PMT14-02772 I
i
City of Menifee Permit No.: PMT14-02772
29714 HAUN RD.
CCE1 MENIFEE, CA 92586 Type: Residential Electrical
MENIFEE Date Issued: 10/16/2014
PERMIT
Site Address: 28215 CALLE GAVIOTA, MENIFEE, CA Parcel Number: 336-272-015
92586 Construction Cost: $2,500.00 �',
Existing Use: Proposed Use:
Description of INSTALL KITCHEN CABINETS, 3 UNDERCAB LIGHTS, 1 MICRO UNIT
Work:
Owner Contractor
PEGGY STEVENSON AAA RESTORATION INC
28215 CALLE GAVIOTA 29850 2ND STREET
LAKE ELSINORE, CA 92532-2420
Applicant Phone: 9514715828
KIRK MUNK) License Number: 834839
A A A RESTORATION INC _
29850 2ND STREET
LAKE ELSINORE, CA
Fee Description Y. Amount IS)
R; . - a. : , Swi
Building Permit Issuance 1 27.00
$159.00
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 budiding 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 my license is in full r Code:The Contractor's License Law does not apply to an owner of a property
Licceense Class License No. --// who builds or improves thereon, and who contracts for the projects with a
E9,3/Z) L Signatur licensed contractor(s)pursuant to the Contractors State License Law).
ORKERS'COMPENSA ON DECLARATI
❑ I am exempt from Iicensure 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 370G of the Labor Cade, for the performance of work for which this improvements covered by this permit, 1 cannot legally sell a structure that I have
permit is issued. built as an owner-building if it has not been constructed in its entirety by licensed
Policy# C Is T SG Yb L(2 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 submitted or at the following Web site:hffp llwww leginfo ca cov/calaw html.
permit is issued.My workers'comppenns�a�tion insurance carrier and policy number are:
Carrier C yN I/f Y1c i6 Property Owner or Authorized Agent Date
'— � 7 Expires � Policy# 0'!45CX�0 /(/2
GGpp�JG y my Signature below, I certify to each of the following: I am the property
Name of Agent Z Phone# � g' �Z/() / /�er 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 aulho a representatives of this city or county to enter the above-
0 1 certify that in the performance of the work for which this permit is issued,I identified pro art or the inspection purposes.
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 l
subject to the workers'compensation provisions of Section 3700 of the Labor arty Owner or Authorized t Date
Code,I shall forthwith comply with those provisions.
ity Business License#
]
Date; 1 U— 1(� M( Applicant,
WARNING: FAILURE TO SECURE RKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS UNLAWFUL, A D 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, OYES 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 ❑NO EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS
I hereby affirm that underthe 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 OYES 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 reason(s)indicated below by the checkmark(s)I have placed OYES 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 OYES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from Iicensure 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 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL ffEPOR"�ING.
compensation,will do( )all of or( ) porting of the work, and the structure is PROPERTY OW O THORIZED 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).
CITY OF 1V11L1®Yll'EE PLCK No: Permit No:
29714 Haun Road Ity of Menifee ?(wr I -Q -z
f=wildi Z
ng & Safety Dept. Date: Date:
Menifee, CA 92586 U - l l.o -ILA
Phone: (951)672-6777 OCT 16 2014 Amount:�t: Amount:
Fax:(951)679-3843 Ck#: q 2 � Ck#:
ETeived
Building Combination Permit
To Be Completed By Applicant
Legal Description: Planning Case: F: L: Rt: R;
Property Address: 7I Assessor's Parcel Number.
G �e 3 3 62 27 2- -ot
ProjecflTenant Name: ITV Unit#: Floor#:
Name: P're No. Fax No.
PropeM l CJ-S q 2 - (l°1
Owner Address: �!S /J�. Unit Number Zip Code
Email Address:
RV 1 LA v : d+C�
Name: 't—I / U r / /n� Phone Np7 / F Z�
Applicant Address: I �f\A s Unit Number Zip Code ��
Email Address: 1
1 G
Name: 0*4_ f �_�L Phone N YIe.7r� Fax No �/��/�
Contractor Address: 9910� City StaJQ A Zip C
Contractor a Uily Business License o- Contractor'�,�ri $tofuim alifo is License No- CIa(as/ific—ation:
Number of Squares: V/ _t rjS
Square Footage
Description of Work: `f � VA.r l-r' Cost of Work:1_17.!V�
Applicant's Signature CiL�V
Date: /U`/G—I C/
j�JTo Se Completed.By.City Staff Only,
Indicate As R-Received or N/A-Not Applicable
5 Completes sets of fully dimensioned,drawn to sale plan 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%x 11)
El Structural Calculations
El Plan ❑ Cross Section ❑ Plumbing Plan ❑ Single Line diagram for eac.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate Ll New Construction Alteration` Addition' Means/Methods
Work Type: Repair' Ll Retrofit' Revision to Existing Permit' 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.Zane
At Project Construction Spdnklered 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 Else.Vehicle Charger Landmark Seismic Retrofit special case:WdF__c4App,,ya1
Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing
For Staff Use Only
Building/Safely Permit Specolisl City Planning I Civil Engineering I EPWM-Armin I Transponalion MgmL Ron[Conlrol
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
City of M Dept.nife
Building & SafetyU
OCT 16 2014 1,_ _ /✓ A/X,
Received ►l,
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