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PMT15-00210 City of Menifee Permit No.: PMT15-00210 29714 HAUN RD. Type: Mobile Home '[;kCCEL/ MENIFEE, CA 92586 MENIFEE Date Issued: 01130/2015 PERMIT Site Address: 27577 WATSON RD, MENIFEE, CA 92585 Parcel Number: 329-232-022 Construction Cost: $4,500.00 Existing Use: Proposed Use: Description of PERMANENT FOUNDATION TO EXISTING MOBILE HOME 1440 SO FT Work: Owner Contractor EDITH CALDERON AMERICAN PLUMBING&ROOTER CORP 27577 WATSON RD 2488 HAMNER AVE#103 MENIFEE, CA 92585 NORCO, CA 92860 Applicant Phone: 8009702577 JERRY ADAME License Number:881068 AMERICAN PLUMBING&ROOTER CORP 2488 HAMNER AVE#103 NORCO, CA 92860 Fee Description Qty Amount I$) Manufactured Permanent Foundation 1 240.72 Permit Fee 1 27.00 $267.72 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 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 Profess5i6 my license i ' ful and a Code:The Contractors License Law does not apply to an owner of a property License Lic se N who builds or improves thereon, and who contracts for the projects with a ExpiresSignet re licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATI N CLARATION ❑ 1 am exempt from Iicensure under the Contractors'State License Law for the I hereby affirm under penalty of perjury one of the following declarations: following reason: 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 permit is issued. improvements covered by this permit, I cannot legally sell a structure that I have 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 ❑ 1 have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this applicaton is section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:htto://www.leginfo.ca.gov/mlaw.htmi. permit is issued.My t Iworkers compensation insurance carder and policy number are: Carder 50 11.-�l KL Property Owner or Authorized Agent Date Expires L019 6A POlicy#w S I O a 2 uh Flo Name of Agent 3. Phone# ❑ 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 constructi uth representatives of this city or county to enter the above• f certify that in the performance of the work for which this permit Is Issued,I identifie Orop r e inspection purposes. (shall not emolov any persons in any manner so as to become subject to the ✓ workers'compensation laws of California, and a t ff I should become S subject to the workers'compensation provision f 3700 of the Labor grope err r orized Al ate Code,I shall forth 'h comply with those prov1 o Date; 5—Applicant; City Business License# WARNING: FAILURE TOC 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, OYES OCCUPANT HANDLE A HAZARDOUS MATERIALORA DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL LABOR CODE, INTEREST,AND ATTORNEYS FEES 0 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 �O Lender's Address DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR OWNER BUILDER DECLARATIONS r GUIDE LINES I hereby affirm under penalty of perjury that I am exempt from the Contractor's PRINT NAME: Ucense 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, after, improve, demolish, j10 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 k,IGES INFORMATION GUIDE AND THE SCAQMD PERMITTING she is exempt from Iicensure and the basis for the alleged exemption. Any 'jam CHECKLIST. I UNDERSTAND MY REQUIREMENTS violation of Section 7031.5 by any Applicant for a permit subjects the applicant to ONO UNDER THE STATE OF IFORNIA HEALTH AND SAFETY a civil penalty of not more than($500).) CODE SECTION 550 25533 AND 25534 CONCERNING ❑ I, as owner of the roe HAZAFfDOUS M RIA PORTING. property,dy, or my employees with wages as their sole compensation,will do( )all of or( )porting of the work,and the structure Is PROPERTY O R THORIZED AGENT not intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's State License Law does not apply to an owner of a property X who, through employees' or personal effort, bullds or improves the property, provided that the improvements are not intended or offered for sale.If,however, the building Or improvement is sold within one year of completion,the Owner- Builder will have the burden of proving that It was not built or improved for the Purpose sale). ` BUILDING & SAFETYPERMIT/PLAN CHECK APPLICATION ka ' Menifee DATE PERMIT/PLAN CHECK NUMBER TYPE: C COMMERCIAL O RESIDENTIAL 0 MULTI-FAMILY '. OBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL 0 MECHANICAL O NEW O PLUMBING 0 RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK Pe vLetj (D e ` ✓I O PROJECTADDRESS io- t�� Q p ^", ee C �a�� ASSESSOR'S PARCEL NUMBER I 3A-,1 �—V D, LOT O 1 A TRACT OWNER NAME T_ V1l I , Ca`j e((� ADDRESS � Wq S-✓1 F PHONE a �o -� �3- EMAIL APPLICANT NAME ADDRESS �v !C� n rX r� rrl� S PHONE �17E C�'S �-�3� 7 EMAIL je Q-1,e 449d C-4 CONTRACTOR'S NAME^^ OWNER BUILDER? (:, S X N`YEO BUSINESS NAME2 Alm / �,, ,/{;•it ADDRESS 3aI U -��G� f(�G ( C PHONE �) 22-73( (/ EMAIL (( Q oc) •eo CONTRACTOR'S STATEE-LII,C NUMBER b 19U1 O6dd0 LICENSE CLASSIFICATION ,y VALUATION$ �I 7 Li v Q FT L SO.FT APPLICANT'S SIGNATURE DATE Sri?. iJly uc�}_L'•l,'i-' DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE PAID AMOUNT AMOUNT • O CASH O CHECK# n O CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT OCASH OCHECK# 0 CREDIT CARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZED LETTER O YES 0 NO City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 STATE OF CALIFORNIA-BUSINESS,CONSUMER SERVICES,AND HOUSING AGENCY EDMUND G.BROWN JR.Governor DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT OVSING q Division of Codes and Standards gas n Z 3 "t 1" w 3�yF Title Search Date Printed: 01/06/2015 Decal#: LBH1438 Use Code: SFD Manufacturer: TOWN HOUSE Original Price Code: AEN Tradename: TOWNHOUSE Rating Year: 1975 Model: Tax Type: LPTCity of Menifee Manufactured Date: 00/00/1975 Last ILT Amount: Building & Safety Dept. Registration Exp: Date ILT Fee Paid: O 2015 First Sold On: 00/00/1975 ILT Exemption: NONJAN 3 Serial Number HUD Label/Insignia Length Width-ReCe1ved S8748X 218434 56' 12' S8748U 218433 56' 12' Record Conditions: Voluntary Conversion to LPT Registered Owner: EDITH CALDERON 13522 TAHOE ST WESTMINSTER,CA 92683 Last Title Date: 05/02/2005 Last Reg Card: 05/02/2005 Sale/Transfer Info: Price$65,000.00 Transferred on 04/12/2005 Situs Address: 27577 WATSON RD MENIFEE,CA 92585 Situs County:RIVERSIDE Inactive DecaUDMV: DECAL AAU2881,DMV SW9706,DMV MC9297,DMV MC9296 *** END OF TITLE SEARCH *** ckJ Cc,)idefc4, a7577 R,' ee CA 3`8o APN - 3a9 - 23Z - oz� 37 '� City of Menifee 7 �, Building & Safety Dept. W 0 JAN 3 0 2015 Received 0A, X 5 i a- 0 CITY OF MENIFEE BUILDING AND SAFETY DEPA ENT PLAN APPROVAL r, REVIEWED BY 3o�is N D v G 'Approval of these plans shall not be construed to be a permit for,or an O approval of,any violation of any provisions of the federal,state or city regulations and ordinances. This set of approved plans must be kept on the `Mo jobsite until completion. O Q Y CL