PMT15-01847 City of Menifee Permit No.: PMT15-01847
29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Alteration
MENIFEE Date Issued: 09/02/2016
PERMIT
Site Address: 28363 PINYON PINE CT, MENIFEE, CA Parcel Number: 336-461-019
92585 Construction Cost: $5,000.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of FIRE DAMAGE REPAIR: EXTERIOR PLASTER REMOVAL, REPLACE EXTERIOR WINDOW,
Work: REPLACE RAFTER AS NEEDED, REPLACE FASSIA AS NEEDED
Owner Contractor
DALE SPARKS TEAM 1 RESTORATION INC
28363 PINYON PINE CT 42088 RIO NEDO STE 102
MENIFEE, CA 92585 TEMECULA, CA 92590
Applicant Phone: 9516342712
KANSAS SPOUSTA License Number: 941432
TEAM 1 RESTORATION INC
42088 RIO NEDO STE 102
TEMECULA, CA 92590 -
Phone: 9516342712
Fee Description gyt Amount I$1
s :0
Residential Water Heater 1 83.00
Air Handling/Condensing Units SFR 1 133.00
Additional Plan Review Building 180 180.00
e , , Il,ig
GREEN FEE 1 1.00
$734.00
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 thereunderwhen 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_Bidg_Permit_Templatexpl Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ lam exempt from licensure under the Contractors'State License Law for the
following reason:
I hereby affirm under penalty or perjury that I am licensed under provisions of
Chapter 9(commencing with section 7000)of Division 3 of the Business and By my signature below I acknowledge that, except for my personal residence in
Professions Code and my license is in full force and effect. which I must have resided for at least one year prior to completion of
License Class Licens improvements covered by this permit, I cannot legally sell a structure that I have
Expires 11_�Zxilll2 S Signature A/ uilt 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
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application is
submitted or at the following Web site:
❑ I hereby affirm under penalty of perjury one of the following declarations: http://www.leginfo.ca.00v/calaw.html.
I have and will maintain a certificate of consent of self-insure for workers'
compensation, issued by the Director of Industrial Relations as provided for by Date
Section 3700 of the Labor Code, for the performance of work for which this
permit is issued. Property Owner or Authorized Agent
Policy# ❑ By my Signature below, I certify to each of the following: I am the property
I have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read this
Section 3700 of the Labor Code, for the performance of the work for which this application and the information I have provided is correct. I agree to comply
permit is issued.My workers'compensation insurance carrier and policy number are: with all applicable city and county ordinances and state laws relating to building
G�Ln,,� I� constructi n.I authori representatives of this city or county to ente the above-
Carrier f,VTA`W�' ANt INS' id nt e poperty foi the insp ci np rposes. (�'
Policy# 530000 h-�b Expire Al Date
Pr pe Owneror At horized Ag�enn q��7
(This section need not be completed if the permit is for City Business License lt 034OJ
one-hundred dollars($100)or less)
HAZARDOUS MATERIAL DECLARATION
❑ I certify that in the performance of the work for which this permit is issued,I
shall not emolov any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or a
workers' compensation laws of California, and agree that if I should become mixture containing a hazardous material equal to or greater that the
subject to the workers' Mpensation visions of Section 3700 of the Labor amounts pecified on the Hazardous Materials Information Guide?
Code, I shall with cprovisionns �� �^ ❑YES NO
Applicant;, O 4 Ll1 J Will the in ended use of the building by the applicant or future building
occupant require a permit for the construction or modification from South
WARNIIN FAILURE TO SE URE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL forguidew s
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND ❑YES 0
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE bounds ofa school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES L�JO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist. I understand my requirements under the State of
agency for the performance of the work which this permit is issued (Section California Health Safety Code,Section 25505 and 25534 concerning
3097 Civil Code) Mhamatei al reporting. �qy
OWNER BUILDER DECLARATIONS 2 n
1 hereby affirm under penalty of perjury that I am exempt from the Contractor's Date v�l
License Law for the reason(s)indicated below by the checkmark(s)I have placed P OP RTY OWNE ORAUTHORIZED AGENT
next to the applicable items(Section 7031.5. Business and Professions Code:
Any city or county that requires a permit to construct, alter, improve, demolish, EPA RENOVATION REPAIR AND PAINTING(RRP)
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 The EPA Renovation, Repair and Painting(RRP)Rule requires contractors
provisions of the Contractor's State License Law (Chapter 9 (commencing with receiving compensation for most work that disturbs paint in a pre-1978
Section 7000)of Division 3 of the Business and Professions Code)or that he or residence or childcare facility to be RRP-certified firms and comply with
she is exempt from licensure and the basis for the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than($500).) employees.For more information about EPA's Renovation Program visit:
❑ I, as owner of the property, or m employees with wa es as their sole www.epa.gov/lead or contact the National Lead Information Center at
P P Y Y9 1-800-424-LEAD(5323).
compensation,will do( )all of or( ) porting of the work, and the structure is
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 ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however, Certified Firm Name:
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 Firm Certification No.:
purpose of sale).
❑ I, as owner of the property an exclusively contracting with licensed No EPA Lead-Safe Certified Firm is required for this project because:
contractors to construct the project(Section 7044, Business and Professions
Code:The Contractor's License Law does not apply to an owner of a property
who builds or improves thereon, and who contracts for the projects with a
licensed contractor(s)pursuant to the Contractors State License Law). If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
& SAFETY PERMIT/PLAN CHECK APPLICATION
°y
Menifee
DATE 0 PERMIT/PLAN CHECK NUMBER PM $ 1
TYPE: {'COMMERCIAL RESIDENTIAL ' MULTI-FAMILY MOBILE HOME 'L% POOL/SPA () SIGN
SUBTYPE: O ADDITION %ALTERATION C) DEMOLITION C) ELECTRICAL O MECHANICAL I�
O NEW O PLUMBING 0 RE-ROOF-NUMBER OF SQUARES j
I
DESCRIPTION OF WORK MQe parMa Q epa\ 12
e`P\ace ext w> ON e s *Qea'ecl
I ck%O G Czep\ace aS r« eae a
PROJECTADDRESS \lV O \\\,I
ASSESSOR'S PARCEL NUMBER 3'�11�� 41.¢\-p\ G-� LOT TRACT
OWNERNAME \'QQQ"(Z
City ng & Safety
ee
ADDRESS
�03 3 1N UN N Building Safety D pt.
PHONE EMAIL
APPLICANT NAME _T' M O - 1 O. OU Ca
ADDRESS 2Q'�bb IC-\U U 4aQUZ M U\ (A q 9
Cl0 RP'CefVP'
PHONE qS , - u3A .211'L EMAIL
CONTRACTOR'S NAME - OWNER BUILDER? OYES ': NO
BUSINESSNAME 'QO,t\(\ \ �0_'i�_S QCk6C) \NC-
ADDRESS �2C )OO 10 N dO 'S \U2
PHONE gGj1 l.P 2-1 )12 EMAIL (J\Q,
CONTRACTOR'S STATE LIC NUMBER Q 4- 432 LICENSE CLASSIFICATION
VALUATION$ rS I (DOU - 0U SOFT LSQFT
APPLICANT'S SIGNATURE - DATE
rCITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT I I CCASH ='CHECK# CCREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT C)CASH :%CHECK# �,CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES C) NO OLNUMBER NOTARIZED LETTER YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6 777
www.cityofinenifee.us Inspection Request Line 951-246-6213