PMT15-02826 i
City of Menifee Permit No.: PMTIB-02826
29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Alteration
MENIFEE Date Issued: 09/11/2015
i
PERMIT
Site Address: 29942 TWIN LAKES RD, MENIFEE, CA Parcel Number: 333-590-002
92585 Construction Cost: $4,000.00
Existing use: 1 &2 Family Residence Proposed Use:
Description of BATHROOM-NEW TUB&SHOWER VALVE, NEW SHOWER PAN, RE-INSTALL TUB. KITCHEN-ROTATE
Work: ISLAND, MOVE ALL PLUMBING& ELECTRICAL IN ISLAND,ADD 2 PLUGS
Owner Contractor
ROBYN ARREOLA AAA RESTORATION INC
29942 TWIN LAKES RD 29850 2ND STREET
MENIFEE, CA 92585 LAKE ELSINORE, CA 92532-2420
Applicant Phone: 9514715828
JOSH BRUNETTE License Number: 834839
A A A RESTORATION INC
29850 2ND STREET
LAKE ELSINORE, CA
Phone:9515790724
Fee Description Qtv Amount IS
Plumbing Fixtures and Vents, fixtures 3 116.00
IN I
u i
Inspections not specified 387 387.21
GREE 11
SMIP RESIDENTIAL 1 1.00
ille .
General Plan Maintenance Fee-Plumbing 1 5.80
$684.42
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 building 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 G License N �ruR " 3_7 improvements covered by this permit, I cannot legally sell a structure that I have
Expires "3-'3 1.1 P Signature built as an owner-building if it has not been constructed in its entirety by licensed
V _ 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 the following declarations: http://www teginfo ca gov/calaw html.
I have and will maintain a certificate of consentt 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
❑ 1 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 or county to enter the above-
Carrier. MMW,, 1:PLti idenh(fifio o e y for the inspection purposes.
Policy# CST Syp Sdyg- Expires 3-31• 10 %- , Date r �i l7
Property Owner or Authorized Agent ?(This section need not be completed if the permit is for City Business License# 7
one-hundred dollars($100)or less) Y
ClI 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'compensation provisions of Section 3700 of the Labor amounts specified on the Hazardous Materials Information Guide?
Code, I shall forthwith comply with those provisions. DYES q 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(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
----SUBJECT-AN-EMPLOYER_-TO-CRIMINAL-PENALTIES AND ---" - " "--"" --_-- _---- _ -- --- _- -- ---
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS DYES QNO
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feetof the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of a school?
LABOR CODE, INTEREST, AND ATTORNEYS FEES DYES S(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 California Health&Safety Code,Section 25505 and 25534 concerning
3097 Civil Code) hazardous material reporting.
OWNER BUILDER DECLARATIONS EYES L9 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 bem(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 fRRP)
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 licensors 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:
El I, owner of the property, or my employees with wages their sole
compensation,will do ( ) all of or ( ) porting of the work, and thee www.epa.govdead or contact the National Lead Information Center at
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 AEAo 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
who builds or improves thereon, and who contracts for the projects with a --
( sh e s/:arc 4655 Tf+Wn
licensed contractorFs)pursuant to the Contractors State License Law). If your protect does not comply with EPA RRP rule oleosa fill nut the RRP
it
1�BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE 9'll lh PERMIT/PLAN CHECK NUMBER
TYPE: 0 COMMERCIAL `" ESIDENTIAL MULTI-FAMILY 0 MOBILE HOME <i POOL/SPA SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION G ELECTRICAL C MECHANICAL
NEW "" PLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK AID A/PM/ -TµlS zr SYfow6v t/q Lvc • /t/G,.0 SHowo(t Ymn
P-e, inSf(gn -rW6 mode 411 FIA4M69� C-,Lbr7v,'e.nL Z IPL,4,7S
PROJECT ADDRESS Z`I°I y? -Tw,h Lq 111E+1,eE
ASSESSOR'S PARCEL NUMBER -,1� " `a"�U� LOT _ TRACT
OWNER NAME P h ArrtOW9-
ADDRESS PHONE q6
'- l /p1
o 5L15(P EMAIL
APPLICANT NAME J661i
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME KCr1- Vv An,`g OWNER BUILDER? OYES C; NO
BUSINESS NAME I\AA -O o
ADDRESS 2qJ4 op _J .
PHONE 961- ;11.01 m d EMAIL
CONTRACTOR'S STATE LIC NUMBER D Tj 49 31 LICENSE CLASSIFICATION C 3 3
VALUATION$ 060 SO FT 45 6 L SO FT
APPLICANT'S SIGNATURE DATE
OTY STAFF USE ONLY
DEPARTMENT DISTRIBUTION ,�'•� iG� CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING EN'•GIttNEER/NG FIRE GREEN U" SMIP L 'V
INVOICE �t'� PAID AMOUNT
AMOUNT $ 'CASH 0CHECK# '-'CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT C;CASH )CHECK# : CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED `',.YES Cl NO DL NUMBER NOTARIZED LETTER i) YES `% NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
r www.cityofinenifee.us Inspection Request Line 951-246-6213
1
City
Building & Safety Dept.
SEP 1 1 2M CITY OF MENIFEE
Received BUILDING AND SAFETY
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PLAN APPROVAL
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may, icy
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