PMT14-02725 i
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City of Menifee Permit No.: PMT14-02725
29714 Type: Residential Addition
Cl MENIFEEEE,, C CA 92 92586 I
6mmanmx s<a`"'"" MENIFEE Date Issued: 05/06/2016 �j
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PERMIT
Site Address: 28102 BLUE DIAMOND LN, MENIFEE, CA Parcel Number: 329-350-011
92585
Construction Cost: $58,195.20
Existing Use: 1 &2 Family Residence Proposed Use:
Description of 2 AS-BUILT HORSE STABLES,40'x 52'AND 40'x 60'WITH A 10'GAP BETWEEN THE STRUCTURES
Work: CE12-0094 S. STOLL
Owner Contractor
JOSE&LETICIA GARCIA
28102 BLUE DIAMOND LANE
MENIFEE, CA 92585
Applicant License Number:
JOSE& LETICIA GARCIA
28102 BLUE DIAMOND LANE
MENIFEE, CA 92585
Phone: 9515919871
Fee Description QQrt Amount
Inspections not specified 129 129.07
GREEN FEE 1 1.00
New Construction Permit Fee 1 267.70
$575.14
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.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
Professions Code and my license is in full force and effect. Code:The Contractor's License Law does not apply to an owner of a property
License Class License No. who builds or improves thereon, and who contracts for the projects with a
Expires Signature licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ I am exempt from licensors under the Contractors'State License Law for the
❑ I 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 issued.
Policy# 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 of 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 sur brniIt dpr at th�lowi g Wqq site:httx//www.le info.ca. ov/c Iaw.html.
permit is issued.My workers'compensation insurance carrier and policy number are: ��,.r rMMNf' oS-0G120/ $-
Carrier y Owner or Author' ed gent Date
Expires Policy#
❑ 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 ordinances and state laws relating to building
construction.I authorize representatives 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 identified roperty for the inspection purposes.
shall not emnlov any persons in any manner so as to become subject to the v
workers' compensation laws of California, and agree that if I should become - �,---y t� 0S- Q4 `2,
subject to the workers'compensation provisions of Section 3700 of the Labor Property Owner or Aut orized Agent Date
Code,I shall forthwith comply with those provisions.
City Business License#
Date; Applicant;
WARNING: FAILURE TO SECURE WORKERS' 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, ❑YES 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 [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
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address ❑NO 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 reasons)indicated below by the checkmark(s)I have placed ❑YES 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 ❑YES 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
SECDOUS SECTION
MATE 505AL ffE5533PORI,AND 25534 CONCERNING
❑ 1, 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 PROPERTY OWNER OR AUTHORIZED AGENT
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 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).
1 --
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SCOPE OF WORK
Off C-OR -
INSPECTION PROGRAM
And Designation Of
SPECIAL INSPECTORS
SPECUL INSPECTIONS
(Only checked items are required)
Firm or individual to be responsible for all Special Inspections:
--- — Name: Phone: ( ) County Registration:
If different firms or individuals are responsible for different items,list names,phones and
re ' trations below.
ITEMS SPECIAL INSPECTORS
Concrete W r -7 p.o y
Bolts installed in Concrete
El Special Moment-resistmg Concrete Frame
Reinfoccen Stcel and Prestressing Steel Tendons z
Structural Weldin
Hi -stren Boltin
Structural M
❑Reinforced Gypsum Concrete
lasuIating Concrete Fill l
j ❑S ra -a liedFire-resistive Materials
-Piling,Drilled Piers an Caissons
Shotcrete .
Special Grading,Excavation and Filling
i U Smoke-control S tem --�
❑Others:
DECLARATION BY OWNER OR ARCMnCf/ENGINEER OR RECORD
I,the❑Owner ❑Engineer or❑Architect of record,declare that the above listed Special Inspector(s)is are
hired by me.
fi
s
Signature Date
Ott BUILDING AND SAFETY DEPAR
PLAN APPROV L
REVIEWED
'Approval of these plans shall not be construed to be
- — approval of,any violation of any provisions of the fed(
Office COPY regulations and ordinances. This set of approved plan
jobsite until completion.
STRUCTURAL OBSERVATION PROGRAM
AND DESIGNATION OF THE
STRUCTURAL OBSERVER
PROJECT ADDRESS: /Jjr��lvIV'��11Z,�, W.e }�j {wt1I9 1A7 . PERMIT APPL. NO.:
Description of Work: .l 'W �fd'.,.: 4_rx 1,
Owner p �f� (1jf lk Architect: f Engineer:
STRUCTURAL OBSERVATION
yxeheckeditems are;required)
Firm or Individual to be responsible for the Structural Observation:
Name: ... Phone: 71 -. .: .
(. - Qg,7 Calif. Registration:_
FOUNDATION WALL .- FRAME DUFPHRAGM
IP Footing, Stem Walls, Piers p Concrete O Steel Moment Frame O•-Concrete
O Mat Foundation -�,]l IasonryJOSteel Braced Frame
O:Steel Deck
❑ Caisson, Piles, Grade Beams ❑Wood' O Concrete Moment Frame ❑Wood
❑ Stepp'g/Retain'g Foundation. • 0 thers: ❑Masonry Wall Frame - ❑-Other s:
Hillside Special Anchors
O Others: ❑Others:
DECLARATION BY OWNER
I, the Owner of the Project, declare that the above listed firm or individual is hired by me to be the
Structural Observer.
Signature
Date
DECLARATION BY ARCHITECT OR ENGINEER OF RECORD (required if S.O.is different from the A/E of Record) _
I, the Architect or Engineer of record for the project; declare that the above listed-firm or individual is
designated by me to be iesponsibie for the Structural Observation.
Signolure license No.
Dole
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SO CAL INSPECTIONS, INC.
3783 Sierra Ave • Norco, CA 92860 AWS/CWI- ICBO/ICC
Phone (626) 482-9231 ALL CITIES &JURISDICTIONS
Fax (951) 479-5476 INSPECTION & MATERIAL TESTING
REGISTERED INSPECTOR'S DAILY REPORT Job Number Date
❑ Reinforced Concrete 02
-27-15
TYPE OF
® Structural Steel Assembly ❑ Quality Control
INSPECTION ❑ Post Tensioned Concrete ❑ Fireproofing ❑ Epoxy Anchors
REQUIRED ❑ Structural Masonry ❑ Asphalt ❑ Other
Job Address
cry
28102 Blue Diamond Lane Menifee, CA
Job Name Permit Number Issued By
Type of Structure Architect
Single Family Home
Material Description gypto grade source) Engineer
Contractor
Inspectors Name Subcontractor
Charles F. Ramsey III
INSPECTION SUMMARY- LOCATIONS OF WORK INSPECTED,TEST SAMPLES TAKEN,WORK REJECTED,JOB PROBLEMS, PROGRESS,
REMARKS, ETC. INCLUDES INFORMATION ABOUT AMOUNTS OF MATERIAL PLACED OR WORK PERFORMED,
NUMBER,TYPE AND IDENTIFICATION NUMBERS OF SAMPLES TAKEN. STRUCTURAL CONNECTIONS(WELD
MADE H.T. BOLTS TORQUED)CHECKED,ETC.
Quality Control:
Preformed inspection of already build horse arena located in rear of home. Observed
(2) existing 5/8" bolts at each of(24) 2"x6" HSS columns baseplates. Columns
were welded to baseplate at footings. Truss was connected to column with
connection plate that was welded to truss and then (8) screws into column.
Ridge connections was welded at top joint. No approved plans on site.
SAMPLES
CONCRETE M ROUT BL PRI M DE I
PAGE .� OF .� TIME IN TIME OUT REG.HOURS OT I5X OT 2X
10:00 4
CERTIFICATION OF COMPLIANCE: To the best of my knowledge,all of the reported work,
unless otherwise noted,is in conformance with the approved plans,specifications,and All inspections based on a minimum of 4 hours.Over 4 hours=B hours minimum,
applicable sections of the governing building laws. Any inspections extending past noon will be charged as an 8 hour minimum.
APPROVED
BY:
ICC Steel: 5296764 PROJECT SUPERINTENDENT
Signature of Special Inspector Certifi2Ntlon Number