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PMT16-00269 City of Menifee Permit No.: PMT16-00269 29714 HAUN RD. �1C A_�. MENIFEE,CA 92586 Type: Residential Addition MENIFEE Date Issued: 0 2/1 812 01 6 PERMIT Site Address: 28387 CIDER ST,MENIFEE, CA 92585 Parcel Number: 329-381-008 Construction Cost: $1,900.00 Existing Use: 1 &2 Family Residence Proposed Use: Description of WALL TR 29495-1 JASPER PLACE Work: 6'x 20 L FT BLOCK WALL LOT 24 Owner Contractor FH ll, LLC FH II HOMEBUILDERS INC 8330 UTICA AVE#300 8300 UTICA AVENUE 300 RANCHO CUCAMONGA, CA 91730 RANCHO CUCAMONGA,CA 91730 Appllcant Phone:9093548000 SUSAN PARADISO License Number.985046 FH II HOMEBUILDERS INC 8300 UTICA AVENUE 300 RANCHO CUCAMONGA. CA 91730 Fee Description O—t Amount 181 Building Permit Issuance 1 27.00 Wall/Fence, non-standard 1 133.00 GREEN FEE 1 1.00 SMIP RESIDENTIAL 1 1.00 General Plan Maintenance Fee-Building 1 6.65 $168.65 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 building operations being carded on thereunder when in violation of the Building Code or of any other ordinance of City of Men'Ifee.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_eldg_Pennit_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 Cade and my license is in full force and effect. which I must have resided for at least one year prior to completion of License,CCla{s�s___,_�t License to 6 L improvements covered by this permit,.I cannot legally sell a structure that I have Expires�f�4,=F�X Signature r — built as an owner-building if it has not been constructed in its entirety by licensed 0// contractors. I understand that a copy of the applicable law,Section 7044 of the WORKERS'COMPENSATION DECLARATI 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: httoJ/www.leoinfo.ca.aovlcalaw.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 Data 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. 1 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.L i My workers'compepsation insurance carrier and policy number are: with all applicable city and county ordinances and slate laws relating to building �Gy construction.t authorize representatives of this cIor county to enter the above- Carrier 1 identified property for the inspection purposes. Date Policy#��n'"��d-ID-LD Expires Properly Owner orAulhorized Agent (This section need not be completed if the permit Is for City Business License# one-hundred dollars($100)or less) HAZARDOUS MATERIAL DECLARATION ❑ 1 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 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 P 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 WARNIN 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 Q NO CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 1 ($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 100.D feet of the outer DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of a school? LABOR CODE,INTEREST,AND ATTORNEYS FEES DYES ONO 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. r / OWNER BUILDER DECLARATIONS DYES INO I hereby affirm under penalty of perjury that 1 am exempt from the Contractor's - �� Date License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY O 9llT RIZEDAGENT r next to the applicable item(s)(Section 7031.5.Business and Professions Code: My city or county that requires a permit to construct, alter,improve,demolish, EPA RENOVATION,REPAIR AND PAINTING(RRP) sr repair any structure,prior to its issuance, also requires the applicant for the 3ermit to file a signed statement that he or she is licensed pursuant to the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors 3rovisions of the Contractor's Stale License Law(Chapter 9(commencing with receiving compensation for most work that disturbs paint in a pre-1978 5eclion 7000)of Division 3 of the Business and Professions Cade)or that he or residence or childcare facility to be RRP-certified firms and comply with the is exempt from licensure and the basis for the alleged exemption. Any required practices.This includes rental property owners and property dolation 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 r civil penalty of not more than($50D).) employees.For more information about EPA's Renovation Program visit www.epa.govfiead or contact the National Lead'Informalion Center at 7 I, as owner of the property, or my employees with wages as their sole 1-800424-LEAD(5323). :ompensation,will do ( )all of or( )porting of the work,and the structure is iot intended or offered for sale.(Section 7044,Business and Professions Code; he Contractor's State License Law does not apply to an owner of a property ❑An EPA Lead-Safe Certified Renovator will be responsible for this project oho, through employees'or personal effort, builds or improves the property, irovided that the improvements are not Intended or offered for sale.If,however, Certified Finn Name- ie building or improvement is sold within one year of completion,the Owner- iutlderwill have the burden of proving that it was not built or Improved for the Firm Certification No.: urpose of sale). 1 11 as owner of the property an exclusively contracting with licensed No EPALeadSafe Certified Firm is required for this project because: ontractors to construct the project(Section 7044,Business and Professions ;ode:The Contractor's License Law does not apply to an owner of a property rho builds or improves thereon, and who contracts for the projects with a ii Wen fee DATE - /(y PERMIT/PLAN CHECK NUMBER l 6l TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK 0 r PROJECT ADDRESS ASSESSOR'S PARCEL NUMBER �� /�(S� LOT TRACT OELJ - OWNER NAME ADDRESS PHONE �l'lJ�9 - ��-�D�k EMAIL APPLICANT NAME [ (�.L ! i ADDRESS Sri, IN A C- hAI(' PHONE EMAIL CONTRACTOR'S NAME OWNER BUILDER? O YES O NO BUSINESS NAME ADDRESS _ PHONE EMAIL CONTRACTOR'S STATE LIC NUMBER Gl�'/ra. C$ LICENSE CLASSIFICATION /� VALUATION$ 110� SQ L SO FT 4o LfT APPLICANT'S SIGNATURE DATE CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS UCENSE NUMBER BUILDING PLANNING ENGINEERING FIFE GREEN SMIP INVOICE I PAID AMOUNT AMOUNT 0CASH 0 CHECK 0 OCREDITCARD %AWMC PLAN CHECK FEES PAID AMOUNT O CASH O CHECK N O CREDIT CARD ViSA/MC OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO