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PMT16-00896 City of Menifee Permit No.: PMT16-00896 29714 HAUN RD. <AACCELA? MENIFEE, CA 92586 Type: Commercial Addition MENIFEE Date Issued: 06/08/2016 PERMIT Site Address: 29775 HAUN RD, MENIFEE, CA 92584 Parcel Number: 336-380-074 Construction Cost: $100,000.00 Existing Use: Proposed Use: Description of CONSTRUCT WATER FOUNTAIN FEATURE Work: NO FINAL UNTIL PLANNING APPROVES STONE FINISH Owner Contractor MENIFEE UNION SCHOOL DIST NEFF CONSTRUCTION INC 30205 MENIFEE RD P O BOX 1488 MENIFEE, CA 92584 ONTARIO, CA 91762 Applicant Phone:9099473768 RON KOUSESERIA' License Number:790576 P O BOX 1488 ONTARIO, CA 91762 Phone:9092236775 Fee Description gtv Amount f5l Non-Residential Appliances, up to 1 HP 2 232.00 Power Apparatus 2 300.00 Receptacle, Switch, Outlet&Fixture 9 156.00 Building Permit Issuance 1 27.00 Additional Plan Review Building 545 545.45 GREEN FEE 1 4.00 SMIP COMMERCIAL 1 28.00 New Construction Permit Fee 1 460.00 General Plan Maintenance Fee-Electrical 1 34.40 General Plan Maintenance Fee-New 1 23.00 Construction $1,809.85 The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and specifications orfrom 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 CITY OF MENIFEE ICENSED 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). Chapter!)(commencing with section 7000)of Division 3 of the Business and n 1 am exempt from licensure under the Contractors State License Law for Professions Code and my¢license is in full farce and effect. the following reason: License Class F/ License No. 7_ O S7 to By my signature below I acknowledge that,except for my personal residence .Expires INU Signature , i�-_ in which l must have resided for at least one year prior to completion of 7Z 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 hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section ave and will maintain a certificate of consent of self-insure for workers 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 ofthe Labor Code,for the performance of work for which www.leainfo.ca.aov/calaw.html. this permit is issued. Policy# Date PROPERTY OWNER OR AUTHORIZED AGENT o I have and will maintain workers compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which D By my signature below I certify to each of the following:I am the property this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this number are: I f application and the information I have provided is correct.I agree to comply '50* homml t L T`( �C lN�81(-(ry (0L T�� AL /��J((-try (10. with all applicable city and county ordinances and state laws relating to Carrier building construction.I authorize representatives of this city or county to Policy# I�oOoo�bbf Expires 4(/17 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 o 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# workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the workers compensation provisions of Section 3700 of the Labor I shall forth ' co ,ply wit those provisions. ` Will the applicant or future building occupant handle hazardous material or a licant Date "ell 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 15 o Yes ❑No UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES / Will the intended use of the building by the applicant or future 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 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines CONSTRUCTION LENDING AGENCY o Yes o 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) o Yes D No OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD 1 hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of California Health&Safety Code,Section 25505 and 25534 concerning Contractors license Law for the reason(s)indicated below by the azardous material rep rting. checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Y n No Business and Professions Code).Any city or county that requires a permit to Date 6/e116 construct,alter,improve,demolish or repair any structure,prior to its PROPERTY115AEA 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 Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRPI License Law(Chapter 9(commencing with Section 70D0)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 exempt from Rcensure 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 D I,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.epa.gov/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-800424-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. o No EPA Lead-Safe Certified Firm is required for this project because: n I,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 .heck A License-License Detail Page 1 of Contractor's License Detail for License # 790576 DISCLAIMER:A license status check provides information taken from the CSLB license database. Before relying on this information,you should be aware of the following limitations. CSLB complaint disclosure is restricted by law(B&P 7124.6)If this entity is subject to public complaint disclosure,a link for complaint disclosure will appear below.Click on the link or button to obtain complaint and/or legal action information. Per B&P 7071.17,only construction related civil judgments reported to the CSLB are disclosed. Arbitrations are not listed unless the contractor fails to comply with the terms of the arbitration. Due to workload,there may be relevant information that has not yet been entered onto the Board's license database. Business Information NEFF CONSTRUCTION INC P 0 BOX 1488 ONTARIO, CA 91762 Business Phone Number:(909)947-3768 Entity Corporation Issue Date 01/29/2001 Expire Date 0113112017 License Status his license is current and active. II information below should be reviewed. Classifications GENERAL BUILDING CONTRACTOR Bonding Information Contractor's Bond This license filed a Contractor's Bond with OLD REPUBLIC SURETY COMPANY. Bond Number: WL11206081 Bond Amount: $15,000 Effective Date: 01/01/2016 Contractors Bond History Bond of Qualifying Individual he qualifying individual EDWARD CURTIS MIERAU certified that he/she owns 10 percent or more of the voting stock/membership nterest of this company;therefore,the Bond of Qualifying Individual is not required. ffective Date: 01/29/2001 Workers' Compensation his license has workers compensation insurance with the STARR INDEMNITY&LIABILITY COMPANY olicy Number:1000001681 ffective Date: 04/01/2016 Expire Date: 04/012017 orkers'Compensation History Other Personnel listed on this license(current or disassociated)are listed on other licenses. ttps://www2.cslb.ca.gov/OnlineServices/CheekLicenseII/LicenseDetail.aspx?LicNum=790576 6/8/201