PMT14-03235 City of Menifee Permit No.: PMT14-03235
29714 HAUN RD.
lWCCIELJQ, MENIFEE, CA 92586 Type: Residential New
MENIFEE Date Issued: 04/16/2015
1
PERMIT
Site Address: 26762 KELLER RD, MENIFEE, CA 92584 Parcel Number: 384-050-015
Construction Cost: $426,390.61
Existing use: 1 &2 Family Residence Proposed use: 1 &2 Family Residence
Description of NSFR AS-BUILT NO INSPECTIONS AFTER SLAB APPROVAL
Work: 3709/770
Owner Contractor
KANGSAN TRUST No. 26762
21704 DUNN ST
WI LDOMAR, CA 92595
Applicant License Number:
KANGSAN TRUST
21704 DUNN ST
WILDOMAR, CA 92595
Fee Description C3yt Amount isl
cps , eta board„s; ap rdl Cep ers&�,an�s� � :,
Receptacle, Switch, Outlet&Fixture 146 841.00
b n" F�tltes`rtt� ent ' XY res +Z 6.0
Gas System 1 116.00
Residential Water Heater 1 83.00
Air Handling/Condensing Units SFR 1 133.00
Administrative Fee 1,811 �. 1,811.40
GREEN FEE 1 18.00
New Construction Permit Fee 1 1,961.40
$6,815.80
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_Templatexpt 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 and my license is in full force and effect. 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
❑ 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 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 b this permit, cannot legally sell a structure that have
permit is issued. P Y P 9 Y
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 b site:http://www.leginfo.ca.gov/calaw.htmf,
permit Is issued.My workers'compensation Insurance carrier and policy number are: 'Gt ��. ¢_ /S
Carrier '1 peny Owner or Autinorized Agent Date
Expires Policy#
Name of Agent Phone# - Lr`BY my Signature below, I certify to each of the following: I am the property
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-
❑ I certify that in the performance of the work for which this permit is issued,I identified property for the inspection purposes,
shall not emoloy 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 or Authorized A
Code,I shall forthwith comply with those provisions. P Y gent Date _
Date; 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, DYES OCCUPANT HANDLE AHAZARDOUS 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 []YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
Lender's Address FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
E 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 EYES 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($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING
NN i, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL AEPORYING.
compensation, will do( )all of or ( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that It was not built or improved for the
purpose of sale).
ABUILDING & SAFETY PERMIT/PLAN CHECK
PPLICATION
Menifee
01*22,`P
DATE 2 OG{ Z-®��{ PERMIT/PLAN CHECK NUMBER . (� Z 3
TYPE: _Q COMMERCIAL A RESIDENTIAL D MULTI-FAMILY U MOBILE HOME J POOLISPA 0,SIGN
SUBTYPE: C ADDITION .0 ALTERATION G DEMOLITION O ELECTRICAL 0 MECHANICAL
NEW O PLUMBING -3 RE-ROOF--NUMBER OF SQUARES
DESCRIPTION OF WORK ( I V �TV�AI aVl EK15fiV1 vloZ'
PROJECTADDRESS 1616Z. Kelle+. Rd I`fevtr-06t�
ASSESSOR'S PARCEL NUMBER :�194 - 0 _019 / LOT TRACT CU/
OWNER NAME YG(4T 4i jr-uisl /JD • 2676 Z ''µ�rt��0. Ctjo _True_
J
ADDRESS 2l -70 f7 �'p�' c_
toild0kww, 4?25z?
PHONE RSl- 6qt -ogez EMAIL ,$'EMG(_ C-A0(PtXlaj�uci(_Cayir
APPLICANT NAME Sew C u I fee
ADDRESS 2.,4?03'? guff At -:#D2065 HttrraeqLeL C44 a2S-93 _
PHONE 05( - 160/ - 42- EMAIL fie"-CA o@ k1oh-K tW 11e7_r7
CONTRACTOR'S NAME /�'�P! OWNER BUILDER? Q YES Q NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE DC NUMBER LICENSE CLASSIFICATION
VALUATION$ SO FT e,2 -7 O Gj //-7-70 TL SQ FT ,, /
APPUCANT'SSIGNATURE T DATE 12loQ lzo(T
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OE MENIEEE BUSINESS UCENSE NUMBER
RuiLDING PLANNING ENGNEERws FLRE GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT CASH =CHECK# CREW CARD VkSA/NK
PLAN CHECK FEES PAID AMOUNT -CASH O CHECK# a CREDITCARD VLSA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O 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
Perris Union High School District
t ' V
j/
(�H i��V �t � '"�'aa�n�mrw{ge 7f��arAIsrdv9'Wrm�rcµgfin Aiatlmru:naaeaws";
t
SC:II()QDL FACII.I7"IES FEES
155 East Fount, PT SD APPLICATION: 3200 Date:10/1012007
Street
Prins,cahka mia ]
92570-2124 Boildin�-Dept.Pcianit## BRS061 M
Ma nu rruumbei Project Address: 26762 Keller Road
951-943.4369
I&a➢enafee,CA
Supeiea mdHuna's
Office
Fax 95H-940-5378 Tract#(s), PM 14979 APIS`. 384-080-01.5 I:.of ,#(�s): 4
office Applicant's Nan= Stephen Durand Applicanfs Phone.949-2444128
FAX 951-943-4159
Applicant's Address: 26762 Keller Road
OfficeAe±enfee CAA
FAX 95H-?843-9&.>"3 � a
Tvpe Development:
5FI➢/MA'YQlia&lCiln9lp 4y' ^°Ly c'IDIi7kXN9rdal El
Adat Replacement Senior Rate Alm RuRding []
Number of Units/Lots: 1 Total Square F'eet**: 3709
[,card
of I "I f final budding perinit is over'20 t1bea mole or less than thii naumlaer,applicant mast a4lust ahe&'p..e paid
"7'orrsaees ! accordingly,
Joan D.C: iey I certify that the :above inforaaantion is tree.
Joe E.Daugherty
William F-PlAmIn
Eric Krococke
C;arolyu A.7`w,praoan Dale: !!' 'l_;f_A._1TID1d�x'Ilt'at.
C;ERTII+` CATIt a9 TO TJFI ,0E;PAWrll F `r O BUILDING SAFETY
Disariat 'This co-tifies that the schmi ffacipitdes fees annaaose➢persuannt to(X)Cafifhn in a 43a vmnlrent Coale Sedion
Supuximtend nt 53OM O Pre-leod authority @m the amount of$1.35 dows3709 R*me tea,01 $5„007.I5(I®ta9
Dennis iz.149unay amount of fees'),and have been paw to the Disatict+for alae above-8ioLd pr(h)Ybes,and that building permits
j for tMs square footage in rltis proposed development unsay now be ys-sucd by yoasr,guriWichon.
Date: 10l10Y2007 I'rp ar d By
Approved I3 -✓ r
Basn'les SS° es Dept.
J
Menifee Union School District
30205 Menifee Road, Menifee CA, 92584
I
CERTIFICATE OF COMPLIANCE
PAYMENT OF SCHOOL FACILITY FEES
Date: 10/10/2007 Certificate 8: 07108-1040
Developer/Applicant:_ Stephen Durand Telephone M 949-492AI28
Bldg.Dept. Plan Check M BRS061092
Address: 26762 Keller Road
Location of Project: Menifee Tract/Lot#: PM 14979/Lot 4 Parcel lt: 384-060-015
RESIDENTIAL SPACE Number of Square Feet
CFD 94-1 x 1.92 Total: $0.00
Approved 04124107 3,709 x 3.68 Total: $13,649A2
COMMERCIAL& INDUSTRIAL SPACE
Approved 2114106 x 0.3024 Total: $0.00
The above representations as to square footage are true. Developer/Applicant agrees that if it is later determined
that such representations are untrue,then this certificate shall automatically terminate and the County shall be notified.
NOTICE:THERE IS A 90-DAY PERIOD FOR PROTEST OF FEES. Section 66020 of the Government Code
enacted as Assembly Bill 3081,set forth as Chapter 549,Statutes of the State of California, 1996 effective January 1,
1997, requires that this school district provide a written notice to the project applicant at the time of payment of school
fees, mitigation payments or other exactions. This notice is to advise you that any protest In regard to such amounts
or the validity thereof in accordance with Section 66020 of the Government Code and other applicable law,
commences with such payment or performance of any other requirement as described in Section 66020 of the
Government Code. Additionally,this notice advises that the protest thereof must occur within 90 calendar days
there r. .04
D L PE APPLICANT
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government
Code Section 65995. Menifee U.S.D.agrees that building permits for this square footage in the proposed
development may now be issued by your jurisdiction.
Bruce H. Shaw
-
Director of Facilities
Certificate of Compliance Template 07-08