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PMT15-01571 i City of Menifee Permit No.: PMT15-01571 i 29714 HAUN RD, Type: Residential Alteration MENIFEE, CA 92586 MENIFEE Date Issued: 0 610 9/201 5 { PERMIT Site Address: 29114 BLUE SPRUCE CIR, MENIFEE, CA Parcel Number: 339-443-008 92584 Construction Cost: $0.00 Existing use: 1 &2 Family Residence Proposed Use: Description of HOURLY INSPECTION FOR FIRE DAMAGE ASSESSMENT Work: Owner Contractor PAUL WOOD CALIFORNIA CONSTRUCTION & FIRE 29114 BLUE SPRUCE CIRCLE RESTORATION INC MENIFEE, CA 92584 158 WEST SAN JOSE AVENUE Applicant Phone: 9096252225 EDWARD COSTA License Number:800231 CALIFORNIA CONSTRUCTION & FIRE RESTORATION INC 158 WEST SAN JOSE AVENUE CLAREMONT, CA 91711 Fee Description Ott, Amount(8) Inspections not specified 129 129.07 $156.07 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 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. g DO Z?j ( who builds or improves thereon, and who contracts for the projects with a Expires I D 3! \$Signature it [ I `Y-- 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 ❑ 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 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.leciinfo.ca.qp3L/calaw.htmi. permit is issued.My workers'compensation insurance carrier and policy number are: Carrier FF�1-�0—�� 2 or G� Property Owner or Authorize Agent Date Expires `C) > (I l\ Policy# �Z�—I 1 f ❑ 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 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 Code,I shall forthwith comply with those provisions. Property Owner or Authorized Agent Date `� City Business License# Date;B�O��—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, OYES 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 El 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 DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION FROM THE SOUTH COAST AIR QUALITY MANAGEMENT Lender's Address ❑NO 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 ❑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($500).) CODE, SECTION 25505, 25533 AND 25534 CONCERNING ❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL REPORTING. compensation,will do( ) all of or( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZEDAGENT not intended or offered for sale.(Section 7044, Business and Professions Code; The Contractor's Stale License Law does not apply to an owner of a property X who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale.If,however, the building or improvement is sold within one year of completion,the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). BUILDING & SAFETY • APPLICATION �i: Menifee DATE 0(41 S PERMIT/PLAN CHECK NUMBER 5 - TYPE: O COMMERCIAL "ESIDENTIAL 0 MULTI-FAMILY C) MOBILE HOME C' POOL/SPA SIGN SUBTYPE: C;ADDITION ALTERATION C DEMOLITION C ELECTRICAL {; MECHANICAL O NEW ,C) PLUMBING .) RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK PROJECTADDRESS Sf-fe-k GL--. ASSESSOR'S PARCEL NUMBER -443-� LOT CityofM 09 61YD 7L DPt. ..:ialnn OWNERNAME PftL, p ADDRESS PHONE EMAIL Receive APPLICANT NAME ADDRESS rjg ,'r(7S r u PHONE��,��—z EMAIL CONTRACTOR'S NAME — jl,Q, OWNER BUILDER? 0 YES <LN,5- BUSINESS NAME ADDRESS \ t,,J- S 0&A 1 PHONE -Z'L'2��.g EMAIL�711 �SI�t� ,cm CONTRACTOR'S STATE LIC NUMBER 7J OD LICENSE CLASSIFICATION VALUATION$ e SO FT L SO FT / APPLICANT'S SIGNATURE DATE CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE PAID AMOUNT AMOUNT 1---'CASH --'CHECK# "CREDITCARD VISA/MC PLAN CHECK FEES PAID AMOUNT C%CASH >CHECK 9 CCREDITCARD VISA/MC OWNER BUILDER VERIFIED ':)YES :) NO DLNUMBER NOTARIZED LETTER C% YES City of Menifee Building& Safety Department 29114 Hann Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 CALIFORNIA CONSTRUCTION & Fire Restoration Inc AUTHORIZATION TO SIGN PERMITS FOR CONTRACTOR I Alexar Medina hereby authorize Edward Acosta to act on my behalf in obtaining permits from the Building Department and to sign permit applications, cancel permits, etc. for me. I am properly licensed as required by the State of California for the property address below referenced. I assume full responsibility under the law for permits etc. taken by persons authorized to act on my behalf. I understa authorization is required and is included. Alexar M a Calif0 ' Construction & Fire Restoration, Inc. (909 25-2225 Q State of California I County of Los Angeles On 11 U2,D 14 before me, 11107 107 iJ IW�7YI- Notary public, personally appeared Alexar Medina, proved to me on basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature in the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and :correct. WITNESS my hand and official seal. 0 197 LILI sI 197I Cammttslo� 1909 z Notary Public-Callfomla Lot A"&County Mv Comm.Ex Iret A r 6,2016 r State Lic. #800231 • Prior Lic. #532783 Office: (909) 625-2225 • Fax: (909) 625-2238 • Email: info@caconstructionco.com 158 W. San Jose Ave., • Claremont, California 91711