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PMT15-01171 City of Menefee Permit No.: PMT15-01171 29714 HAUN RD. GCM-/ MENIFEE, CA 92586 Type: Residential Alteration Gmmmm Wk., MENIFEE Date Issued: 06/05/2015 PERMIT Site Address: 29194 FALL RIVER LN, MENIFEE, CA Parcel Number: 364-290-070 92584 Construction Cost: $6,000.00 '.. Existing Use: 1 &2 Family Residence Proposed Use: Description of GARAGE CONVERSION FROM SALES OFFICE TO GARAGE 643 SO FT Work: Owner Contractor CENTEX/PULTE CENTEX HOMES 27101 PUERTA REAL 6210 STONERIDGE MALL ROAD MISSION VIEJO, CA 92691 SUITE 500 Applicant Phone: 9252493200 ALICE RALL License Number: 992569 CENTEX HOMES 6210 STONERIDGE MALL ROAD SUITE 500 PLEASANTON, CA 94588 Fee Description Qtv Amount is Inspections not specified 129 129.07 $166.07 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 i C4 f Menifee I' 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 ' - )tSignature licensed contractor(s)pursuant to the Contractors State License Law), WORKERS'COMPENSATION DECLARATION ❑ I 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: 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, cannot legally sell a structure that have permit is issued. built as an owner-building if It has not been constructed in Its entirety by licensed Policy# 7.,li 5"(ocp 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 Web site:http://www.leqlnfo.ca.gov/calaw.html. permit is issued.My workers'compensation insurance carrier and policy number are: Carrier O\A::k?� ,rb� r Properly Owner or Authorized Agent Date Expires �--1 —\-5 Policy# YY\L l) 0— 3y2\S'"7etio ❑ By my Signature below, I certify to each of the following: I am the property Name of Agent Phone# y( (z 7_.c"3 -"l\"iZ 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- ❑ 1 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 property Owner or Authorized Agent Date Code, I shall forthwith comply with those provisions. Authorized Date; r\ t l Applicant;�� -s �� -City Business License# Vs S ��_ � 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 ❑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 OYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION FROM THE SOUTH COAST AIR QUALITY MANAGEMENT Lender's Address ONO 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 OYES 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 (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 OYES INFORMATION GUIDE AND THE SCAQMD PERMITTING she is exempt from Iicensure 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 lEPORI'ING. 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 Slate 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). PLCK No- it 6_O' % C I T Y O F M E N I F E F. ! 29714 Haun Road Date: Date Menifee, CA 92586 Amount: mount: Phone: (951)672-6777 Fax:(951)679-3843 Ck#'. Ck#: Building Combination Permit To Be Completed By Applicant Legal Description: Lot 370 Tract 30422-2 Planning Case: F: L Rt: I Property Address 29194 Fall River Lane Menifes,CA Assessors Parcel Number: 3642900070 ProjectlTenant Name: Lakes I I Unit#' Floor#: Name: Centex/Pulte Group Phone No.949.330.8537 Fax No. PropertyAddress: 27101 Puerto Real Mission Viejo,CA. Unit Number Zip Code 92691 Owner Email Address: sohail.bokharl0pultegroup.com Name: Alice Rail Phone No. 951.892.0022 Fax No. Applicant Address: 40810 County Center Drive,Temecula,CA. Unit Number Suite 100 ip Code 92591 Email Address: ARSIIORBF.com Name: Centex/Pulte Group Phone No. .949.330.8537 Fax No. Contractor Address: 27101 Puerto Real Mission Viejo,CA. City, State Zip Code Contractors City Business License No. Contractors City State of California License No. Iasslflcation: A/B 992569 Number of Squares: Square Footage Description of Work: NSFR Plan 16E L3 2822/643 ost of Work: S Applicants Signature .ate.: To Be Completed By City Staff Only Indicate As.R-Recelved or N/A-Not Applicable 5 Completes sets of fully dimensioned,drawn to sale plans which Include 1 set of documents which Include ■ Title Sheet ■ ■ Structural CAlculations ■ ■ ElumbiDa Plan ■ Single Une d1aaram for MP ■ Floor Plan ■ Framing Plan&Details■ Shoring Plan ■ Sound Report-Residential Class Code: Indicate New Construction Alteration' ddition" Means/Meth Work Type. Repair" Retrofit' evision to Existing Permit' es NO Proposed Building Use(s): Existing Building Use(s)' #Buildings: #Units #Stories: Will the Building BasemenKHave Y of I Bldg.Code Occupancy indlcata if Indicate all Geo tech Haz Zone t Project prinklarea NO that 1 Coastal Zone Completion: Indicate Construction YES: apply:y' Types (s): C.fO R q i Noise Zone o Listed on Historic. CITY PLANNING STAFF ONLY APPROVALS: Costal Arch. Review Board Landmark Comm Planning Comm Zoning ommiss Administrator — City Projcctt Elect.Vehicle Charger Landmark Selsmic Retrofit Fee. Exempt Spacial COsa:Bldg Official Approval. Expedite Project(s) Child Care Icity Pro a Green Building Landmark Affordable Housing For Staff Use Only Buildln Safe 'Premit S ecialiS It. ent Comm T H A N K YOU FOR HELPING US CREATE A BETTER COMMUNITY