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PMT16-00536 City of Menifee Permit No.: PMT16-00536 29714 HAUN RD. Type: Residential Alteration <ACCEL/-> MENIFEE, CA 92586 MENIFEE Date Issued: 03/18/2016 PERMIT Site Address: 28944 LOIRE VALLEY LN, MENIFEE, CA Parcel Number: 364-122-005 92585 Construction Cost: $40.000.00 Existing Use: 1 &2 Family Residence Proposed use: Description of REPAIR FIRE DAMAGE TO LIVING ROOM AND 2ND STORY TO INCLUDE ROOF SHEATHING& Work: TILE,TRUSS REPAIR, DRYWALL, INSULATION,WINDOWS,AND CABINETS Owner Contractor ANTHONY SILVA PO BOX 691886 LOS ANGELES, CA 90069 Applicant License Number: ANDREW BARSOUM POWELL&ASSOC 9980 INDIANA AVE,STE 3 RIVERSIDE,CA 92503 Phone:9513523588 Fee Description ON Amount f$) Receptacle,Switch,Outlet&Fixture 44 331.00 Plumbing Fixtures and Vents,fixtures 3 116.00 Building Permit Issuance 1 27.00 Additional Plan Review Building 74 74.18 GREEN FEE 1 2.00 SMIP RESIDENTIAL 1 6.00 General Plan Maintenance Fee-Plumbing 1 5.80 General Plan Maintenance Fee-Electrical 1 16.55 $578.53 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_Pennit Template.rpt Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State license Law). Chapter9(commencing with section 7000)of DMsion 3 of the Business and ❑I am exempt from Iicensure under the Contractor's State License Law for Professions Code and my license is in full force and effect. the following reason: License Class License No. By my signature below I acknowledge that,except for my personal residence Expires Signature in which I must have resided for at least one year prior to completion of improvements covered by this permit.I cannot legally sell a structure that I WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by ❑I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section have and will maintain a certificate of consent of self-insure for worker's 7044 of the Business and Professions Code,is available upon request when compensation,issued by the Director of Industrial Relations as provided for this application is submitted or at the following website: by Section 3700 of the labor Code,for the performance of work for which ,,,,�,leeinfo.ca.eov/calaw.html. this permit is issued. H, Policy# Date ❑I have and will maintain worker's compensation insurance,as 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 fallowing:I am the property this permit is issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this number are: application and the information I have provided is correct.I agree to comply Cartier with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy# Expires a rt a above id�entif property for inspection purposes. (This section need not to be completed Is the permit is for one-hundred LG y/lG�le c(—Si A,K Date dollars($100)or less PROPERTY OWNE R AUTHORIZED AGENT ❑I 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 CITY BUSINESS LICENSE# worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the worker's compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a Applicant Date mixture containing a hazardous material equal to or greater that the amounts specified on the Hazardous Materials Information Guide. WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes ❑No UNLAWFUL,AND SHALL SUBIECF AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant orfuture building AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist IN SECTION 37060E THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines CONSTRUCTION LENDING AGENCY ❑.Yes ❑No I hereby affirm that under the penalty of perjury there is a construction Will 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 outer boundary of a school? (Section 3097 Civil Code) ❑Yes ❑No OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD permitting.checklist.I understand my requirements under the State of I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the reason(s)indicatedh below by the Californiaealth al Safety Code,Section 25505 and 25534 concerning hazardous us material reporting. chxkmark(s)I have placed next to the applicable Rem(s)(Section 7031.5 oyes ❑No Business and Professions Code).Any city or county that requires a permit to Date construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWN ER OR AUTHORIZED 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 Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRPI 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 or she is exemptfrom Iicensure 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 a .owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit: � \ ensation,will do( )all of or( )portion of the work,and the structure is www.eoa.eovRead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-80o-424-LEAD(5323). lN" Code,The Contractor's 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: I,as owner of the property am exclusively contracting with licensed tractors to construct the project(Section 7044,Business and Professions Code:The Contractor's 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. Authorization Letter City of Menifee Building & Safety Dept. MAR 18 2016 Received Attention: City of Menifee- Bernice Rivera Regarding Property at 28944 Loire Valley Lane Menifee Ca 92584 To Whom It May Concern, I Anthony Jacob Silva hereby authorize my sister and property manager Christina Warrell with Golden Eagle Properties to handle all matters related to the above referenced property to act on my behalf. Ability to pull all necessary permits etc. in the rebuilding of the fire damaged home. Contact information is: Anthony Silva at 310-422-1388 waldman23@hotmail.com or Christina Warrell at 951-206-7593 tinawarrell@hotmail.com Sincerely, A� nthony acob Silva California`All-Purpose Certificate of Acknowledgment - notary notary public or other officer completing this certificate verifies only the iee,,{��tii�t )rt�ry{?yI t i� pgWigned the document to which this certificate is attached, and not the truthfulness,acaf'rab ,b�3al�dily of that document. State of Cal'lorrr is MAR County of I�� Sr�� s.s. -� deceived On 1Y)arZGI 7 T llo before me, Name of Notary Public,Title personally appeared At-,--) y Name of Signer(1) Name of Signer(2) who proved to me on the basis of satisfactory evidence to be the person(s)whose name(s) is/aFe'subscribed to the within instrument and acknowledged to me that heL%heA hey executed the same in hisJlerlN=rerir authorized capacity(tW, and that by his/beatheir signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws ......,,,, of the State of California that the foregoing paragraph is "^^r " ...DAVEBER�HOFFn z �, Ccnm. E ol368 true and correct. iL'. "� Nctory PubticCollfomlo)> ate . Rivers�cle County. N V m1y kc ch 2i'o207�Pites„ ` WITNESS my hand and official seal. z " Seal Signature ary Pub[c PTIONAL INFORMATION Although the information in this section is not required by law, it could prevent fraudulent removal and reattachment of this acknowledgment to an unauthorized document and may prove useful to persons relying on the attached document. _ Description of Attached Document The preceding Certificate of Acknowledgment is attached to a Method of Signer Identification ' document titled/for the purpose of �f Proved to me on the basis of satisfactory evidence: ❑forms)of identification ❑credible witness(es) containing pages,and dated ' Libte Notarial event is detailed in noteryjoumal on: The signer(s)capacity or authority is/are as: Page#_ Entry#_ ❑ Individual(s) Notary contact ❑ Aflomey4n-fact other ❑ Corporate Officer(s) lille(s) ❑ Additional Signer ❑ Signer(s)Thumbprints(s) ❑ Guardian/Conservator ❑ Partner-Limited/General -_ ❑ Trustee(s) _ ❑ Other. representing: Ramefs).f P....no)Enfitypes)signer is Representing i ©2009-2015 Notary Learning Center-All Rights Reserved You can purchase copies of this form from our web site at vn m.ThcNolarysStcrc.com