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PMT15-03828 City of Menifee Permit No.: PMT15-03828 29714 HAUN RD. Type: Mobile Home �ACCFIA-. MENIFEE, CA 92586 MENIFEE Date Issued: 0110512016 PERMIT Site Address: 27972 JEFFERSON AVE, MENIFEE, CA Parcel Number: 329-193-015 92585 Construction Cost: $72,000.00 Existing Use: Proposed Use: Description of REPLACEMENT OF MOBILE HOME 1680 SQ FT Work: Owner Contractor HILARIO&LILIA TERRONES , 27972 JEFFERSON AVE MENIFEE,CA 92585 Applicant License Number: HILARIO&LILIA TERRONES 27972 JEFFERSON AVE MENIFEE,CA 92585 Phone:9512650413 Fee Description r,3yt Amount t$1 Manufactured Install 1 240.72 Permit Fee 1 27.00 $267.72 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_Pemiit Template.rpt Page 1 of 1 City Of Menifee LICENSED DECLARATION ❑ 1 am 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 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 the following declarations: httol/www.lecinfa.ca.cov/calaw.html. I have and will maintain a certificate of consentt of self-insure for workers' compensation,issued by the Director of Industrial Relations as provided for by �;I I C- Z YIM�, Date y/ 05 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.Myworkem'compensation insurance carrier 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 ida9 tifie property for the inspection purposes. Policy# Expires J.—��( � 2 — erirM� Date S 6 Property Owner or Authorized Agent (This section need not be completed if the permit is for City Business License# one-hundred dollars($100)or less) HAZARDOUS MATERIAL DECLARATION ❑ I certify that 1n 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 permitting 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 DYES ❑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 fRRPI or repair any structure, prior to its issuance, also requires the applicant for the permit to rile 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 ❑ 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 Stale 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 Firm 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 El, as owner of the property an exclusively contracting with licensed No EPA Lead-Safe Certified Firm 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 r" Menifee lddDATE PERMIT/PLAN CHECK NUMBER 6 03ga8 TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY ,GMOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF-NUMBER OFSQUARIES DESCRIPTION OF WORK C rPC� l4 PROJECTADDRESS q a. -Pf (% vy,� A v' CJ .S ASSESSOR'S PARCEL NUMBER �"I�(7� LOT �� TRACT OWNERNAME q1jrjyj6Q c, r ADDRESS ?g — U LS PHONE QL4 115 EMAIL G 1 APPLICANT NAME ADDRESS PHONE EMAIL CONTRACTOR'S NAME OWNER BUILDER? ES O NO BUSINESS NAME ADDRESS PHONE EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION$ �f]I,()(� SO., J�SD LSO FT APPLICANT'S SIGNATURE Ll II ti 4 � �YY1MP� DATE CITYSTAFF USE ONLY .. _ DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE r�1 PAIDAMOUNT O AMOUNT .1 • 0CASH 'CHECK# 0CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT 0CASH 0CHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO City of Menifee Building&Safety Department 29714 Houn Rd. Menrfee, CA 92586 951-672-6777 www.ciryofinenifee.us Inspection Request Line 951-246-6213 PLOT/SITE PLAN N REAR PROPERTY LINE i r f Boil ding SaC"y Of fety Dept. -t 0 f DEC 1 ? 2015 F � rwsfi'wt Pir �+ hfe1�r L MM � W i z z CITY OF MENIFEE � ,f\ & BUILDING AND SAFETY DEPARTMENTUj , \� J $�_ PLAN APPROVAL �� H L 1 REVIEWED BY t DATE "Approval of these plans shall not be construed to be a permit for,of an approval of,any violation of any provisions of the federal,state or dt regulations and ordinances. This set of approved plans must be kept on the t jobsite until completion. ' i L ti� > fed 90 WOkr Gus Nlehl- MeiPr JJ FRONT PROPERTY LINE Property Owners Natne_(��ct rl r?rrr]rlES h`i/;y ,—,iv /C'rrl7��Fs Property Address, -- :27�s72 Jaf' r.i(J�7vA si�r�:� �nt� ysj`