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PMT15-02108 City of Menifee Permit No.: PMT15-02108 29714 HAUN RD. �CCELA_. MENIFEE, CA 9258E Type: Residential Alteration MENIFEE Date Issued: 10/09/2015 PERMIT Site Address: 25563 PELION RD, MENIFEE, CA 92584 Parcel Number: 339-281-007 Construction Cost: $20,000.00 Existing use: 1 &2 Family Residence Proposed Use: Description of FIRE DAMAGE REPAIR IN GARAGE 468 SO FT Work: Owner Contractor DONNA&JULIAN POLAND GARLAND RESTORATION INC 25563 PELION RD 610 RICHFIELD ROAD MENIFEE,CA 92584 PLACENTIA, CA 92870 Applicant Phone: 7146660190 , CA License Number. 820650 Fee Description ON Amount iS Receptacle,Switch,Outlet&Fixture 1 116.00 Building Permit Issuance 1 27.00 Inspeetlo not specified 367 387.21 Additional Plan Review Building 210 210.00 GREEN FEE 1 1.00 SMIP RESIDENTIAL 1 3.00 $744.21 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_Pemnit_Template.rpt Page 1 of 1 City Of Menifee LICENSED DECLARATION ❑ 1 am exempt from licensure under the Contractors'State License Law for the I hereby affirm under penalty or perjury that 1 am licensed under provisions of following reason: 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 y license is in full force and effect. _ which I must have resided for at least one year prior to completion of License Class i 4C,2 License Z < D improvements covered by this permit, I cannot legally sell a structure that I have Expires D ! Signature �.�c� �--f 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 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 t the following for workers; http://www.leginfo.ca.gov/calaw.htmi. I have and will maintain a certificate of consent of self-insure far 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 action 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'compensafion insurance carrier and policy number are: 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- Carrier CJ4,-,;7r,*5S identified property for the inspection purposes. Policy#_3Z6oc9.S&L7/e Expires ! / Date Property Owner or Authorized Agent (This section need not be completed if the permit is for City Business License# one-hundred dollars($100)or less) ❑ I certify that in the performance of the work for which this permit is issued, I HAZARDOUS MATERIAL DECLARATION shall not employ 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',Vompcnsition provisions of Section 3700 of the Labor amounts s ecified on the Hazardous Materials Information Guide? Code,I shall forthwit com Rh those provision ❑YES NO Applicant; _ Date; e/// S— Will the intended use of the building by the applicant or future building occupant require a permit for the construction or modification from South WARN NG- : FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guideli as SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES Y/J NO 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 boundary fa school? LABOR CODE, INTEREST,AND ATTORNEYS FEES ❑YES NO 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 Califomia Health&Safety Code, on 25505 and 25534 concerning 3097 Civil Code) hazardous material rig. OWNER BUILDER DECLARATIONS DYES 10 I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date c License Law for the reason(s)indicated below by the checkmark(s)I have placed PR TY OWNER R AUTHORIZED AGENT next to the applicable Item(s)(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 firths and comply with she is exempt from Iicensure 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 my employees with wages as their sole www'epa.gov/lead or contact the National Lead Information Center at compensation,will do( )all of or( )porting of the work, and the structure is 1-800-424-LEAD(5323). 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 purpose of sale). Firm Certification No.: ❑ 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 BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION J. Me,nifee DATE PERMIT/PLAN CHECK NUMBER 6�T S/ O�16� TYPE: O COMMERCIAL &RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN t!' SUBTYPE: O ADDITION O ALTERATION O DEMOLITION A tLEQRICAL ,)<MECHANICAL O NEW 4PLUMBING O RE-ROOF-NUMB R OF SQUARES DESCRIPTION OF WORK PROJECTADDRESS ASSESSOR'S PARCEL NUMBER LOT TRACT OWNER NAME ADDRESS �l PHONE EMAIL APPLICANT NAME t� ADDRESS !O Lli [ RCG:�I' [ c•, _q._ T PHONE EMAIL CONTRACTOR'S NAME [. OWNER BUILDER? O YES . -NO ♦r BUSINESS NAME ADDRESS CJ t B PHONE 7 / " EMAIL CONTRACTOR'S STATE LIC NUMBER pic-v(p� LICENSE CLASSIFICATION VALUATION$ p2 a� LSQ FT APPLICANT'S SIGNATURE DATE CITYSTAFFUSEONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE PAID AMOUNT AMOUNT OCASH OCHECK# QCREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# 0 CREDIT CARD VISA/MC OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES 0 NO City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.LIS Inspection Request Line 951-246-6213