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PMT14-02872 i City of Menifee Permit No.: PMT14-02872 29714 HAUN RD. Type: Residential Addition MENIFEE, CA 92586 MENIFEE Date Issued: 1 110 612 01 4 PERMIT Site Address: . 29233 FALL RIVER LN, MENIFEE, CA Parcel Number: 364-290-001 92584 Construction Cost: $3,340.00 Existing Use: 1 &2 Family Residence Proposed Use: Description of WALL TR 30422-2 Work: 6'X 95 L FT LOT 216 Owner Contractor CENTEX/PULTE J GINGER MASONRY LP 27101 PUERTA REAL#300 8188 LINCOLN AVE STE 100 MISSION VIEJO, CA 92691 RIVERSIDE, CA 92504 Applicant Phone: 9516885050 RANDY ARNETT License Number: 940581 J GINGER MASONRY LP 8188 LINCOLN AVE STE 100 RIVERSIDE, CA 92504 Fee Description ,O�t Amountrr I$1 Wall/Fence, non-standard 1 133.00 1 SMIP RESIDENTIAL 1 1.00 $162.00 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 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 licensi Chapter 9 (commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professioi 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 propel License Class C�� License No. �/G I who builds or improves thereon, and who contracts for the projects with ExpiresZ?13111 3 Signature_ licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATION DECLARATION D I am exempt from licensure under the Contractors'State License Law for tl ❑ 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 acknowled a that, except for m compensation,issued by the Director of Industrial Relations as provided for by 9 P Y personal residence which i must have resided for at Section 3700 of the Labor Code, for the performance of work for which this least one year prior to completion permit is issued. improvements covered by this permit, I cannot legally sell a structure that I ha Policy# built as an owner-building if it has not been constructed in its entirety by licens contractors. I understand that a copy of the applicable law, Section 7044 of t �- I have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:hai2:L/—WwL/.Ieg!nLo.ca.gov/calaw.htmi. permit is Issued.My workers'compensation insurance carrier and policy number are: Carrier i�u„-l.+s P�p re /ry ?�-r Property Owner or uthorized gent Date Expires 7h�/ 5- Policy# V7C!:uR/a TT-G Name of Agent Phone# ❑ By my Signature below, I certify to each of the following: I am the props owner or authorized to act on the property owner's behalf. I have read tl (This section need Dot be completed if the permit Is for application and the information I have provided is correct. I agree to coml one-hundred dollars($100)or less) with all applicable city and county ordinances and state laws relating to buildi construction. I augth�ep sentatives of this city or county to enter the abo� ❑ I certify that in the performance of the work for which this permit is issued,I identifie errs r e insoe6tion purposes. shall not amble v any persons in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall Forthwith comply with those provi 'on . Pro rty Owner or Authorized Agent Date Date;= Applicant; City Business License# d 3 5 /CJ QJ 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, DYES OCCUPANT HANDLE A HAZARDOUS MATERIAL ORA 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 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 3097 Civil Code) WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE Lender's Name AYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION Lender's Address FROM THE SOUTH COAST AIR QUALITY MANAGEMENT ❑NO 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 ❑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 (Chapter9 (commencing with I HAVE READ THE HAZARDOUS MATERIAL Section 7000)of Division 3 of the Business and Professions Code)or that he or AYES INFORMATION GUIDE AND THE SCAQMD PERMITTING she is exempt from icensure 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 CALI FORN IA HEALTH AND SAFETY a civil penalty of not more than($500).) CODE, SECTION 25505 25533.AND 25534 CONCERNING l ❑ 1, as owner of the property, or my employees with wages as their sale HAZARDOUS MATERIAL�EPORTING. 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). CITY OF MENIFEE PLCK No: P i No: -t 29714 Haun Road Date: Cat �y'I 1� Menifee, CA92586 10 0414 Phone: (951)672-6777 Amount: Amoun`iba,OD Fax:(951 )679-3843 Ck#: Ck#: Building Combination Permit To Be Completed By Applicant Legal Description:_ Planning Case: F: L: Rt Property Address: Assessor's Parcel Number: ProjechTenant Name: Unit#: Floor#: /7c5 Name: Phone No, 6 708 Fax No. Property Address: 7/�/ _ Unit Number Zip Code aG9 Owner r. r e /l�• S .' Y'e �G Email Address: Name: Phone No. Fax No. Applicant Address: Unit Number Zip Code Email Address: Name: _ Phone No. Fax No. 8 036 Contractor Address: Cr State ,A/ Zip Code Contractor's Ciry Business License No. Contractor's City State of California License No. Classification: 96a5 / C � Number of Squares: Square Poe;age 370 4e Desorption of Work: Cost of Work: $ ce Applicant's Signature Date: �C`ti�ijp)€Cg�i BY�dh'St?��9`f. r�fi Indicate As R-Received or N/A.-Not Applicable 5 Completes sets of fully dimensioned,drawn io sale plans which include: t set of documents which include ❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Goo Tech/Soils Report(on ed only) ❑ Plot/Si:.a Plan ❑ Rocf Plan ❑ Mechanical Flan ❑ Title 24 Energy(on S Y x 11) Foundation Flan ❑ Structural Calculations ❑ ❑ Cross Section ❑ Plumbing Plan ❑ Single Line diagram for elec.services over 400 AN1P ❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan ❑ Sound Report-Residential Class Code: indicate New Construction Alteration' Addition` I Id Nleane/Nfehods Work Type: Repair' Retrofit' R°vision to Existing Pamlit` Required? YES NO Proposed Building Use(s): 11 Existing Building Use(s): Buildings: #Units: #Stories: %Arill the Building Have a Basement? Y of N Bldg. Code Occupancy Group Indicate if Indicate all Geo-tech.Haz. Zone Indicate YES or NO At Project r Sprink!ered that a P: Coastal Zone Completion: Cons ruction PP 1 Type(s): C Of ir 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 Elec.Vehicle Charger Landmark Seismic Retrofit special case dog. lMcial Approval Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing For Staff Use Only Building/Safety Parma Specialist Ciry Planning I Cnil Engineering 'oPN ivi-Adm!n Trrsporatinn Nlgmt. Rent Conn.of