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PMT15-01536 { City of Menifee Permit No.: PMT15-01636 29714 HAUN RD. ';RCCeL.t"�?` MENIFEE, CA 92586 Type: Residential Addition MENIFEE Date Issued: 06/05/2015 PERMIT Site Address: 25913 WEST WINDS DR, MENIFEE, CA Parcel Number: 329-262-018 92585 Construction Cost: $900.00 Existing use: 1 &2 Family Residence Proposed Use: Description of INSTALLATION OF CARPORT AWNING TO NEW MANUFACTURED HOME 12'X 60' Work: Owner Contractor STACY D FELTS TERRA FIRMA CONSTRUCTION INC 25913 WEST WINDS DR 913 MAPES ROAD MENIFEE, CA 92585 PERRIS, CA 92570 Applicant Phone: 9517575731 BRUCE EVANS License Number: 796315 TERRA FIRMA CONSTRUCTION INC 913 MAPES ROAD PERRIS, CA 92570 Fee Description - City Amount is Deck/Patio, non-standard 1 133.00 SMIP RESIDENTIAL 1 1.00 $162.00 The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and specifications or from preventing builiding operations being carried on thereunder when in violation of the Building Code or of any other ordinance of City of Menifee. Except as otherwise slated, a permit for construction under which no work is commenced within six months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be forfeited. AA_Bldg_Permit Template.rpt Page 1 of 1 City Of Menifee i LICENSED DECLARATION I hereby affirm under penalty or perjury that I am licensed under provisions of ❑ I, as owner of the property an exclusively contracting with licensed Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professions Professions Code and my license is in full ore e ec,$.- Code:The Contractor's License Law does not apply to an owner of a property License Clas C Licens No. J who builds or improves thereon, and who contracts for the projects with a Expires Signature licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'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, 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 __L.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:httpa/www.leginfo.ca.gov/calaw html. permit Is issued.My workers'compensation insurance carrier and policy number are: Carrier -C,ll(y- t 'T_-Z AIA-(Wrt/V`C Property Owner or Authorized Agent Date Expires Policy# ❑ 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- El I certify that y the performance the work for which this permit is issued, id lf�d property FAhe inspe if n purposes. shall not employ any persons in any manner so as to become subject 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. WA City Business License# Date � pllcant; �j'—� ( -� 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, AYES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE ,� MIXTURE CONTAINING A HAZARDOUS MATERIAL LABOR CODE, INTEREST,AND ATTORNEYS FEES ,.ENO 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 GUIDE9 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 0 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 ❑YES 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, �—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 _nyffS_I N FORMATION 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 REPORTING. compensation, will do ( )all of or ( ) porting of the work, and the structure is JZN PR Yt R(q U r�;t) GENT not intended or offered for sale.(Section 7044,Business and Professions Code; iV`� -v.._ 'Y V 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). BUILDINGPERMIT/PLAN APPLICATION Menifee DATE 6 v - I S PERMIT/PLAN CHECK NUMBER TYPE: 0 COMMERCIAL -1-RESIDENTIAL ii MULTI-FAMILY 0MOBILE HOME i:1 POOL/SPA %SIGN j SUBTYPE: <:i ADDITION 0 ALTERATION v'DEMOLITION O ELECTRICAL (:; MECHANICAL O NEW O PLUMBING 0 RE-ROOF-NUMBER OF SQUARES 7 DESCRIPTION OF WORK OF S( X/S-TIN q QM (AIJM vr�� I u_w /15i W PROJECTADDRESS (22 v)�1 w ((Ia4 V6 .Y ASSESSOR'S PARCEL NUMBER ,jlrf 2 6;?Dj�- 1 LOT l 3 TRACT S t7 OWNER NAME > IrS ADDRESS 3 e-J-- tiJ V�irJS .D04 N1.bCJAA/F) (�. ZS PHONE �S(�y�� b -� EMAIL APPLICANT NAME 56rw cc- F rk� ADDRESS I . C4,0,- ZS � PHONE EMAIL CONTRACTOR'S NAME OWNER BUILDER? is YES '-' NO BUSINESS NAME r0ty'k- R 14�', )&)C, ADDRESS kl- Lm .LSS CAW- PHONE q5-I -S��a'�7 I EMAIL CONTRACTOR'S STATE LIC NUMBER ' 63/s LICENSE CLASSIFICATION C VALUATION $ SO L SO FT [I APPLICANT'S SIGNATURE r DATE I DEPARTMENT DISTRIBUTION I� CITY OF MENIELE B SINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP (a�j INVOICE PAID AMOUNT AMOUNT 'J CASH C%CHECK# ;.''CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT CASH CHECK# CREDIT CARD VISA/MC OWNER BUILDER VERIFIED DYES 0 NO DLNUMBER NOTARIZED LETTER > YES Q NO City of Menifee Building&Safety Department 29714 Noun Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 �R1S ri X�l� SCHOOL FACILITES FEE WAIVER DATE: 6/5/15 "Growing Together Through Education" TO: DEPARTMENT OF BUILDING &SAFETY 2010.2011 Advanced Placement Achievement District SUBJECT: Board of Trustees Edward Agundez Applicant's Name: Bruce Evans Joan D.Cooley William F.Hulstrom Owner: Bruce Evans David G.Nelissen Carolyn A.Twyman Building Dept. Permit#(s): PMT 15-01535 Jonathan L.Greenberg,Ed.D. Assessor Parcel#(APN): 329-262-018 Superintendent Project Address: 25913 West Winds Dr Candace Reines Assistant Superintendent Menifee, CA Business Services Marcy savage Applicant's Current Address: 25913 West Winds Dr Assistant Superintendent Educational Services Menifee, CA Steve Swartz Applicant's Phone#: (951) 757-5731 Assistant Superintendent Human Resources TO WHOM IT MAY CONCERN: District Administration Center 155 E.Fourth Street The Perris Union High School District does not intend to collect School Facilities Perris,CA 92570 fees(Developer Fees on the above-mentioned project because of the following 951-943-6369 ( P ) P 1 g Fax Numbers: reason(s): Mobile Home Replacement. Therefore, building permits for this Superintendent's Office project may now be issued by your jurisdiction. 951-940-5378 Business Services 951-940-5301 Sincere) Human Resources Y, 951-943-9852 n Student Services Center 1151 N.A Street Perris,CA 92570 Perris Union High School District 951-943-6369 Facilities Planning Department Fax:951-943-6799 District Website: www.puhsd.org