PMT14-02880 1
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City of Menifee Permit No.: PMT14-02880
29714 HAUN RD. Type: Residential Addition
'' CCIE1..%� MENIFEE, CA 92586 II
s� xsM`" MENIFEE Date Issued: 11/0 612 01 4
PERMIT
Site Address: 29170 FALL RIVER LN, MENIFEE, CA Parcel Number: 364-290-068
92584 Construction Cost: $1,056.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of WALL TR 30422-2 '..
Work: 6'X 33 L FT
LOT 368
Owner Contractor
CENTEX/PULTE J GINGER MASONRY LP
27101 PUERTA REAL#300 8188 LINCOLN AVE STE 100
MISSION VIEJO, CA 92691 RIVERSIDE, CA 92504
Applicant Phone: 9516885050
RANDY ARNETT License Number: 940581
J GINGER MASONRY LP
8188 LINCOLN AVE STE 100
RIVERSIDE, CA 92504
Fee Description ,(C[ty Amount l$)
Wali/Fence, non-standard 1 133.00
0 .
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_eldg_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 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 propei
License ClassC,94 License No. 9%^is J who builds or improves thereon, and who contracts for the projects with
Expires/,9/3/1i 3 Sign sture f 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 tl
❑ 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' . gy 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
permit is issued.Section 3 of the Labor Code, for the performance of work for which this 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 licens
contractors. I understand that a copy of the applicable law, Section 7044 of t
17d� have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon requestwhen this application
section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:bttp://www.leginfo.ca.gov/calaw,html.
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier Fz / s `J- C y�, Property Owner or Authorized Agent Date
Expires 7z�/ Policy# V77:1! Ua%Y�n'13T�
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 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 auth ' sentatives of this city or county to enter the alsm
❑ 1 certify that in the performance of the work for which this permit is issued,I identife .� a in ion 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 Owner or Authorized Agent Code, I shall forthwith comply with those provi 9 Date
o - C7�5 /O QJ
Date; -a l / Apple nt; 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, 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 ❑NO EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS
1 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 blame ❑YES 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 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 AYES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from licensure and the basis for the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREMENTS
vlolation 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($500).) CODE, SECTION 25505 25533, AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL REPORTING.
compensation,will do ( )all of or( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not intended or offered for sale. (Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or Improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that It was not built or improved for the
purpose of sale).
CITY OF MEiNIFEiE PLCK No:
29714 Haun Road Date: Date:
' �g�
Menifee, CA 92586
Phone: (951)672-6777 Amount: Amount:
Fax:(951)679-3843 Ck#: Ck#:
Building Combination Permit
To Be Completed By Applicant
Legal Description:_ _ 68 I Planning Case: F: L: Rt: R:
Property Address: Assessors Parcel Number:
Project/Tenant Name: 7' Unit#: Floor#:
Name: Phone No.
G 7r7B Fax No,
Property Address: Unit Number Zip Code
Owner ] i
Email Address::
Name: r--- Phone No. Fax No.
Applicant Address: Unit Number Zip Code
Email Address:
Name: _ Phone No. Fax No.
Contractor Address: Ci State/ Zip Code
Contra ctor's city Business icensa o. Contractor's City State of California License No. Classification: C
Number of Squares:
Square Footage /5`
Description of Work: / / A 3 �1+ G / ! Cost of Work:$ �e-
tX
Applicant's Signature _ Date:
Corppletept By City-Staff ODIY4( Wlll
Indicate As R-Raceived or N/A-Not Applicable
5 Completes sets of 4;Ily dimensioned,drawn to sale plans which include: 1 set of documents which include
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Gad Tech/Soils Report(on ad 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 ❑ Structural Framing Plan 8 Details ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration` Addition` MeansiMethods
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 a Basement? Y of N
Bldg. Code Occupancy Group Indicate if Indicate all Geo-tech.Haz.Zone
Indicate YES or NO th Coastal Zone a pply:At Project Spdnklered at
Completion: Construction
Type(s): C 0f O YES or NO Noise Zone
Required? Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board Landmark Comm. I Planning Comm.Zoning Administrator
Fee Exempt: City Project Elea Vehicle Chargerl Landmark I Seismic Retrofit I special case:Tag.
Official Approval
Expedite Project(s): Child Care City Project Green Building I Landmarki I Affordable Housing
For Staff Use Only
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Building/Safety I Permit Specialist City Planning Civil Engineering EPVe'M-Armin I Transportation Mgmt. I Rent Control