PMT16-00502 City of Menifee Permit No.: PMT16-00502
29714 HAUN RD.
-(;kCCEL/-> MENIFEE, CA 92586 Type: Commercial Alteration
MENIFEE Date Issued:
02129/2016
PERMIT
Site Address: 27762 HWY 74, MENIFEE,CA 92585 Parcel Number: 329-171-027
Construction Cost: $25,000.00
Existing Use: Proposed Use:
Description of HOURLY INSPECTION TO ASSESS DAMAGE TO OFFICE BUILDING DUE TO VEHICLE COLLISION
Work:
Owner Contractor
RANDY&DEBORAH LECHNER ENDRESEN DEVELOPMENT
6755 MIRA MESA BLVD#123 15301 ALVARADO ST
SAN DIEGO, CA 92121 LAKE ELSINORE,CA 92530
Applicant Phone:9517575695
JOSH ENDRESEN License Number:922677
15301 ALVARADO ST
LAKE ELSINORE, CA 92530
Fee Description Qtv Amount 151
Building Permit Issuance 1 27.00
Inspections not specified 129 129.07
$156.07
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 carded 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_Pernit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
With a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that 1 am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect the following reason:
License Class R Uc �se�0. "? By mysignature below lacknowledge that,except for my personal residence
Expires AI-�_Signatu in which Imust have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell a structure that I
(bySection
R'S COMPENSATION DECIARA
have built as an owner-builder if it has not been constructed in its entirety by
by affirm under penalty of perjury one of the fallowing declarations:I licensed contractors.I understand that a copy of the applicable law,Section
wed will maintain a certificate of consent of self-insure for worker's 7044 of the Business and Professions Code,is available upon request when
sation,issued by the Director of Industrial Relations as provided for this application is submitted or at the following wehsite:
3700 of the labor Code,for the performance of work for whichwww.leeinfo.co.eov/ralaw.htmi.
mit is isssued,J 0U-)C.L.h"7 Q,�i Date
rrfhave and will maintain workers compensation insurance,az required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which ❑By my signature below I certify to each of the following:I am the property
this permit is issued.My workers compensation insurance Tamer 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.1 agree to comply
Carrier Oora L)P��f-j I NSr 7,r rCl7rzv�l7 r with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy a_1O wC 66'7 S-)6 Expires fS b I/6 enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
M certify that in the performance of the work for which this permit is issued,
I shall not employ any persons in anX manner so as to become subject to the Cl
USINESS LICENSE g
workers compensation laws of Ca' ia,and agree that if I should becomepRDOUS MATERIAL DECLARATION
subject tot he or sc ensile ovisions of Section 3700 of the Labor
I shall fo i comp) o rovisions. // l the applicant orfuture building occupant handlehazardous materialora
plica Date -7�-/o ure containing a hazardous material equal to or greater that the
unts specified on the Hazardous Materials Information Guide.
WARNI G:FAIL RE TO SECURE WORKER'S COMPENSATION COVERAGE IS es 0 No
UNLAWFI�I, A SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($300,000),IN pant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR st Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES uidelines
CONSTRUCTION LENDING AGENCY s ❑No
1 hereby affirm that under the penalty of perjury there is a construction 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 r boundary of a school?
(Section 3097 Civil Code) s ❑No
OWNER BUILDER DECLARATIONS ve read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the itting checklist.I understand my requirements under the State of
Contractors License Law for the reason(s)indicated below by the fornia Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 rd uqNo
9-
Business and Professions Code).Any city or county that requires a permit to Date 7- ZQ-'(6
construct,alter,improve,demolish or repair any structure,prior to its PROPEORIZED 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 EP RE AND PAINTING RRP
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 orshe is exempt from licensure receiving compensation for most work that disturbs paint in a pre-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.eoa.eovAead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-80D-424-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 for this 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 Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
❑1,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
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
""'Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL O 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 — — d�
O rn
PROJECTADDRESS -Z 7b W\ 11 4�
ASSESSOR'S PARCEL NUMBER I�� T� LOT 7j'JjON TRACT
OWNER NAME 'Pp
ADDRESS
PHONE EMAIL
APPLICANT NAME
ADDRESS I t U ' T LA.46 eIS/A}9P-Q., CA ZS Q
PHONE q6i -�j7`J�6G�j EMAIL Y
CONTRACTOR'S NAME - or OWNER BUILDER? O YES VN0
BUSINESS NAME
ADDRESS 5SO laL.11�2h00 �T. ISINO .�.
PHONE q°JI - 75�7? --5645 EMAIL paUF �J
CONTRACTOR'S STATE LIC NUMBER aZZ6Z7 LICENSE CLASSIFICATION
VALUATION$ 25 :0 SQ FT L SQ FT
APPLICANT'S SIGNATUR DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE 1r�-�^�
AMOUNT J PAID AMOUNT OC�H 0CHECK# OCREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH OCHECK# 0CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-5777
www.cityofinenifee.us Inspection Request Line 951-246-6213