PMT15-03630 City of Menifee Permit No.: PMT15-03630
_ 29714 HAUN RD. Type: Residential Alteration
�!-�CCEL/4? MENIFEE, CA 92586
MENIFEE Date Issued:
11120/2015
PERMIT
Site Address: 28944 LOIRE VALLEY LN, MENIFEE, CA Parcel Number: 364-122-005
92584 Construction Cost: $5,000.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSPECTION TO ASSESS FIRE DAMAGE&DEMO DRYWALL AND CARPET DUE TO FIRE
Work:
Owner Contractor
ANTHONY SILVA JOSEPH McCANN, INC dba SERVPRO
28944 LOIRE VALLEY LN 433 FLEETWOOD PL
MENIFEE,CA 92584 GLENDORA, CA 91740
Applicant Phone:6268529922
JOSEPH McCANN License Number.944464
JOSEPH McCANN, INC dba SERVPRO
433 FLEETWOOD PL
GLENDORA, CA 91740
Phone: 6268529922
Fee Description lyt Amount 1$)
Building Permit Issuance 1 27.00
Demolition Permit 1 140.00
Inspections not specified 129 129.07
GREEN FEE 1 1.00
General Plan Maintenance Fee-Building 1 6.45
$303.52
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of enors 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 Men"rfee.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_61dg_Permit_Template.rpt Page 1 of 1
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. 46` which I must have resided for at least one year prior to completion of
License Class A License No. cl improvements covered by this permit, I cannot legally sell a structure that I have
Expires'31-31 Signature / (i� 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:
❑ 1 hereby affirm under penalty of perjury one of the following declarations: hitoJ/www.leginfo.m.goutmalaw.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
f
section 3700 of the Labor Code, for the performance of the work for which this application and the information I have provided is corecL 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.I authorize representatives of this city or county to enter the above-
Carrier h Ci >V/AE 1-i c,4 0 INS identified property for the inspection purposes.
Policy# tZw C. a q `6S40 N P-Expires It t (� Date
Property Owner orAuthprized Agent
(This section need not be completed if the permit is for City Business License#
one-hundred dollars($100)or less)
HAZARDOUS MATERIAL DECLARATION
Q I certify that in the performance of the work for which this permit is issued,I
etfff not employ any persons in any manner so as to become subject to the WIII 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 she 1W pl wth hose provisions. DYES 0
Applicant; ate; l(t' Z p t i Will the in ended 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 DYES PNO
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the 6posed 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 ❑YES M 0
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 EKYES ❑NO
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date It I�
License Law for the reason(s)indicated below by the checkmark(s)I have placed 171107D NER 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(RRPI
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 Iicensure 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 EPKs Renovation Program visit,
www.epa.gov/lead or contact the National Lead Information Center at
❑ 1, as owner of the property, or my employees with wages as their sole 1-80D-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:qmr c-4 Sn.cc llJ.,tv WC
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: 2iL- - 1 g 31 ri — I S - act rr17
purpose of sale).
❑ 1, as owner of the property an exclusively contracting with licensed ycNo EPA Lead-Safe Certified Finn is required for this project because:
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors 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
Menifee ax
DATE PERMIT/PLAN CHECK NUMBERRO-T( 3
TYPE: O COMMERCIAL $>RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION 0 ALTERATION Q$DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Demolition Only L7,2 w n r4R e 4—
PROJECFADDRESS 28944 Loire Valley Lane, Menifee, CA92584
ASSESSOR'S PARCEL NUMBER 3(Qy' "toN311I LOT Lm TRACT
OWNER NAME Anthony Silva
ADDRESS 28944 Loire Valley Lane, Menifee, CA 92584
PHONE 310-422-1388 EMAIL
APPLICANT NAME Joseph McCann
ADDRESS 433 Fleetwood Place, Glendora, CA 91.740
PHONE 626-852-9922 EMAIL 'mccann sery rogsd.com
CONTRACTOR'S NAME Joseph McCann OWNER BUILDER? O YES O NO
BUSINESSNAME Joseph McCann, Inc. dba SERVPRO of Glendora/San Dimas
ADDRESS 433 Fleetwood Place Glendora CA 91740
PHONE 626-852-9922 EMAIL hcotterman sery ro sd.com
CONTRACTOR'S STATE LIC NUMBER 944464 LICENSE CLASSIFICATION B
VALUATION$ 5,000. SO FT J Q Q lJ L SO FT
APPLICANT'S SIGNATURE DATE 1
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT -�
AMOUNT I OCASH OCHECK# ` CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building &Safety Department 29714 Houn Rd. Menifee, CA 92586 951-572-6777
www.cityofinenifee.usInspection Request Line 951-246-6213