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PMT15-01047 City of Menifee Permit No.: PMT15-01047 29714 HAUN RD. Type: Residential Electrical <IGCfE-A> MENIFEE, CA 92586 MENIFEE Date Issued: 04/23/2015 PERMIT Site Address: 29982 BOATHOUSE CV, MENIFEE, CA Parcel Number: 333-600-037 92585 Construction Cost: $440.00 Existing Use: Proposed Use: Description of RUN 55 L FT 1" ELECTRICAL CONDUIT FOR FUTURE SPA,220 AMP Work: Owner Contractor DEDRA CLARK J R CONCRETE&LANDSCAPE 29982 BOATHOUSE CV 24992 SPRINGBROOK WY MENIFEE, CA 92585 MENIFEE, CA 92584 Applicant Phone: 9517684136 JR BRIONES License Number: 840495 J R CONCRETE& LANDSCAPE 24992 SPRINGBROOK WY MENIFEE, CA 92584 Fee Description Qty Amount($1 Butldm+ Permitfssuanc0 7i..,k1- Inspections not specified 116 116.00 $144.00 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 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 II Signature ® A licensed contractor(s)pursuant to the Contractors State License Law). WORKEIS�ATION ECLARATION y Lawforthe r""�M� ❑ I am exempt from licensure under the Contractors'State License I hereby affirm under penalty,of perjury one of the following declarations: following reason: I have and will maintain a ce ficate of consent of self-insure for workers' By my signature below I acknowledge that, except for my personal residence in compensation,issued by the Dir 'tor 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 is ,ryd(-/•� r ( built as an owner-building if it has not been constructed in its entirety by licensed Policy# �f.�l�tiX— \ \ contractors. I understand that a copy of the applicable law, Section 7044 of the li�°Cf r Business and Professions Code,is available upon request when this application is sC I have and will maintain workers' compensation insurance, as required is section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:http'L/www.leciinfo.ca.aov/calaw.html. permit is issued, y workers'compensation InsuranQa carrier and Iicy number are: 0 e. _ngNi `1� Property Owner or Authorized Agent Date Carrier a/J�i \�-y" 9 q Cr Expires 0o 1_ 1(fJ Policy# (U ( U /_! ❑ 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($100)or less) with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to enter the above- ❑ I certify that in the performance of the work for which this permit is issued, I identified property for the inspection purposes. shall not employ any persons in any manner so as to become subject to the _ workers' compensation laws of California, and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Pro Owner or Authorized Agent Date Code, I shall forthwith comply with those provisions. /1 City usiness License# '\. Date; 223 /$� Applicant; i WARNING: FAILURE T SECURE WORKERS' HAZARDOUS MATERIAL DECLARATION COMPENSATION COVERAGE � UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER Tq 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, AYES 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 -�,N(O 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 .PERMIT FOR THE CONSTRUCTION OR MODIFICATION FROM THE SOUTH COAST AIR QUALITY MANAGEMENT Lender's Address 7'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: ',9� BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A Any city or county that requires a permit to construct, alter, improve, demolish, ' 0 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 ($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING ❑ 1, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL IAEPORIING. compensation,will do( )all of or ( ) porting of the work, and the structure is PROPERTYOWNER O AUTHORIZED AGENT not intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's State License Law does not apply to an owner of a property X who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale.If,however, the building or improvement is sold within one year of completion, the Owner- Builder will have the burden of proving that it was not built or improved for the / purpose of sale). APPLICATIONL & SAFETY PERMIT/PLAN CHECK �.. Menifee DATE �3 r S PERMIT/PLAN CHECK NUMBER TYPE: C COMMERCIAL \f? RESIDENTIAL :% MULTI-FAMILY t:% MOBILE HOME POOL/SPA 0SIGN SUBTYPE: O ADDITION — ALTERATION C% DEMOLITION &ECTRICAL 0 MECHANICAL ANEW " PLUMBING C: RE-ROOF-NUMBER OF SQUARES DE CRIPTION OF WORK O Ir PROIECTADDRESS ASSESSOR'S PARCEL NUMBER 01 LOT TRACT 3yIO V OWNER NAME - ADDRESS 1 PHONE 50--s-3 3`�D3 EMAIL /^ APPLICANT NAME S4=1 o ADDRESS 2- rrZ / �L PHONE — P 9--J '/ A'j EMAIL Cly CONTRACTOR'S NAME OWNER BUILDE YES kVO BUSINESS NAMpEj 3f e \ ADDRESS `� J, n VD nro PHONE ��-�76�-VI,13� EMAIL /- CONTRACTOR'S STATE LIC NUMBER ( �� LICENSE CLASSIFICATION 'Z 7 ct n / VALUATION$ ` L:�ZIQ FT - L SO.FT S- APPLI( DATE �ITYSTAFF USE ONLY DEPARTMENT DISTRIBUTION / CITY O05, EyIFEEg, s ESSS UINSE NUMBER BUILDING PLANNING ENGINEERI RE GREEN SMIP jj5 55 77 INVOICE PAI AMOUNT AMOUNT % CASH C)CHECK# C%CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT iCASH CHECK# CCREDITCARD VISA/MC OWNER BUILDER VERIFIED '.)YES tD NO DL NUMBER NOTARIZED LETTER C> YES C' NO City of Menifee Building&Safety Department 29714 Hour) Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 PLOT/SITE PLAN CI I Y OF MENIFEE REAR PROPERTY LIN 'fee BUILDING A D S �uuding & Safety Dept. S 1� uNN APPR AL APR 2 3 2015 eived REVIEWED B - *Approval of these p ns shall not be construed to be a permit for,or an f the jederaii,state or city approval of,anyviolal ion of any p�ouisions ooved plans he kept on the regulations and ordin noes. This set of app p jobsite until completi n. Z is z L Uj w w 0 " / w w LO it F ONT PROP LINE Prop ERerty Owners Name r is CYC i a- Property Addressc2- jcq D�j 2— a?x� 4