PMT14-02876 i
City of Menifee Permit No.: PMT14-02876
i
29714 HAUN RD.
4� -1 MENIFEE, CA 92586 Type: Residential Addition
c°""°`""Almt ' MENIFEE Date Issued: 11/06/2014
PERMIT
Site Address: 29185 FALL RIVER LN, MENIFEE, CA Parcel Number: 364-290-005
92584 Construction Cost: $1,760.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of WALL TR 30422-2
Work: 6 X 55 L FT
LOT 220
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 Oft Amount f$1
Wall/Fence, non-standard 1 133.00
G
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 staled, 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_Permil_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 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,9 4 License No. who builds or improves thereon, and who contracts for the projects with
Expiresl�/3/Z/ 3 SignatureZ�� licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ 1 am exempt from licensure under the Contractors'State License Law for 11
❑ 1 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 I must have resided for at least one year prior to completion
Section 3700 of the Labor Code, for the performance of war[(for which this improvements covered by this permit, cannot legally sell a structure that he
permit is issued. built as an owner-building If it has not been constructed In its entirety by[loans
Policy# 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:hoVwww leginfo ca oov/calaw html.
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier ieus ��.r, C s��./77>+ Property Owner or Authorized Agent Date
1 r,
Expires 7// Policy#_YTe7a9,1-9 Wo I3 TAG
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 t1
(This section need not 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 build[
construction.I out sentatives of this city or county to enter the abe%
ElI certify that in the performance of the work for which this permit is issued,I identifie e d e in p 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 pro rty Owner or Authorized Agent Date
Code, I shall forthwith comply with those provisions--'�
City Business License# G 5 /G Ql
Date; ,a l /, Applicant;
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, AYES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES El 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 DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address ❑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 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(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 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 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 sale HAZARDOUS MATERIAL f4iEPORI'ING.
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 it
29714 Haun Road Date: Date: /
Menifee, CA 92586
Phone: (951)672-6777 Amount: Amount: ,o_
Fax:(951)679-3843 Ck#: Ck#: �(/]�"
Building Combination Permit
To Be Completed By Applicant
Legal Description:, Planning Case: F: L: Rt: R:
Property Address: Assessor's Parcel Number: G�d� /O�
Project/Tenant Name: Unit#: J Floor#:
/ems
Name: yu/ Phone N�o. G OB Fax No,
Property Address: ,} Unit Number �� Zip Code a
Owner 7/Q� „ /t�,`S 7T
Email Address:
Name: r--- _ Phone No. Fax No.
Applicant Address: Unit Number Zip Code
Email Address:
Name: _ Phone No. D _ Fax No.
Contractor Address: Ci /J State Zip Code
Contra ctor's rty Business icense No. Contractor's city State of California IJcense No. Classification:
9�a5 / C 9
Number of Squares:
Square Footage 3 G
Description of Work: &
/GP A yy !� G 'N, o L�� Cost of Work: S 74G «.
Applicant's Signature e� O Date:
.- - e.q@�.„ . _ - ley City_Staff OnIY+,.
Indicate As R-Received or N/A,Not Applicable
5 Complaies sets of fully dimensioned,drawn to sale plans which include: t 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%x 11)
❑ Structural Calculations
❑ Foundation Plan ElCross Section ❑ Plumbing Plan ❑ single Line diagram for elec. services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan 8 Details ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate New Construction :Alteration' Addition" Means/Methods
Work Type: Repair' Retrofit' Revision to Existing Permit' Required? YES NO
Proposed Building Use(s): Existing Building Use(s):
#Buildings: #Units: #Stories: Will the Building Have Basement? Y of N
Bldg.Code Occupancy Group Indicate indicate H YES or NO Indicate all Geo-tech.Haz.Zone
At Project Construction SPdnklered that apply: Coastal Zone
Completion: Type(s): C Of o Noise Zone
Re uirad7 YES or NO
n Listed an Historic Resources Inventory i
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board Landmark Comm. Planning Comm.Zoning Administrator
Fee Exempt: City Project Elec.Vehicle Chargerl I Landmark Seismic Retrofit Special Case:Bldg.
Official Approval
Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing !,
For Staff Use Only
Building/Safety Permit Specialist City Planning Civil engineering EPWM-Admin I Transportation Mgmt. I Rent Control