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PMT14-03172 i i City of Menifee Permit No.: PMT14-03172 29714 HAUN RD. MENIFEE, CA 92586 Type: Residential Plumbing s""""" MENIFEE Date Issued: 12/03/2014 1 PERMIT 3 Site Address: 28611 MILKY WAY, MENIFEE, CA 92586 Parcel Number: 339-213-006 Construction Cost: $5,000.00 Existing Use: Proposed Use: Description of REPLACE EXISTING SHOWER WITH NEW SHOWER, COUNTER TOP WITH 2 SINKS ONE GFI IN Work; BATHROOM Owner Contractor CRISTINE M BUSH PRESIDENTIAL HOME DESIGN INC 28611 MILKY WAY P O BOX 4522 MENIFEE, CA 92586 VALLEY VILLAGE, CA 91617 Applicant Phone: 8884663147 MANUEL JIMENEZ License Number: 562932 PRESIDENTIAL HOME DESIGN INC P O BOX 4522 VALLEY VILLAGE, CA 91617 Fee Description O�rt Amount l$) r�Reteptacle 1Swltch QufleE& Fixture -1 f 1 *1q6 009 Plumbing Fixtures and Vents, fixtures 3 116.00 ullA Pef,i 1t Iseuance .? ,- 27 OO GREEN FEE �1 1.00 $260.00 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 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 Cod my license is in full f rc and effect. Code:The Contractor's License Law does not apply to an owner of a property License Class C2 Licens o. who builds or improves thereon, and who contracts for the projects with a Expires/2•— 1�'Signature licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATION DECLARATION ❑ lam 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. built as an owner-building if it has not been constructed in its entirety by licensed Policy# contractors. I understand that a copy of the applicable law, Section 7044 of the ❑ 1 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:http//www.Ieginfo.ca.gov/caIaw.htmI. permit is issued.My workers'oompensati n insurance carrier and policy number are: Property Owner or Authorized Agent Carrier WYL- Date Expires���—�J✓ 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 city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to enter the above- 0 1 certify that in the performance of the work for which this permit is issued,I identified property for the insp rction purpos S. 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 Property Owner orAuthoriz g nt Date Code, I shall forthwith comply with those provisions. Date; Applicant; City Business License# � WARNING: FAILURE TO SECURE WORK RS' HAZARDOUS MATERIAL DECLARATION COMPENSATION COVERAGE IS UNLAWFUL, AND S ALL - 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 OR A 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 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 GUIDE LINES OWNER BUILDER DECLARATIONS 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 DYES 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, D 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 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 CALIFORNIA HEALTH AND SAFETY a civil penalty of not more than($500).) HA07-DAR SE 9TMANERIALSF}EPOR�INGD 25534 CONCERNING ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do( )all of or( ) porting of the work, and the structure is PROP R UTHORIZED AGENT not intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's Slate License Law does not apply to an owner of a property X who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale.If,however, the building or improvement Is sold within one year of completion, the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). CUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION City of Menifee Y 'Menifee Building & Safety Dept. DATE DEC 0 3 2014 PERMIT/PLAN CHECK NUMBER FO l TYPE: 0 I ®RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA 0 SIGN SUBTYPE: 0 ADDITION ALTERATION i DEMOLITION 0 ELECTRICAL (:% MECHANICAL NEW Q PLUMBING 0 RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK / IF PROJECT ADDRESS Z& If df-0411 Su vt ff 'n/t ASSESSOR'S PARCEL NUMBER 3 001V LOT TRACT oW OWNER NAME s ADDRESS PHONE �5�,- (p7Z 77 f3�, EMAIL APPLICANT NAME , npAje ADDRESS Sr. PHONE 6 EMAIL CONTRACTOR'S NAME OWNER BUILDER? 0YESkO BUSINESS NAME ADDRESS?©, J�2'y PHONE �/�-�Z,�a{67 EMAIL CONTRACTOR'S STATE LIC NUMBER 3?j LICENSE CLASSIFICATION VALUATION$ ��O�C�.�6 SO,FT L SQ FT APPLICANT'S SIGNATURE DATE CITY STAFF USE ONLY r DEPARTMENT DISTRIBUTION CI1YOFMENIFEE9USIN SLICENSENUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP Q INVOICE I'D PAID AMOUNT AMOUNT 00CASH 'CHECK# OCREDITCARD VISA/MC PLAN CHECK FEES PAID AMOUNT ':::'CASH %CHECK# 0CREDITCARD VISA/MC OWNER BUILDER VERIFIED " YES NO DL NUMBER NOTARIZED LETTER :% YES NO City of Menifee Building& Safety Deportment 29714 Houn Rd. Menifee, CA 92585 951-672-6777 www.cityofmenifee.us Inspection Request Line 951-246-6213 30� ,o �pv4' q'V CITY OF MENIFEE ���( � ( 1(41 LK� [ )kj BUILDING AND SAFETY DEPARTMENf>I,WL PLAN APPROVAL City of MenifeeDePt. O wi REVIEWED BY((; lding & Safety/2�� DATE DECO 3 2014 *Approval of these plans shall not be construed to be a permit for,or an Received r- approval of,any violation of any provisions of the federal,state or city regulations and ordinahces. This set of approved plans must be kept on the jobsite until completion.