PMT15-03824 City of Menifee Permit No.: PMT15-03824
29714 HAUN RD. Type: Residential Addition
�ACCEL/? MENIFEE, CA 92586
MENIFEE Date Issued: 05113/2016
PERMIT
Site Address: 28398 JENNY LN, MENIFEE, CA 92584 Parcel Number: 388-022-004
Construction Cost: $66,814.86
Existing use: 1 &2 Family Residence Proposed use:
Description of CONSTRUCTION OF 1542 SO FT DETACHED GARAGE W/ELECTRICAL
Work:
Owner Contractor
KEN&KELLY LEN ,
28398 JENNY LN
MENIFEE, CA 92584
Applicant License Number:
CA
Fee Description QttV Amount 13)
Services, Switchboards, Control Centers& Panels 1 116.00
Receptacle, Switch,Outlet&Fixture 28 251.00
Plan Check Fee 103 102.50
Plan Check Fee 205 205.00
Building Permit Issuance 1 27.00
Inspections not specified 258 258.14
Additional Plan Review Building 342 342.00
GREEN FEE 1 3.00
SMIP RESIDENTIAL 1 9.00
New Construction Permit Fee 1 307.35
General Plan Maintenance Fee-Building 1 12.91
General Plan Maintenance Fee-Electrical 1 18.35
General Plan Maintenance Fee-New 1 15.37
Construction
$1,667.62
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 MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractors)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure underthe Contractors State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class License No. By my signature below I acknowledge that,except for my personal residence
Expires Signature in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that 1
have 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:I licensed contractors.I understand that a copy of the applicable law,Section
have and will maintain certificate of consent of self-insure forworkers 7044 of the Business and Professions Cade,is available upon request when
compensation,issued by the Director of Industrial Relations as provided for this application is submitted or at the following website:
thisSection 3700 of the Labor Code,for the performance of work for which www.Ipginfo.ca.aov/caIaw.htm 1.
this permit is issued. nf fo'ca.¢ov�
Policy# C/. �„Jlf\ �- Datey�
/ 1
o I have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which D 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 policy owner or authorized to act on the property owners behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
Carrier with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# Expires enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred V, 14— Date �3
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
❑I 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 CITY BUSINESS LICENSE It
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 ❑Yes ❑No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant orfuture 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
CONSTRUCTION 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) ❑Yes ❑No
WNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I 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 item(s)(Section 7031.5 DYes o 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 for the permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION.REPAIR AND PAINTING(RRPI
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 apre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with
an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
❑1,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�Lov/lead/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800424-LEAD(5323).
Code,The Contractors State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible forthls 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 Finn Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved forthe 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
Code: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.
CITY OF MENIFEE
NENIFE�
Planning Department
APPLICATION FOR CONCURRENT PROCESSING
This is an application to request that the Department of Building and Safety review construction plans
concurrently with the Planning Department's processing of the related development application. Please
complete the required information and sign the waiver and assumption of risk, and return the completed
application to the Planning Department.
INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED
PLANNING APPLICATION NO: � r DATE SUBMITTED:
APPLICATION INFORMATION
- (-
Applicant's Name: ( eWnj Y ` r I E-Mail: kcra en CyticCo of�e�5 R I
Mailing Address: 2_c3 M!B� `}cnnq (, c_
lrlen, �ec stree
City state ZIP
Daytime Phone No: (` 09 ) Z02 -C(o(flq Fax No: (CIS( ) q 7( — SIG 6f
As applicant for the above-referenced project, INVe hereby request that the ff Building and Safety
Department accept construction plans for review concurrent with the Planning Department's processing
of the applicable development applications.
As applicant for the above referenced project, INVe acknowledge that acceptance of plans by the
Department of Building & Safety for review prior to final action on the proposed project does not
explicitly or implicitly suggest that the project will receive final approval. I/We assume the full risk that
the plans submitted at this time may not ultimately conform to the approved project or any changes
necessitated by the final conditions of approval, or that the subject proposed project may ultimately be
denied. I/We recognize that any fees submitted to the Department of Building & Safety Department for
the processing of plans may be nonrefundable if this project is ultimately denied, or if subsequent
project redesign or the final conditions of approval result in the requirement for changes in the plans,
and that additional fees may be required by the Department of Building & Safety Department for the
processing of plans required due to project redesign. INVe further acknowledge that acceptance of
construction plans and the payment of fees to the Department of Building & Safety does NOT obligate
the Planning Department to support a proposed project design.
PP.INTED NAME OP APPLICANT SIGNATURE OF APPLICAN r
29714 Haun Road
Menifee, California 92586
(951)672-6777 • Fax (951)B79-3843
Form 29.5-1015(0410 VQ.)
Pa4e 1 of 2
APPLICATION FOR CONCURRENT PROCESSING
DATE: _--- L TO: DEPARTMENT OF BUILDING & SAFETY
FROM: PLANNING DEPARTMENT
RE: REQUEST FOR CONCURRENT PROCESSING
�-`-'L.Yl
PLANNING APPLICATION NO. -nil
The applicant for the above referenced case has requested that the Department of Building & Safety accept
construction plans concurrent with the filing of the above referenced planning case. The Planning Department has
no objection to the acceptance of such plans by the Department of Building & Safety pending a final decision on the
subject planning application. Concurrent review does not explicitly or implicitly suggest that the specific project
design has been found acceptable at this time. The applicant assumes the full risk that a project redesign,
approved conditions of approval, or denial of the project may make the construction plans unacceptable or moot,
and that any or all of the fees for the processing of the plans may be nonrefundable. Acceptance of construction
plans and the payment of fees to the Department of Building and Safety does NOT obligate the Planning
Department to support or approve a proposed project design.
ADDITIONALLY, NO PERMITS SHALL BE ISSUED BY THE DEPARTMENT OF BUILDING AND SAFETY PRIOR
TO AN APPROVAL OF THE ABOVE REFERENCED DEVELOPMENT PROPOSAL, AND ISSUANCE OF THE
FINAL CONDITIONS OF APPROVAL BY THE PLANNING DEPARTMENT.
CITY OF MENIFEE PLANNING DEPARTMENT
As applicant for the above referenced project, I/We acknowledge that acceptance of plans by the Department of
Building and Safety for review prior to final action on the project proposal does not explicitly or implicitly suggest
that this project will receive final approval. I /We assume the full risk that the plans submitted at this time may
not ultimately conform to the approved project or any changes necessitated by the final conditions of approval, or
that the subject proposal may ultimately be denied. I/We recognize that any fees submitted to the Department of
Building and Safety for the processing of plans may be nonrefundable if this project is ultimately denied or if
subsequent project redesign or the final conditions of approval result in the requirement for changes in the plans,
and that additional fees may be required for the processing of plans due to project redesign. IMe further
acknowledge that acceptance of construction plans and the payment of fees to the Department of Building and
Safety does NOT obligate the Planning Department to support or approve a proposed project design.
PRINTED NAME OF APPLICANT SIGNATURE OF APPLICANT
Form 295-1015(04/09/12)
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