Loading...
PMT14-02842 i City of Menifee Permit No.: PMT14-02842 29714 HAUN RD. ' "'ACCIE-. MENIFEE, CA 92586 Type: Residential Addition MENIFEE Date Issued: 01/1 312 01 5 PERMIT Site Address: 28084 WINDSOR DR, MENIFEE, CA Parcel Number: 337-164-003 92586 Construction Cost: $41,120.64 '... Existing Use: 1 &2 Family Residence Proposed Use: Description of CONSTRUCT ATTACHED GARAGE 968 SO FT Work: Owner Contractor MARIANNE JONES WOLVERINE CONSTRUCTION 28084 WINDSOR DR 28118 WINDSOR DR MENIFEE, CA 92586 SUN CITY, CA 92586 Applicant Phone: 9519709181 JACK KEERSMAEKERS License Number: 555309 WOLVERINE CONSTRUCTION 28118 WINDSOR DR SUN CITY, CA 92586 Fee Description ,... f3yt Amount Services,Switchboards Control Centers 4 Panels 1 116ob Receptacle;Switch Outlet& Fixture 32 271.00 Plumbing FixtUresanaVentslixtures 1T6-90.' Gas System 1 116.00 Piping/Repiping" Single Family Residential _ 1 16&bo Sewer 1 150.00 Building Permit Issuance 1 27c00 Additional Plan Review Building _ 390 390.44 GR2 EN FEE 1 2 00 SMIP RESIDENTIAL 1 6,00 New Construction Permit Fee $1,546.59 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 building 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_Templatexpt 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 Tof License Q 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'COMPENSA DECLARAT ON ❑ I am exempt from licensure 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. # built as an owner-building if it has not been constructed in its entirety by licensed Policy 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:htto�l/www.leginfo.ca.gov/calaw.html. permit is issued.My workers'compensation insurance carrier and policy number are: Carrier Property Owner or Authorized Agent 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 ordin noes an a laws relating to building construction. I a orize presentative of this ty county to enter the above- I certify that in the performance of the work for which this permit is issued, I identified pr party ems c'bn rpos 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 shout become subject to the workers'compensation provisions of Section 3700 o the Labor r or Aut a Age Date Code,I shall forthwith comply with those provis' no/�� ,ea. it6C'y Business Licen e# � �N Date;, Applican s WARNING: FAILURE SE RE WORKERS' HAZARDOUS MATERIAL DECLARATION COMPENSATION COVERAGE IS UNLA FUL, 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 ENO 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 q DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION Lender's AddressO FROM THE SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDE LINES OWNER BUILDER DECLARATIONS I hereby affirm under penally 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, XNO 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 PERMITTI G she is exempt from licensure and the basis for the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREM TS violation of Section 7031.5 by any Applicant for a permit subjects the applicant to 10 UNDER THE STATE OF CALIFORNIA HEALTH AND TY a civil penalty of not more than ($500).) CODE, SECTION 25505 25533 AND 5534 CO R ING ❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS AT EPOR'(' G. compensation,will do ( )all of or( ) porting of the work, and the structure is PROP Y OW T OR D AGE 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).