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PMT14-02844 City of Meniffee Permit No.: PMT14-02844 29714 HAUN RD. '9A01^MA MENIFEE, CA 92586 Type: Mobile Home MENIFEE Date Issued: 10/24/2014 PERMIT Site Address: 32860 TINO RD, MENIFEE, CA 92584 Parcel Number: 360-320-011 Construction Cost: $25,000.00 Existing Use: Proposed Use: Description of MOBILE HOME SITE PREP 1280 SO FT Work: Owner Contractor JOHN PETERSON LAND HOME CONSTRUCTION INC 26375 HAYDEN LN 35325 HIGHWAY 74 MENIFEE, CA 92584 HEMET, CA 92545 Applicant Phone: 9518302085 CRAIG DAVIS License Number: 892706 LAND HOME CONSTRUCTION INC 35325 HIGHWAY 74 HEMET, CA 92545 Fee Description 4Qt+ Amount is T;." '"Gf'tTAM^ 'aN^w,tm' zy-•n f'&�� w Permit Fee 1 27.00 $223.00 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 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 underwhich no work is commenced within six months after issuance,orwhere the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be forfeited. AA_Bidg_Permit_Templale.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 f�r e and effect. Code:The Contractor's License Law does not apply to an owner of a property License Class R4 Z,7 Z License No. l Z d� who builds or improves thereon, and who contracts for the projects with a Expires �y AQ . Signature licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATION DEC ARATION ❑ 1 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 Section 3700 of the Labor Code, for the performance of work for which this which I must have resided for at least one year prior to completion of permit is issued. improvements covered by this permit, I cannot legally sell a structure that I have icy# built as an owner-building if it has not been constructed in its entirety by licensed contractors. 1 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:httQ:ILwm.igg[nfo.ca.Qov/calaw.html. permit is issued.My workers'compensation insurance carrier and policy number are: Carrier (i(�ZSS d GS� Property Owner or Authorized Agent Date / 15 3oyK° Expires 6— Policy tK"� Name of Agent Phone# ❑ By my Signature below, I certify to each of the following: I am the property 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- 0 1 certify that in the performance of the work for which this permit is issued, I identified property for the inspection purposes. shall not employ any persons in any manner so s to become subject to the comp �J /o workers'compensation laws of California, and agree that if 1 should become �(yny+ subject to the workers' compensation provisions of Section 3700 of the Labor Property O n or Authorized A Code,I shall forthwith comply with those provisions. P gent Date Date; I6"2- —1 Applicant; City Business License WARNING: FAILURE TO CURE 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, DYES OCCUPANT HANDLEA HAZARDOUS MATERIAL ORA DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL LABOR CODE, INTEREST, AND ATTORNEYS FEES 2/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 Lender's Address i FROM THE SOUTH COAST AIR QUALITY MANAGEMENT UNO 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 items)(Section 7031.5. Business and Professions Code: BE BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A molis Any city or county that requires a permit to construct, alter, improve, deh, 7I 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 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 U'NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY a civil penalty of not more than($500).) CODE, SECTION 25505, 25533 AND 25534 CONCERNING El1, as owner of the properly, or my employees with wages as their sole HAZARDOUS MATERIAL REPORTING. compensation, will do ( )all of or ( ) porting of the work, and the structure is PROP TY OWNER O UTHORIZED 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 (/✓u-'� 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). (C1a 1 `iJ7' ML1gIF!t E PLCKNo: 29714 Haun Road Date: Date: Menifee, QA 92586 101a+-t Phone: (951)672-6777 Amount: Amoynt�3— Fax:(951)679-3843 Ck#: Ck#:CA Building Combination Permit To Be Completed By Applicant Legal Description: Planning Case. F: L: Rt R: Property Address: S2/ 6 �NO k� Assessor's Parcel Number: b 6a-3z6 -o// Project/Tenant Name: y/l4nv O//� Unit#: Floor#: Name: S/P Z i U�') Ppone)o Z Fax No. OwneProper Address: /1 / U//nit umber Zip Code Email Address: Name: ,r�q/,. ` Phone No. ( J Fax No 4V o- o s -9 9Z,6/- 96ZZ Applicant Address: >� Unit Number Zip Code Email Address: q 01Avy / / �� 6 -?# i CSAI p Name: -(IAAl f l emR— 2lN /,/C Phone Nr6 o g.�a`208 Fax No. . V) 5�'U6z Contractor Address: 3 -3� l City �e Slate,n Zip Code�Z5.0 ontractor'a CitY Businesss License Contractor's City St eyf ' d L,tcense No. C.vl J '�( VtCJ Classification: Number of Squares: Square Footage /zoo 5 r Description of Work: �'(/) Cast of Work:s 2 ©ea Applicant's Signature �C�/'� / '0.nT1 Date Indicate As R-Received or NIA-Not Applicable 5 Completes sets of fully dimensioned,drawn to sale plans which Include: t set of documents which Include ❑ The Sheet ❑ Elevations ❑ Electrical Plan ❑ Geo Tech/Soils Report(on cd only) ❑ Plot/Site Plan ❑ Roo(Plan ❑ Mechanical Plan ❑ The 24 Energy(on 8 1A x if) ❑ Foundation Plan ❑ Cross Section El structural Calculations ❑ Plumbing Plan [I Single Line diagram for sine.services over 400 AMP ❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring ` Plan ❑ Sound Report-Residential Class Code: Indicate New Conslmction Alteration' Addition' Means/Methods Work Type: Repair' RetroFlt' 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.Cade Occupancy Group Indicate Indicate if Indicate all Geo-tech.Haz.Zone At Project Sprinklered YES ar NO Completion' Construction that apply: Coastal Zone Type(s): C Of O YES or NO r 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- Cily Project Elec.Vehicle Charger Landmark Seismic Retrofit Pedal Case:Bug. Omcial A pmwv l Expedite Piojecl(s): Child Care City Project Green Building Landmark Affordable Housing For Staff Use Only ]1uIdin9/Safe1y Permi l Specialist City Planning Civil Engineering EPyVNI-Admin Tra is ii alion f IgmL I Rent Control THANK YOU FOR HELPING US CREATE BETTER COMMUNITY