PMT15-03134 City of Menifee Permit No.: PMT15-03134
29714 HAUN RD. Type: Residential Addition
�GGF1/� MENIFEE,CA 92586
MENIFEE Date Issued: 1 210 9/2 01 6
PERMIT
Site Address: 26679 FARRELL ST, MENIFEE,CA 92586 Parcel Number: 335-293-024
Construction Cost: $68,070.72
Existing Use: 1 &2 Family Residence Proposed Use:
Description of ENCLOSE EXISTING PATIO 408 SO FT WITH ELECTRICAL
Work:
Owner Contractor
JESS CUELLAR
26679 FARRELL STREET
MENIFEE, CA 92586
Applicant License Number:
JESS CUELLAR
26679 FARRELL STREET
MENIFEE,CA 92586
Phone: 9518210917
Fee Descrlotlon Oft t Amount($1
Receptacle,Switch, Outlet&Fixture 18 201.00
Building Permit Issuance 1 27.00
Inspections not specified 387 387.21
Additional Plan Review Building 45 45.00
Additional Plan Review Building 225 225.00
GREEN FEE 1 3.00
SMIP RESIDENTIAL 1 9.00
New Construction Permit Fee 1 313.13
General Plan Maintenance Fee-Building 1 19.36
General Plan Maintenance Fee-Electrical 1 10.05
General Plan Maintenance Fee-New 1 15.66
Construction
$1,255.41
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 ME IFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
I hereby affirm under penalty of perjury that 1 am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and (rrY
I am exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full force and effect he following reason:
License Class License No. y my signature below 1 acknowledge that,except for my personal residence
Expires Signature which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION mprovements covered by this permit.I cannot legally sell a structure that I
ave built as an owner-builder if it has not been constructed in its entirety by
❑I hereby affirm under penalty of perjury one of the following declarations:Icensed contractors.I understand that a copy of the applicable law,Section
have and will maintain a certificate of consent of self-insure forworkers044 of the Business and Professions Code,is available upon request when
compensation,issued by the Director of Industrial Relations as provided forhis application is submitted or at the following website:
by Section 3700 of the Labor Code,for the performance of work for which
this permit is issued. ww.a mf a w.i I. �C ��,�gh /
Policy# ! Date�O.A- IL
PERTY OWNER OR AUTHORIZED AGENT
❑I have and will maintain workers compensation insurance,as required by
section 3700 of the Labor Code,for the performance of the work for which By my signature below I certify to each of the following:I am the property
this permit is issued.My workers compensation insurance carrier and policywner or authorized to act an the property owners behalf.I have read this
number are: pplication and the information I have provided is correct.I agree to comply
Carrier ith all applicable city and county ordinances and state laws relating to
uilding construction.I or a representatives of this city or county to
Policy# Expires ove i of d prop for inspection purposes.
(This section need not to he completed is the permit is for one-hundredDatedollars($100)or less RR OWNER OR AUTHORIZED AGENTo I certify that in the performance of the work far which this permit is issued,
I shall not employ any persons in any manner so as to become subject to the BUSINESS LICENSE#
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes ❑No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)?See permitting checklist
for guidelines
CONSTRUCr10N LENDING AGENCY ❑Yes ❑No
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) o Yes ❑No
OWNER BUILDER DECLARATIONS 1 have read the Hazardous Material Information Guide and the SCAQMD
hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
hazardous material reporting.
checkmark(s)I have placed next to the applicable Rem(s)(Section 7031.5 oyes ❑No
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED AGENT
issuance,also requires the applicant forthe permitto file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING(FIRM
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)or that he or she is exempt from licensure receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to beRRP-certified firms and comply with
than($500).Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property
than
managers who do the paint-disturbing work themselves or through their
X(as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.epa.gov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will he responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or Improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm Is required for this project because:
❑I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Cade:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE I �^ PERMIT/PLAN CHECK NUMBER Q
TYPE: ❑COMMERCIAL MffRESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ❑SIGN
SUBTYPE: EZADDITION []ALTERATION ❑DEMOLITION [-]ELECTRICAL ❑MECHANICAL
[-]NEW []PLUMBING ❑RE-ROOF-NUMBEROFSQUARES
DESCRIPTION OF WORK rQe Yw ,
City of Menifee
PROJECTADDRESS Q Building & Safety De t.
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME
ADDRESS (' E)iva"
PHONE EMAIL
APPLICANT NAME
ADDRESS
PHONE 6 A/7 EMAIL
z,—
CONTRACTOR'S NAME OWNER BUILDER? WYES❑NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER �pQ� LICENSE CLASSIFICATION
VALUATION$ aO, — SC1 b" tea L SO FT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE ' PAIDAMOUNT 1
AMOUNT �50 O CASH O CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZED LETTER O YES 0 NO
City of Menifee Building&Safety Department 29714 Naun Rd. Menifee, CA 92586 951-672-6777
www.citycfinenifee.us Inspection Request Line 951-246-6213