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PMT15-00635 City of Menifee Permit No.: PMT15-00635 29714 HAUN RD. Type: Residential Alteration �1GCEt,Pr�.' MENIFEE, CA 92586 Mi "°""°""A3'd`'�" MENIFEE Date Issued: `I 03/30/2015 q� G ® gyp P E R M I T P 4 Site Address: 29762 CALLE TOMAS, MENIFEE, CA parcel Number: 336-204-004 92586 Construction Cost: $1,650.00 Existing use: 1 &2 Family Residence Proposed Use: Description of AS-BUILT CLOSET FROM EXISTING COVERED PATIO, 65 SQ FT, NO ELECTRICAL ADDED, Work: EXISTING CEILING LIGHT,2 WALLS ADDED Owner Contractor LISA ANN CURL NPC CONSTRUCTION INC 29762 CALLE TOMAS 4949 2ND STREET MENIFEE, CA 92586 FALLBROOK, CA92028 Applicant Phone: 7607231961 OVE NAERBO License Number: 615229 NPC CONSTRUCTION INC 4949 2ND STREET FALLBROOK, CA92028 Phone: 7604681088 Fee Description 011Y Amount pBwlding Permit Issuance Inspections not specified 129 129.07 Ad itlonal'Plant♦�eview Building 148 4,14837 GREEN FEE 1 1.00 $305.44 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 000)of Divis' n 3 of the Business and contractors to construct the project(Section 7044, Business and Professions Professions Co �a/r��d./m��y ylicense i in ul�o 2 effect. Code:The Contractor's License Law does not apply to an owner of a property License Class�5ticen who builds or improves thereon, and who contracts for the projects with a hereby 31- Signature licensed contractor(s)pursuant to the Contractors State License Law). MRKERS'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. 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:htto'//www.Ieginfo.ca.00v/gaIaw.htmI. permit is issued.My workers'compensation insurance carrier and policy number are: �_ - Property Owner or Authorized Agent Date Carrier `w""-n� Ex Tres Policy# 5 ❑ By my Signature below, I certify to each of the following: I am the property Name of AgentAj5 ��{ (0�"' ' Phone#76D�73a��t39 ALpro rized act n the property owner's behalf. I have read this (This section need not be completed if the permit is far n the orm on I have provided is correct. agree to comply one-hundred dollars($100)or less) ic le and unty ordinances and slate laws relating to building . ' e r esenlatives 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 sp ction purposes.shall not employ any persons in any mannWeeif ct to the workers' compensation laws of California, become 3I subject to the workers'compensation prowthe Laborner or Authorized Agent ate ode, I shall forthwith comply with those r/n� City Business License# ,Ate; 3d�� 7 Applica t // 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 A HAZARDOUS MATERIAL ORA DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL LABOR CODE, INTEREST,AND ATTORNEYS FEES 1FT NO EQUAL TO OR GREATER THAN THE AMOUNTS CONSTRUCTION LENDING AGENCY -1 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 14 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, k 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 pl`YES INFORMATION GUIDE AND THE SCAQMD PERMITTING she is exempt from licensure and the basis for the alleged exemption. Any CHECKLIS I UNDERSTAND MY REQUIREMENTS violation of Section 7031.5 by any Applicant for a permit subjects the applicant to ❑NO UNDER E AT OF CALIFORNIA HEALTH AND SAFETY a civil penalty of not more than($500).) CODE EC T O 5 25533 AND 25534 CONCERNING ❑ I, as owner of the H DOU MA I E}EPORfING. property, or my employees with wages as their sole compensation, will do( )all of or( ) porting of the work, and the structure is PR PER O AUTHORIZED AGENT not intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's State License Law does not apply to an owner of a property X v who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale.If,however, the building or improvement is sold within one year of completion, the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). I i I AN CHECK APPLICATION &Menifee DATE —a015 PERMIT/PLAN CHECK NUMBER TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY 0 MOBILE HOME O POOL/SPA O SIGN SUBTYPE: ) ADDITION O ALTERATION O DEMOLITION (;ELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF-NUMBER OFS(Q�U'ARES DESCRIPTION OF WORK i " cl P PROJECTADDRESS 37102 ME _Q SUN G ASSESSOR'S PARCEL NUMBER 33(�ZOyOOK -$ LOT y m� TRACT �O�✓ " OWNER NAME ADDRESS C. /yptr C7 SvN� I —//iL5"/irri-� PHONE -514 —6-7 l 1:JLf EMAIL N APPLICANT NAME (OVE KKQjAQ _-- 11Pe qicv) - - ADDRESS 2j kl S Y�'� `�-- PHONE ,P �/�`8 �VO✓7 EMAIL CONTRACTOR'S NAME OWNER BUILDER? O YES NO C' ski its BUSINESS NAME � ADDRESS S PHONE r� EMAIL � CONTRACTOR'S STATELIC NUMBE LICENSE CLASSIFICATION , Zj" q l0� VALUATION $ /. S FT c3, L SQ FT 1 1 APPLICANT'S SIGNATURE DATE / —2Q15 DEPARTMENT DISTRIBUTION v CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP /� INVOICE PAID AMOUNTa AMOUNT CLASH CHECKa {%CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT O CASH O[HECK a C CREDIT CARD VISA/MC OWNER BUILDER VERIFIED C YES 0 NO DL NUMBER NOTARIZED LETTER C: YES CS NO City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-6 72-677 7 www.cityofinenifee.us Inspection Request Line 951-246-6213 NIF Conditions of Approval NAME: Ove Naerbo PLAN CHECK No: PMT15-00635 ADDRESS: 29762 Calle Tomas DESCRIPTION: Add 2- exterior walls to create addition / closet DATE: 3/20/2015 1. Inspector to verify R-19 insulation in walls and R-30 insulation in ceiling. Craig Carlson Senior Inspector City of Menifee 951 -672-6777 ext. 1 1 9