The URL can be used to link to this page

PMT15-02683 i i I 4 City of Menifee Permit No.: PMT15-02683 29714 HAUN RD. Type: Residential Alteration L� MENIFEE, CA 92586 MENIFEE Date Issued: 08/28/2015 9 1 PERMIT s Site Address: 27528 VIA REAL, MENIFEE, CA 92585 Parcel Number: 333-282-026 99 Construction Cost: $1,200.00 Existing Use: 1 &2 Family Residence Proposed Use: Description of ADD FAN LIGHT COMBO, NEW TUB,TOILET&VANITY, MOVE COLD WATER AT VANITY 4" Work: Owner Contractor CATHERINE MACKENZIE AAA RESTORATION INC 27528 VIA REAL 29850 2ND STREET MENIFEE, CA 92585 LAKE ELSINORE, CA 92532-2420 Applicant Phone: 9514715828 KIRK MUNIO License Number: 834839 AAA RESTORATION INC 29850 2ND STREET LAKE ELSINORE, CA Fee Description Q_yt Amount 1$1 Plumbing Fixtures and Vents, fixtures 4 121.00 GREEN FEE 1 1.00 $265.00 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_Templatesirt Page 1 of 1 i City Of Menifee LICENSED DECLARATION i 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 III, Professions Code and my license is in full fp{/ c d 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 > Signature licensed contracer(s)pursuant to the Contractors State License Law), WORKERS'COMPENSATION DECLARATION ❑ I am exempt from licensure under the Contractors'Slate 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 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 w rov I mus covered e this ermat cannot le all sell i structure that have permit Is issued. P y p legally 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 ❑ 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 Ieginfo ca gov/calaw html. permit is issued.My workers'compensation insurance carrier and policy number are: Carrier AVY1Fr(<f9✓E Property Owner or uthorized Agent Date Expires Policy# C'5 / h 00!iocf Name of Agent le,9 J Phone ❑ By my Signature below, I certify to each of the following: I am the property 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- ❑ I certify that in the performance of the work for which this permit is issued,I identified property f r 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 Authorize�pdrAAgent (/� Date Date; ' �5-/b Applicant; City Business License# l✓ 3-7�" 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, EYES OCCUPANT HANDLE 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 3097 Civil Code) WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE Lender's Name DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION Lender's Address �NO FROM THE SOUTH COAST AIR QUALITY MANAGEMENT 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 DYES 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 DYES INFORMATION GUIDE AND THE SCAQMD PERMITTING she is exempt from Iirensure 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($500).) CODE, SECTION-25505, 25533 AND 25534 CONCERNING ❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL REPORTING. compensation, will do ( ) all of or( ) porting of the work, and the structure Is PROPERTY OWNER OR AUTHORIZED AGENT not intended or offered for sale.(Section 7044, Business and Professions Code; The Contractor's State License Law does not apply do an owner of a property X �O%��i= who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale. If,however, the building or improvement is sold within one year of completion, the Owner- Builder will have the burden of proving that it was not built or Improved for the Purpose of sale). APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK Menifee DATE O y- 45 PERMIT/PLAN CHECK NUMBER TYPE: () COMMERCIAL ^ RESIDENTIAL u MULTI-FAMILY OMOBILEHOME POOL/SPA <" SIGN SUBTYPE: ADDITION �"ALTERATION C DEMOLITION <:" ELECTRICAL c:" MECHANICAL 0 NEW C" PLUMBING 0 RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK Iqn1" Iign om& . 41kmu l 7,uge / /4—r t A / 070ve Cali LuiiEIC of PROJECTADDRESS Z? 5-29' v1)9, L Stt/Y l ASSESSOR'S PARCEL NUMBER 3 -a�� LOT ,� TRACT OWNER NAME C)gTH /1'IRC/rtY12l� ADDRESS PHONE /` EMAIL APPLICANT NAME J� ry evY9y7l ADDRESS PHONE EMAIL AAA— jWn ION -MM CONTRACTOR'S NAME /4 1C m ,'64 OWNER BUILDER? " YES NO BUSINESSNAME fg90 Zn, 41- A0- El, ADDRESS K OV' 10tj PHONE g6I 619- O12,H EMAIL j1 CONTRACTOR'S STATE LIC NUMBER g341 LICENSE CLASSIFICATION C 0.�/ G33 VALUATION$ 1,2 Oa SQ FT 50 L SQ FT APPLICANT'S SIGNATURE 5Us DATE CITY STAFF USE ONLY DEPARTMENTDISTRIBUTION - �� CITY OF MENIFEL 15-1 ICEfJ LWBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP ��//JJ� //10��,J.• 111 INVOICE \/-�—] PAID AMOUNT `.-'CASH '.'CHECKp ii CREDIT CARD VISA/MC AMOUNT R(0v PLAN CHECK FEES PAID AMOUNT C-' CASH '."CHECK# �'CREDITCARD VISA/MC OWNER BUILDER VERIFIED •`-:%YES O NO DL NUMBER NOTARIZED LETTER `" YES C NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 � - - / r- \ 7 2 Q e K 2 - 3 _ ■ 0 7 2 ate . _ - ! / ! « . ��----- - ----- - > - o q _ r3- \ 2 L _ \ 2 � � _ m . \ / \K CD ) {\ D i ! « � � f e- :