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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