech.Haz-Zone
Al Project Construction Sprinklered that apply: Coastal Zone
Completion:
Type(s): C Of O YES or NO Noise Zone
Required? Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch. Review Board Landmark Comm. Planning Comm.Zoning Administrator
Fee Exempt: City Project Elec.Vehicle Charger Landmark Seismic Retrofit I bpedal ase:Bldg.
OmcialApproval
Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing
For Staff Use Only
Buildingl8afety I Permit Specialist City Planning ICivil Engineering EPWM-Admen I Transportation mgmt 1 Rent Control
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