PMT14-02868 I
i
I
City of Menifee Permit No.: PMT14-02868
29714 HAUN RD.CCE MENIFEE, CA92586 Type: Residential Alteration
MENIFEE Date Issued: 11/19/2014
PERMIT
Site Address: 28833 CHAMPIONS DR, MENIFEE, CA Parcel Number: 340-123-015
92584 Construction Cost: $25,000.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of FIRE DAMAGE REPAIR 677 SO FT ROOF FRAMING,WALL FRAMING REPAIR, DRYWALL
Work: REMOVAL, ELECTRICAL WIRING.
Owner Contractor
DOROTEO DURAN BARTWOOD CONSTRUCTION INC
28833 CHAMPIONS DR 10840 TALBERT AVE
MENIFEE, CA 92584 FOUNTAIN VALLEY, CA 92708
Applicant Phone: 7149657900
H&H STRUCTURAL ENGINEERS License Number: 592681
CA
Fee Description QQrt Amount is
Building Permit Issuance 1 27.00
f eei- s • � 6ecl' 1� •.
Inspections not specified 516 516.28
GREEN FEE 1 1.00
$1,127.42
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 thereunderwhen 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 a 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 4- r Signature licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECL !TION
❑ 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, 1 cannot legally sell a structure that I have
perPolicyisissu 7). 3 ��11 7� 1� �L I ' '
Policy# 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 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'//www.leginfo.ca.ciov/calaw.html,
permit is issued.My workers''compensation insurance carrier and policy number are:
Carrier L'—1- (1',j`"zS 4 Property Owner or Authorized Agent Date
Expires _Pvolicy#
Name of Agent Phone# �� Z1 (���`) ❑ By my Signature below, I certify to each o f 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 b completed if the ermit is for application and the information I have provided is correct. I agree to comply
one-hundred dollars($100)or less) Lt4
le city and county ordinances and state laws relating to building
uthorize representatives of this city or county to enter the above-
❑ I certify that in the performance of the work for which this permit is issued,I y r the ins ection purposes.
shall not emolov any persons in any manner so as to become subject to theworkers'compensation laws of California, and agree that if I should becomesubject to the workers'compensation provisionsf Section 3700 of the Labor Propr or uthorize - art Date
Code,I shall forthwith comply with those proviioCity i ense#
Date; _ ` Applicant;
WARNING: FAILURE TO SE RE WOR E S' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS UNLAW L, AND SHAL
SUBJECT AN EMPLOYER TO CRIMINAL NALTIES 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 T
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 under the penalty of perjury there is a construction lending INFORMATION GUIDE?
agency for the performance of a 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 AYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address6 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 reason(s)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, O 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 0 UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than ($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOU4 MATERIAL I EPCWtING.
compensation, will do( )all of or( ) porting of the work, and the structure is PROPERTY WNER R Al) H IZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code; _VI
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
CITY OF MENIF'EE PLCK No: P it o: 1 —�
29714 Haun Road Date: Date:
Menifee, CA 92586 , .
Phone: (951)672-6777 Ame ^De Amount:
Fax:(951)679-3843 -JICk#: Ck#:
Building Combination Permit Gl S4
To Be Completed By Applicant
Legal Description: Planning Case: F: L: Rt: R;
Property Address: Assessor's Parcel Number: O �h��'
Z 33 c104MQtaNi OIL
Prolect/Tenant Name: Unit#: Floor#::
n J
Name: ✓,�A1`-r Phone No. Fax No,
Properly Owner 33 CE
Address: Unit Number ZipCode
J�M�'iYYS � r(.
Email Address:
Name: ( 41 T713T1A1V (�at�S Sys Ph ne No. Fax No.
Address: ��
Applicant `( g G� ct �� - Unit Number Zip Code
E all ddress: , '�, � O
d
Name: Phone No.
Fax No.
Contractor Address: City State Zip Code
Contractor's City Business icense o. Contractor's City State of California License No. Classification:
Number of Squares:
Square Footage
Description of Work: C(rz ��-Alm _ -tZ Rcat F xAm i� Cost of ork:$
Applicant's Signature ff I"`^'t' S'e p J
Date: _
- - 75 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 I Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 81/2 x 11)
❑ Cross Section ❑ Structural Calculations
❑ Foundation Plan ❑ Plumbing Plan ❑ Single Line diagram for also.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration' Addition' MeanslMethods
Work Type: - Repair` Retrofit' Revision to FxisUng Permit' Required? YES NO
Proposed Building Use(s): $.F. Existing Building Use(s): S",q
#Buildings: #Units: #Stories: Will the Building Have a Basement?
Y of N
Bldg.Code Occupancy Group Indicate Indicat lere e it Indicate all Geo-tech.Haz.Zone
At Project Sprinkd YES or NO
Completion: Construction that apply: Coastal Zone
Type(s): C Of O YES or NO Noise Zone
Required? Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commis Arch.Review Board Landmark Comm. I Planning Comm.Zoning Administrator
Fee Exempt: City Project Elec.Vehicle Charger Landmark Seismic Retrofit petal ass.umg.
OFicialA mval
Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing
For Staff Use Only
SuitdinglSafely Permit Specialist City Planning I Civil Engineering I EPWM-Adman ITranspodah Mgml. I Rent Control