PMT15-03170 City of Menifee Permit No.: PMT15-03170
29714 HAUN RD. Type: Residential Addition
<A-CCEL/? MENIFEE,CA 92586
MENIFEE Date Issued: 12/16/2015
PERMIT
Site Address: 31039 BYERS ST,MENIFEE, CA 92584 Parcel Number: 358-130-011
Construction Cost: $127,999.20
Existing Use: 1 &2 Family Residence Proposed Use:
Description of RESIDENTIAL ROOM ADDITION 336 SO FT
Work:
Owner Contractor
KATHLEEN SWEENEY MITCHELL CONSTRUCTION
31039 BYERS ST 25647 FARMINGTON RD
MENIFEE, CA 92584 MENIFEE, CA 92584
Applicant Phone: 9512266201
JONATHON MITCHELL License Number:928421
25647 FARMINGTON RD
MENIFEE, CA 92584
Fee Description Owl Amount Isl
Services, Switchboards,Control Centers&Panels 1 116.00
Receptacle, Switch, Outlet&Fixture 52 371.00
Plumbing Fixtures and Vents,fixtures 8 141.00
Gas System 1 116.00
Piping/Repiping Single Family Residential 1 163.00
Plan Check Fee 103 102.50
Plan Check Fee 103 102.50
Residential Water Heater 1 83.00
Sewer 1 150.00
Forced-Air or Gravity-Type Furnace or Burner 1 149.00
Air Handling/Condensing Units SFR 1 133.00
Building Permit Issuance 1 27.00
Additional Plan Review Building 23 22.50
Additional Plan Review Building 45 45.00
Additional Plan Review Building 45 45.00
Additional Plan Review Building 180 180.00
Additional Plan Review Building 45 45.00
GREEN FEE 1 6.00
SMIP RESIDENTIAL 1 17.00
New Construction Permit Fee 1 588.80
General Plan Maintenance Fee-Mechanical 1 14.10
General Plan Maintenance Fee-Plumbing 1 32.65
General Plan Maintenance Fee-Electrical 1 24.35
General Plan Maintenance Fee-New 1 29.44
Construction
General Plan Maintenance Fee-New 1 29.44
Construction
$2,733.28
AA_Bldg_Penoit_Template.rpt Page 1 of 2
City Of Menifee
LICENSED DECLARATION ❑ lam exempt from licensure under the Contractors'State License Law for the
I hereby affirm under penalty or perjury that I 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 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 jilb. fdW11 X improvements covered by this permit,I cannot legally sell a structure that I have
Expires �—r�'F{—17 Signature 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 DEC RATION Business and Professions Code,is available upon request when this application is
11 submitted or at the following Web site:
❑ 1 hereby affirm under penalty of perjury one of the following declarations: htto://www.lealnfo.ca.cov/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 orAulhorized 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 owners 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 carder and policy number are: with all applicable city and county ordinances and state laws relating to building
construction t� a rs of this city or county to enter the above-
Carrier identified ring rfor a�InpspecUonpurposes. 1
Policy# Expires 71EDate
Pro rty wner orAuthorized Agent
(This section need not be completed if the permit Is for ity Business License#
one-hundred dollars($100)or less)
AsI certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
all not emolov 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 forth 'th mply with those provisions. DYES �+NO
i ! `
Applicant; Date; /1 —/�. "/5 Will the intended use of the building by the applicant or future building
occupant require a permit for the construction or modification from South
WARNI FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist
COMP NSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUB CT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES )kNO
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 of a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES AND
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& afety Code,Section 25505 and 25534 concerning
3097 Civil Code) hhazardous,�teri r porting.
OWNER BUILDER DECLARATIONS raYES "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 PR R' OWNER ORAUTHORIZED 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, A ENOVATION 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 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.gov/lead or contact the National Lead Information Center at
❑ I, as owner of 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 Finn 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 Firm Certification No.:
purpose of sale).
❑ I, as owner of the properly an exclusively contracting with licensed No EPA Lead-Safe Certified Firm is required for this project because:
contractors to construct the project(Section 7D44, 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