PMT15-00743 r
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City of Menifee Permit No.: PMT1S-00743
29714 HAUN RD. Type: Residential Addition
OW6CG1* MENIFEE, CA92586
MENIFEE Date Issued: 04/16/2016
i
PERMIT
Site Address: 28970 W WORCESTER RD, MENIFEE, Parcel Number: 339-133-009
CA 92586 Construction Cost: $25,000.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of ENCLOSE CARPORT, REMODEL, ELECTRICAL, PLUMBING
Work:
Owner Contractor
ALICIA VEGA-VANDERGELD
1343 DELAY AVE
GLENDORA, CA 91746
Applicant License Number:
ALICIA VEGA-VANDERGELD
1343 DELAY AVE
GLENDORA, CA 91746
Phone: 6268330135
Fee Description gtv Amount($1
4Receptacle Switch4 putlet&Fixture _ 3 n LL128 00
Building Permit Issuance 1 27.00
`Inspe�tionsnots�eclfed "�,�r* 4* ., � 25$ � c 'r 25�.14
Administrative Fee 384 384.14
`Adds tonal Alan Reylew9ulldin�_ '�t ,�4 :' s x 4�` �� r �?�',148 37
GREEN FEE 1 1.00
$948.65
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 Marilee.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 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 contractors)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑
/ I am exempt from licensure under the Contractors'State License Law for the
i: 1 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 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
❑ 1 have and will maintain workers' compensation insurance, as required by Busine s 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 submitt d or at the following Web site:http'//www leginfo.ca. ov/c aw.html.
permit is issued.My workers'compensation insurance carrier and policy number are: )C—
Carrier Pro rt Owner or AuthaflZed Agent a
Expires Policy#
Name of Agent Phone# ❑ By my Signature below, I certify to each of the following: I am the property
9 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 ide tified property for the inspection purposes.
shall not emolov 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
Code, I shall forthwith comply with those provisions. Pr + ty wner or Authorized Agent Date
City Business License#
Date; Applicant;
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, 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 []YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address 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 ES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable items)(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 / I HAVE READ THE HAZARDOUS MATERIAL
Section 7000)of Division 3 of the Business and Professions Code)or that he or �yES 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 IkEPOVbNG.
compensation, will do( )all of or( ) porting of the work, and the structure is PRO RTY O NER 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).
i
City of Menifee
February 17, 2015
Building a Safety Dept,
FEB 19 .2015
To: City of Menifee,:Building Dept,
From: Alicia Vega-Vandergeld z� Received
Re: 25871 Cherry Hills Blvd,Menifee, Ca 92586
This is written authorization for Saul Macias to obtain a building permit for the subject property on my
behalf as owner of record. Saul is assisting me as my time is limited.
The building permit is to enclose an existing carport to an enclosed garage.
Thank you for your assistance in this matter. If you have any questions,you may contact me at 626-
833-0135. rp
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//Ar '.ix ,Fr� tt Lp
California All. Purpose Acknowledgement
State of California
County of. Los Angels
On -(/� — �Ib�ef�ore me, Tames J. Lee, NOtary_Public
personally appeared
who proved to on the basis of satisfactory evidence to be the person(.)
whose name(s) are subscribed to the within instrument and who acknowledged
to me that he/ /they executed the same in his/herd/their authorized rapac"
ity(ies) , and by his/�:/their signature(s) on e14 instrument the person(s) ,
or entity upon behalp of which the 'person(s) acted, executed the instrument.
I certify under PENALTY of PERSI7& under the laws of the state of California
that the foregoing paragraph is tr a and correct.
WITNESS hand and i ia . sea JAMES J.LEE
COMM.#2076480 m
Notary public-California�
o m LOS ANGELES COUNTY A
(Signature of aryl My Comm.Exp.Aug.28,2018
My Commission Expires: 8,128120t8
�NIF
CORRECTIONS
city of men ifee
1st Review Building & Safety Dept.
NAME: Saul Macias APR 112015
PLAN CHECK No : PMT15-00743 Received
ADDRESS: 28970 W. Worcester
DESCRIPTION: Carport to Garge Conversion, Fill-in walls replace doors
DATE: 4/8/2015
1. Indicate on plans the following for NEW wall construction: Office Copy
a. Indicate on plans means of attachment for Sill Plate, min 4'-0" o.c.
b. Indicate on plans Sill Plate size and pressure treated.
2. Provide positive connection at new 4x4x8 posts at garage door sill plate and framing plate.
3. Door at kitchen to be a 20min rated door, self-closing, and self-latching.
4. Pictures indicate new romex installed, w/new boxes, indicate on plans.
PLEASE RETURN ALL PAPERWORK. Indicate ALL revisions/corrections with a delta and cloud.
Submittal Documents are to be COPIES, Originals.
Craig Carlson
Senior Inspector
City of Menifee
951 -672-6777 ext. 119
4/14QO15 28970 worcester meiWee-Google Maps
/ram To see all the details that are visible on the
Goodereen, use the "Print" link next to the map.
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