PMT15-02825 City of Menifee Permit No.: PMT15-02825 9
29714 HAUN RD. Type: Residential Electricals,
MENIFEE, CA 92586
s xwnr. n MENIFEE Date Issued: 09/11/2016
PERMIT
Site Address: 30284 OISE DR, MENIFEE, CA 92584 Parcel Number: 364-122-039
i
Construction Cost: $1,000.00
Existing Use: Proposed Use:
Description of ADD 5 CAN LIGHTS, 2 PENDANTS, 1 SWITCH IN KITCHEN
Work:
Owner Contractor
MICHELLE PRINGLE A A A RESTORATION INC
30284 OISE DR 29850 2ND STREET
MENIFEE, CA 92584 LAKE ELSINORE, CA 92532-2420
Appiicant Phone: 9514715828
JOSH BRUNETTE License Number: 834839
A A A RESTORATION INC
29850 2ND STREET
LAKE ELSINORE, CA
Fee Description Qtty Amount($1
Building Permit Issuance 1 27..00
General Plan Maintenance Fee-Electrical 1 7.55
$186.55
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
City Of Menifee
LICENSED DECLARATION ❑ I am 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 License,,N,/A. 3t-1 u i 9 improvements covered by this permit, I cannot legally sell a structure that I have
Expires 3-'�I-I t? Signature_ _±�, t built as an owner-building if it has not been constructed in its entirety by licensed
UUU"'��` contractors. 1 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:
❑ hereby affirm under penalty of perjury one t the following declarations: http://www.leciinfo ca ciov/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
construction.I authorize representatives of this city orcounty to enter the above-
Carrier r"61-'t-Pief identife ro e y f Date
or the inspection purposes.
Posey# CSr 5(,oSdy'� Expires t]'Id 7
1
Prope Owner or Authorized�Agent
(This section need not be completed if the permit is for City Business License# V 7&3q
one-hundred dollars($100)or less) y
El HAZARDOUS MATERIAL DECLARATION I certify that in the performance of the work for which this permit is issued,I -
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'compensation provisions of Section 3700 of the Labor amounts specified on the Hazardous Materials Information Guide?
Code, I shall forthwith comply with those provisions. ❑YES N NO
Applicant; Date;� Will the intended use of the building by the applicant or future building
occupant require a permit for the construction or modification from South
WARNING: FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAOMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL forguidelines
---SUBJECT-AN-EMPLOYER-TO-CRIMINAL"PENALTIES-AND - - ---__---- - ---- -__- - -- —-- -
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS DYES ENO
($1 00,000), 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 of a school?
LABOR CODE, INTEREST, AND ATTORNEYS FEES DYES 6LNO
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) hazardous material reporting.
OWNER BUILDER DECLARATIONS DYES N NO
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OWNER OR AUTHORIZED AGENT
next to the applicable dem(s) (Section 7031.5. Business and Professions Code:
Any city or county that requires a permit to construct, alter, improve, demolish, EPA RENOVATION. REPAIRAND 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 7D00)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:
www.epa.govdead or contact the National Lead Information Center at
❑ 1, as owner or the property, or my employees with wages as their sole 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 purpose of sale). Firm Certification No.:
,, �
❑ I, as owner of the property an exclusively contracting with licensed V41 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 No?u T x I„^-�
1 '�T d 55 J ff lf�
who builds or improves thereon, and who contracts for the projects with a rAC f1Dr'Yr6 �,- /q.}^� ��SS 'rV�ilrn /,y y�
Ilcensed contractor(s)pursuant to the Contractors Slate License Lasv). If your project does not comply with EPA RRP rule please fill not the RRP
t • & SAFETY PERM IT/PLAN CHECK IT/PL. APPLICATION
Menifee
DATE 9.11 -i1 PERMIT/PLAN CHECK NUMBER
TYPE: " COMMERCIAL - RESIDENTIAL j MULTI-FAMILY 0 MOBILE HOME ? POOL/SPA SIGN
SUBTYPE: " ADDITION O ALTERATION O DEMOLITION OELECTRICAL % MECHANICAL
C% NEW 0PLUMBING C% RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK AoR Z TZ1h DAIn TS - SWI rM,
PROJECTADDRESS ?O&fq Oise vr. fie"i J-tww!�fJ q
ASSESSOR'S PARCEL NUMBER �� l�oZw LOT � TRACT o 1
OWNER NAME ry11Ch E 116� 5n L,E
ADDRESS
PHONE � 5n 0�-'1�' (� 1 L I EMAIL
APPLICANT NAME 044
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME %- OWNER BUILDER? 0 YES "'.' NO
BUSINESS NAME PjM yf2rA,1*Tj0N
ADDRESS tg r-6614,ft
PHONE s-tg'o zq EMAIL
CONTRACTOR'S STATE LIC NUMBER 3 LICENSE CLASSIFICATION C"S U3
VALUATION$ DOD SO FT L SQ FT
APPLICANT'S SIGNATURE DATE
CITYSTAFF USE ONLY
DEPARTMENT U151KIBUIIUN ap CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE I Q�,., yj 'rJ PAID AMOUNT
AMOUNT CTE�. CASH CHECK It C%.CREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT % CASH C%CHECK# %CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0'YES NO DLNUMBER NOTARIZED LETTER Q YES C% NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92585 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-245-6213
City of Nienifea
Building & Safety Dept.
SEP 1 1
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CITY OF
BUILDING AND SAFETY DEPARTMENT V
i`?.AN APPROVAL s
U,'OEWE.D Pz ---
`A L,cwli of tnese r a 00 a permit for,or an
apl:ovai ut, any viola top of -N 0V federal,state or rity -'5
regulations and ordinances. This set of approwl plans must be kept on the ,
jobsite until completion. .w