PMT16-00151 City of Menifee Permit No.: PMT16-00151
29714 HAUN RD.
<ACCELA_> MENIFEE, CA 92586 Type: Commercial Addition
MENIFEE Date Issued: 0 610 712 01 7
PERMIT
Site Address: 29150 HOLLAND RD, MENIFEE, CA Parcel Number: 364-200-016
92584' Construction Cost: $95,589.00
Existing Use: Proposed Use:
Description of PARK RESTROOM AS-BUILT
Work: HCD REHAB PERMIT REQUIRED
LOT 375 TR30422-2
Owner Contractor
LENNAR HOMES OF CALIFORNIA LENNAR HOMES OF CALIFORNIA INC
980 MONTECITO DR. 25 ENTERPRISE
CORONA,CA 92584 ALISO VIEJO,CA 92656
Applicant Phone: 949349B269
LENNAR HOMES OF CALIFORNIA INC License Number.728102
25 ENTERPRISE
ALISO VIEJO, CA 92656
Fee Description Amount I$1
Building Permit Issuance 1 27.00
Inspections not specified 258 258.14
Additional Plan Review Building 148 148.37
GREEN FEE 1 4.00
SMIP COMMERCIAL 1 27.00
General Plan Maintenance Fee-Building 1 12.91
$477.42
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
State of CaI fomia sac
FO_R INSPECTION PLEASE CALL Business,Tronspartationand Hawin A en oo ""
CARLOS ARCE TMENT OF HOUSING AND COMMUNITY DEVELOPMENT { L / b-V�l�� o• I „ Fz
Division of Codes and Standards
619-717-1195 HCD 415 APPLICATION FOR ry a� o°
❑. ] Alternate Approval W Technical Services ❑ Inspection To Obtain Insignia
CONTRACTOR/OWNER-BUILDER DECLARATIONS SECTION 1-UNIT INFORMATION
Not required for5pedal Purpose Commercial Modular
1 UCENSED CONTRACTORS DECLARATION I/We are requesfing services for the following unitis]: !
]Check Appropriate Box] Y
I hereby n under ppenaty of perjury that am licensed under provisions of
Chapter 9[commmmencing wilts Section effect.
t.Division 3 of the Business and Professions ❑ Manufactured Homeured Ho ore DTN!Permit NO.
Code and my license k in full force and effect. ❑ Mult'#amly Manufactured Home Q
Ucense Class Uc.No. Exp.Date ❑ Commercial Modular(Occupancy Group I Fee \,
❑ Special Purpose Commercial Modular r,, ']
Contractor Dale Decal Number Date ��- `Z�-I /
2 OWNER-BUILDER DECLARATION
r
I hereby affirm under penalty of perjury that 1 am exempt from the Contractors' Senol Numberlsl/VIN Numbe AA NO.
License Law for the following reason:
(Sec.7031.5 Business and Professions Code: Any city or county which requires a pennif RT TO �L�-E
to construct,alter,improve,demolish,or repair any structure,prior to its issuance•dw Manufacturer Name/Model Name ll
requires the applicant for such permit to file a signed statement that he or she is FIT BY
licensed pursuant to the provisions of the Contractors' License Law Chapter 9
(commencing with Section 7000 of Division 3 of the Business and Professions Cade)or
that he or she is exempt there tram and the bask far the alleged exemption. Any Year of Manufacture
violation of Section 7031.5 by any applicant for a pelntitsubjects the applicant to a civil
pe I of not more than five hundred colors(j500)) Insignia/HUD Label Number(s)
[ ] I, as owner of the property, or my employees with wages as their sole
cam sation,will do the work and the structure is not intended of offered for sale. SECTION 2-OWNER/APPPUCANT INFORMATION
aSec. 7044, Business and Professions Code: The Contractors' License Law does not 1 JL ,` i
pply to an owner of property, who builds or improves thereon,and who does such Owner�.o m o4+r - F!}�fl., _r/% t
work himself or herself or through his or her own employees, provided that such L) (��,p < t i-, I Il s U a
improvements are not intended or offered for sale. IL however. the building or Address
improvement is sold within one year of completion, the owner-builder will hove the
burden ofproving thathe orshe d Af
dnot build orimprove forthe purpose ofsale.). City u(Ju County )w)1.,C Zipp 1Z )
[ I I, as owner of the properly, am exclusively contracting with licensed T`�t . Plc f lf t
contractors to construct the project Location Address(u l 4l! 0(11 tv, r^ .� V•
(Sec.7044,Buse and Professions Code:The Contractors'License Law does not apply Park Name of Applicable) -e 4 i+ Park ID#
to an owner///ggqf perry who builds or improves thereon,and who contracts for such r 11
projects wlflla'po Yracfor(s)licensed pursuant to the Contractors'License Law.). Applicant F AW r vs` C I- IN r• 1' `� !ra n Br L,
[ ]lain!¢}seer{t\\1�t untler Sec. B.d P.C.for Mk reason: 2c s h J•
lV Address_ U t) �tY L i:. Vff
County F. �-,
�)'�41 Zip
Owner
3. �r — Date S >• tr7 r {
"1 Telephone-Appricar�t t"I�C'�J ?R Homeowner
P N N N l
y� (if Different than Applicant)
I hereby afry under penalty of perjury one of the following declarafions: SECTION 3-CONTRACTOR,ARCHITECT OR ENGINEER INFORMATION
( ] I have and will maintain a cerffiicote of consent to self.insure for workers
compensation, as provided for by Section 3700 of the Labor Cade. for the Contractor's Name
performance of the work far which this permit Is Issued.
I J I have and will maintain workers compensation Insurance. as required by Address
Section 3700 of the Labor Code,for the performance of the work for which this permit is
issued. My workers compensation insurance curler and policy number are: Architect/Engineer Name
Cartier Registration No.
Polley Number Address
I ]I c at in the performance of the work for which this permit is issued.I
shall not era r pperson In any manner so as to become sub�t'eect to workers SECTION 4-DESCRIPTION OF WORK/ACTIVITY AND VALUATION
compensatlo I of CaI'Ifomla,and agree mat it I should become su=f to workers'
compensation psi,riom of Section 3700 of me Labor Code. shaA forthwith comply Describe the proposed work/activity in detail. Attach additional pages if necessary. where
With those pro rm9�it structural alterations or additions are proposed, complete plans, specifications, details, and
-�{_.Iij calculations ore required to be attached to this form. Provide the make and model of any
Applicant. Date i ( appliance to be installed and provide complete electrical calculations for any electrical
'y alterations or additions.
W D SHALL
SUBJEfET URE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL. ,
AND SHALL SUBJE D EMPLOYER T$ID0.0CRIMINAL INPENALTIESADDITION
CIVIL FINES UP TO ONE I P,1A a- ,a, {01J�\r
HUNDRED THOUS'A'ND DOLLARS PROVIDED
S AI O 370 TO THE COST E
COMPENSATION,O AGES AS PROVIDED FOR IN SECTION 37D6 OF THE LABOR CODE
INTEREST.AND ATTORNEYS FEES.
4 CONSTRUCTION LENDING AGENCY
I hereby offrm under penalty of perjury that there Is a construction lending agency Ind i the TkJ
he Work to be Performed
for the performance of the work for which this permit Is Issued (Section 3097, CNA
Code). SECTION 5-SID CERTIFICATION
Lenders Name
1/Wa herebyation for the services designated above.
Lenders Addre /--5 CERTIFICATIONt5'gnoture Date �J
I certify at l ihi sve read this application and state that the above information is
correct I rdo to comply with all city and county ordinances and state laws relating -DEPARTMENT USE ONLY'
to buid'nglconit)uFtibn,and hereby authorize representatives of this county to enter
upon the aPove{n�nRioned property for inspection purposes. Permit Expiration Dolor
O APPROVED ❑ CONDMONS(seereverseside) ❑ DISAPPROVED(see reverseside)
i1
�{ /—y/ Issued By: Dote:
Signature of App)i<ani ar Agent Closed/Signature of District Representative Date
HCD 415(Rev.07/2013)VOffice " DISTRIBUTION: YELLOW-DEPARTMENT WHITE-AREA OFFICE PINK-OWNER/APPUCANT