PMT14-03149 1
City of Menifee Permit No.: PMT14-03149
29714 HAUN RD. Type: Residential Alteration
'r CC EL MENIFEE, CA 92586
MENIFEE Date Issued: 1 210 2/2 01 4
A
PERMIT
9
Site Address: 27166 ALTA VISTA WAY, MENIFEE, CA Parcel Number: 336-010-001
92586 Construction Cost: $3,000.00
Existing use: 1 &2 Family Residence Proposed use:
Description of INSTALL 2 LAYERS OF 30 MIN OVER EXISTING PANELS, SELF FURRING STUCCO MESH, 1 COAT
Work: STUCCO FINISH COLORED
Owner Contractor
DC WILCOX PROPERTY LLC C A& L A INC
981 W ARROW HWY#394 1042 N MOUNTAIN AVENUE#6132
SAN DIMAS, CA 91773 UPLAND, CA 91786
Applicant Phone: 9096302404
GARY PARK License Number: 852608
CA&LAINC
1042 N MOUNTAIN AVENUE#13132
UPLAND, CA 91786
Fee Description Qtv Amount f$1
ui(�tll�Ig�e"'if�sS��ua�lme 2e+00
Inspections not specified 258 258.14
New Construction Permit Fee 1 13.83
$299.97
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,orwhere 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 aq my license is in full for a act. 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 ( (( 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 the
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 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, I cannot legally sell a structure that I have
permit is issued.
Policy# 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
❑ I 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:htti),//www.leajnfo.ca.gov/Calaw.html.
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier Property Owner or Authorized Agent Date
Expires Policy#
❑ By my Signature below, I certify to each of the following: I am the property
Name of Agent Phone# owner or authorized to act on the property owner's behalf. I have read this
(This section need not be completed if the permit is for application and the information I have provided is correct. I agree to comply
one-hundred dollars($100)or less) with all applicable ciE nd county ordinances and state laws relating to building
construction.I out rize representatives of this city or county to enter the above-
El I certify that in the performance of the work for which this permit is issued,I identified prope the inspection 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 I
subject to the workers'compensation provisions of Section 3700 of the Labor r Owner or Authorized Agent Date
Code,I-shall forthwith comply with those provisions.
City Business License#
Date; ��' �' Applicant; //[/�"9'l"� ° -w 1
_ WARNING: FAILURE TO ECU E 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, Ip�YES 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 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 Address ❑NO DISTRICT(SCAQMD) SEE PERMITTING CHECKLIST FOR
GUIDE LINES
OWNER BUILDER DECLARATIONS
I hereby affirm under penalty of perjury that I am exempt from the Contractor's PRINT NAME pas
License Law for the reason(s)indicated below by the checkmark(s)I have placed MYES WILL THE PROPOS 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 1 HAVE READ THE HAZARDOUS MATERIAL
Section 7000)of Division 3 of the Business and Professions Code)or that he or MYES 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 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 HAZARDOUS MATERIAL�EPOR'1'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).
SAFETYBUILDING & • APPLICATION
`Menifee
DATE ( /7 PERMIT/PLAN CHECK NUMBER P ( —o 4�
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA O SIGN
SUBTYPE: O ADDITION >MTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK ,Q��>f LACCO
PROJECT ADDRESS
ASSESSOR'S PARCEL NUMBEER, Q -�1� -Q�� LOT TRACT ��
OWNERNAME w�� QX Liz
ADDRESS "1 *`F�ALAI Q)I
PHONE EM IL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NA ( K OWNER BUILDER? O YES )& NO
BUSINESS NAME ,
ADDRESS f7 3a- ( (JA
PHONE _oi -� EMAIL W
CONTRACTOR'S STATE LIC NUMBER LICENSE
VALUATION $ �jQv�^ ' FT ek, LSO FT
APPLICANT'S SIGNATURE DATE /D l
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
PAIDAMOUNT
AMOUNT dl 1 ,
l `� i," CASH C?CHECK# UCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT CASH OCHECK# 'CiCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER I? YES NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
I
Job Site Address: 27166 Alta Vista, Sun city Bulling & S foty Dopt.
Scope of Work: Stucco DEC 0 2 2014
Size of Stucco Area: 200 Sq/yd (1800 Sq/Ft) Received
Steps of Work: 1. Install 2 Layers of 30 min. of Black Paper on Top of Existing Panels
which have another layer of Black Paper inside
2. Install Self Furring Stucco Mesh
3. Apply 2 coats of Stucco Cement
4. Apply 1 coat of Finish Stucco (Colored)
CITY OF ME
BUILDING A
PLAN APPRI
REVIEWED I
'Approval of these pl
approval of,any viola
regulations and ordin
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