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PMT14-02873 City of Menifee Permit No.: PMT14-02873 29714 HAUN RD, MENIFEE, CA 92586 Type: Residential Addition MENIFEE Date Issued: 11/O6/2014 PERMIT Site Address: 29233 FALL RIVER LN, MENIFEE, CA Parcel Number: 364-290-001 92584 Construction Cost: $800.00 Existing Use: 1 &2 Family Residence Proposed Use: Description of WALL TR 30422-2 Work: 6'X 25 L FT LOT 217 Owner Contractor CENTEX/PULTE J GINGER MASONRY LP 27101 PUERTA REAL 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 (3yt Amount f$1 Wall/Fence, non-standard 1 133.00 G'E FEE 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 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_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 license Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professloi 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 propei License Class ea4 License No. who builds or improves thereon, and who contracts for the projects with Expires/,3 3/�i 3 Signature_ licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATION DECLARATION ❑ I am exempt from licensure under the Contractors'State License Law for V ❑ 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 compensation,issued by the Director of Industrial Relations as provided for by which must have resided for at least one year prior to completion Section 3700 of the Labor Code, for the performance of work for which this permit is issued. improvements covered by this permit, I cannot legally sell a structure that I he Policy# built as an owner-building if it has not been constructed In its entirety by Ilcens contractors. I understand that a copy of the applicable law. Section 7044 of t fB' 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:http:/LmLom.leginfo.ca,gov/calaw.html. permit is issued.My workers'compensation insurance carrier and policy number are: Carrier i�o-„ 1�r s ��n Ce f. h"y 1„r roperty Owner or ut oozed Agent Date Expires 7Z Policy# �C.—e,R<iA9eYf n'/3TJ-G Name of Agent Phone# ❑ By my Signature below, I certify to each of the following: I am the prope 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 auth 11 tatives of this city or county to enter the oboe El certify that in the performance of the work for which this permit is issued,I identlfie > e in lion 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 subject to the workers'compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provi ' a . Profp6ty Owner or Authorized Agent Date Date; ,a " /, Applicant; City Business License# 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, OYES 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 DNO 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 EYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION Lender's Address - FROM THE SOUTH COAST AIR QUALITY MANAGEMENT ONO 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 AYES 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 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 ❑NO UNDER THE STATE OF CALIFORN IA HEALTH AND SAFETY a civil penalty of not more than ($500).) CODE, SECTION 25505, 25533 AND 25534 CONCERNING ail ❑ I, as owner of the property, 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 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 •a aJli NIFEE PLCK No: e i 1 1 / O 29714 Haun Road Date Date : �{` Menifee, CA 92586 161--18 114 Phone: (951)672-6777 Amount: Amount Fax:(951 )679-3843 Ck#: Ck#: Building Combination Permit S1 To Be Completed By Applicant Legal Description:, _ c91 Planning Case: F: L: Rt: R: Property Address: r Assessor's Parcel Number: ProjecVTenant Name: Unit#: Floor#: Fic S Name: Phone No, Fax No. 959.G 706 Property Address: Unit Number �j Zip Code 9aGi Owner 7�� `' lt�••5 ,r 14 a Email Address: Name: r-°— Phone No, Fax No, Applicant Address: Unit Number Zip Code Email Address: Name: _ Phone No. Fax No. — in /lG Y GI7 d oS6 Ccrtrctor Address: ICi. ��/ State Zip Code v S' is Oct e/ 644 I L C/ Contractor's City Business�License No. Contractor's City St� a f/rnia License No. Classification: ^ p Number of Squares: C' Square Footage / G Description of Work: Cost of Work: $ Applicant's Signature Date: '4.@e�ainpl�fe,.1d BY�l�".eS� dl7.Y Indicate As R-Received or N/A,Not Applicable 5 Completes sets of filly 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/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8 Y x 11) ❑ Structural Calculations ❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Single Line diagram for elec. services over 400 AMP ❑ Floor Plan. ❑ StrucNral Framing Plan&Details ❑ Shoring Plan 1 ❑ Sound Report-Residential Class Code: Indicate New Construction Alteration- Addition` MeansiMethods Work Type, Repair' Retrofit* Revision to Exisdng PermiP Required? YES NO Proposed Building Use(s): Existing Building Use(s): #Buildings: #Units: #Stories: Hill the Building Have a Basement? Y of N Bldg. Code Occupancy Group Indicate if indicate all Geo-tech. Haz,Zone At Project Indicate Spdnkler=_d YES or NO that apply: Coastal Zone Cons ruction Completion: Type(s;: C Of O Noise Zone YES or NO Required? Listed on Historic Resources Inventory CITY PLANNING STAFF ONLY APPROVALS: Costal Commis, Arch. Review Board Landmark Comm. Planning Comm.Zoning Administrator Fee Exempt: City Project Flec.Vehicle Char er Landmark Seismic Retrofit cpecal case:a, g. P y J 9 OfriCeA Aporoval Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing For Staff Use Only I Budding/Safety Permit Specialist City?fanning Qvil Engineering Rent Control