PMT15-03395 City of Menifee Permit No.: PMT15-03395
29714 HAUN RD. T Residential Addition
�l-�CCEL/� MENIFEE, CA 92586 yam'
MENIFEE Date Issued:
01/28/2016
PERMIT
Site Address: 28410 TULITA LN,MENIFEE, CA 92584 Parcel Number: 388-042-003
Construction Cost: $45,864.00
Existing use: 1 &2 Family Residence Proposed use:
Description of ADD 1260 SQ FT ATTACHED GARAGE W/ELEC.
Work:
Owner Contractor
DAVID KOWALESKI
28410 TULITA LANE
Applicant License Number:
DAVID KOWALESKI
28410 TULITA LANE
MENIFEE,CA
Phone: 9092387946
Fee Description gttv Amount 1E1
Receptacle, Switch, Outlet&Fixture 12 171.00
Plan Check Fee 205 205.00
Building Permit Issuance 1 27.00
Inspections not specified 516 516.28
Additional Plan Review Building 225 225.00
GREEN FEE 1 2.00
SMIP RESIDENTIAL 1 6.00
New Construction Permit Fee 1 210.97
General Plan Maintenance Fee-Electrical 1 8.55
General Plan Maintenance Fee-New 1 10.55
Construction
$1,382.35
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 varied 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_Templale.rpt Page 1 of 1
City Of Me}},nifee
LICENSED DECLARATION kI am exempt from licensure under the Contractors'Stale License Law for the
cfollowing 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 No. improvements covered by this permit, I cannot legally sell a structure that I have
Expires 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 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 of the fallowing declarations: htt .le fnfo.ce. ov/ca�ht
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 (t7i(,{n, 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 career 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 ida, iW property r e f p purposes.
Policy# Expires �� Date ) ( )/'
Property Owner orAuthorized Agent
(This section need not be completed if the permit is for City Business License#
one-hundred dollars($100)or less)
HAZARDOUS MATERIAL DECLARATION
❑ 1 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. DYES ❑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 pemritting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES ❑NO
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 ❑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 El YES ❑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 item(s)(Section 7031.5. Business and Professions Code:
Any city or county that requires a permit to construct, alter, improve, demolish, EPA RENOVATION.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 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:
❑ I, as owner of the roe or m employees with wa es as their sole www'epa.gov/lead or contact the National Lead Information Center at
property,rty� Y9 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).
❑ 1, as owner of the property an exclusively contracting with licensed ❑No EPA Lead-Safe Certified Finn 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
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
Acknowledgement.
\\ I 1 ^6
�INL- I
SAFETYBUILDING & • APPLICATION
`Menifee
DATE //"3-TS� PERMIT/PLAN CHECK NUMBER lS-033�5
TYPE: ❑COMMERCIAL ❑✓ RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑✓ ADDITION ❑ALTERATION []DEMOLITION ❑ELECTRICAL ❑MECHANICAL
[:]NEW ❑PLUMBING ❑RE-ROOF-NUMBEROFSQUARES
DESCRIPTION OF WORK Add 1260 sq ft attached garage U3
PROJECT ADDRESS 28410 Tulita Ln. Menifee,CA 92584
ASSESSOR'S PARCEL NUMBER 388-042-003 LOT 16 TRACT 7730-1
PROPERTY OWNER'S NAME David Kowaleski City of Menifee
w I
ADDRESS 28410 Tulita Ln.Menifee,CA 92584
PHONE (909)238-7946 EMAIL dkowalesk@gmail.com
APPLICANT NAME David Kowaleski
ADDRESS 28410 Tulita Ln. Menifee,CA 92584
PHONE (909)238-7946 EMAIL dkowalesk@gmail.com
CONTRACTOR'S NAME OWNER BUILDER? ❑✓ YES❑NO
BUSINESS NAME
ADDRESS
PHONE - EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ LA'3 WI SQF7j LSQFT
APPLICANT'S SIGNATURE DATECITY STAFF LISE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN 2 SMIP
INVOICE PAID AMOUNT /1/1 ^,
AMOUNT OH '*CHECK# 411SE'1 OCREDITCARD VISA(MC
PLAN CHECK FEES PAID AMOUNT (/'l OCASH CHHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES G No DL NUMBER NOTARIZED LETTER Q YES 0 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
• • .IN ••
° e
E _ .--_---- __G 111111IIII1,
-'��-=G_-� a r_�__r �- - • e
•___.__ ___�.-_c C1_yam•Cc_=ee_=e�CCIII•IIIIL11111G.o-
n • • e --eE_;e=eeE_:e== =fail Ctill ilia 111111' Eg=E • v:'Ec_gG
E:i:=Es�•�= �eG:- __e ?_�� I • E�
cINnluItaf nuGIutill =E_�=a? =E.nNlnuIlininnwnl•uiaC-S6e= -e'c-;l ualuulsm jc=eE=-Ce=
=e
.G_GJ1111r111•l,ll•II,11•Ilel•W,I•Irlrl•
• --ee-.=S=c_E G-.-�-Ee E-E__ •G-:-ee 1� -E�_�'E=_e•- _a!n==un�'ni pp 1111111i1i1iNuIiIiIiIiNI111.1ame11�d� G1Ci11!1i1ug1n11l 1n1nl1,11
e _ 1111 -E- =GEy E €�_-EC--R
e t�niilCl�'C��I�C��' r ?p� 1ni�1 4M
E �' eE _ �1l1 , =_ =_=
_
'RIIIIIii } il -
;ems=i?Ee • ' . _=E:E _E' e fillip
�e�1111111IIJ:c5L�=e;��- -_
Ee '=•er-E ' e 5=a -E--_-_ a E 'iii�i'°_._=e_-e-[•2_c E- G1�cecec =-=c_=EE Ee
�' ec= .E- E-=cc- � E-.c- = E_e�i:�r,==e�-G-_c=•=-_E
e°Ee =t2E c� • ' 3-�Go _ G_=_ a un1 - =-ce=3._� G = __ __ e__==:p
•_l_�eE3cEG? -E: 3cG e.E-e ec peE Eei E '__ E- __•c EE --
� 3
�: it ' a• 2EE=:-=E'=E- j°= c°==e= c-GE_-E eGE-::: mi
eE-= E
E--:_�==eE`e:@Et
E--'_''==.:E �wee= E=-r'c�•-__�EE ec-��- E • - .$
Ea-=
aE EE
�Ec G EE_Ee:_Ec is--
_
�E E
wiG3==.e-G�aE_iai�c7GeaG_�icc- p �eE�::E -
um- E_=
• EE3E--:E_ E
•-:- -=GCE c E_
__
:E_
eSE-ME
2GE_-.a=-_e=-=E
'"' •r. _E=� =--ems eEE�.E
ME
EcaeEEe E_e c�=-