PMT16-01117 City of Menifee Permit No.: PMT16-01117
29714 HAUN RD.
4l%CCEL/-%> MENIFEE, CA 92586 Type: Residential New
MENIFEE Date Issued: 09/22/2017
PERMIT
Site Address: 33577 DAILY RD, MENIFEE, CA 92584 Parcel Number: 384-020-005
Construction Cost: $275,856.78
Existing use: Proposed use: 1 &2 Family Residence
Description of NEW CUSTOM SFR 2083/951
Work:
Owner Contractor
ROCKY JMEYER ,
29344 LAKE HILLS DR
MENIFEE,CA 92585
Applicant License Number:
ROCKY J MEYER
29344 LAKE HILLS DR
MENIFEE,CA 92585
Phone: 9516635728
Fee Description Qtv Amount ISI
Services, Switchboards, Control Centers&Panels 1 116.00
Receptacle, Switch, Outlet&Fixture 136 791.00
Plumbing Fixtures and Vents,fixtures 14 171.00
Gas System 1 116.00
Piping/Repiping Single Family Residential 1 163.00
Plan Check Fee 103 102.50
Plan Check Fee 205 205.00
Plan Check Fee 205 205.00
Plan Check Fee 308 307.50
Residential Water Heater 1 83.00
Sewer 1 150.00
Forced-Air or Gravity-Type Furnace or Burner 1 149.00
Air Handling/Condensing Units SFR 1 133.00
Building Permit Issuance 1 27.00
Additional Plan Review Building 90 90.00
Additional Plan Review Building 1,214 1,214.24
Additional Plan Review Building 74 74.18
GREEN FEE 1 12.00
SMIP RESIDENTIAL 1 36.00
New Construction Permit Fee 1 1,268.94
General Plan Maintenance Fee-Mechanical 1 14.10 -
General Plan Maintenance Fee-Plumbing 1 34.15
General Plan Maintenance Fee-Electrical 1 45,35
General Plan Maintenance Fee-New 1 63.45
Construction
$5,571.41
AA_Bldg_Permit_Template.rpt Page 1 of
CITY OF MENIFEE
LICENSED DECLARATION property we d mmnictor
ho builds or im(s)pursuant to the Contractors State License Law).proves thereon,and who contracts for the projects
I hereby affirm under penalty of perjury that I am under provisions of with a licens
Chapter9(commencing with section 7000)of Division 3 of the Business and 194 am exempt from licensure under thne Contrarpr's State License Law for
Professions Cade and my license is in full force and effect. the fallowing reason: D Gws.c/ IJ. I I'L
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 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 of the Labor Code,for the performance of work for which
this permit is issued. www.le info,ca. ov calaw. �i
Policy# -_ Date ( — Z Z -17
PROPERTY OWN6 OR AUTHORIZED AGENT
in I have and will maintain workers compensaQpq, nsW4mj dSTequired by
section 3700 of the Labor Code,for the p2kjdt WMe&f8ltNi&9k Wy*ch ❑By my signature below I certify to each of the following:I am the property
this permit is issued.My workers compensation insurance carder and policy owner or authorized to act on the property owners behalf.I have read this
number are: SEP Z 2 L�1�:, application and the information I have provided is correct.I agree to comply
Carrier with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# Ezpir `,QQ r enter the above identified property for inspection purposes.
p///+++
(This section need not to be completed is th p A+g ppp e
Date
dollars($300)or less PROPERTY OWNER OR AUTHORIZED AGENT
❑I certify that in the performance of the work for which this permit is issued,
I shall not emolov 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
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 15 ❑Yes P'No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES WIII the Intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($500,000),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)7 See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guideliffes
CONSTRUCTION LENDING AGENCY ❑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) ❑Yes �(No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I 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 hazardous material reportin
checkmark(s)I have placed next to the applicable items)(Section 7031.5 Ayes ❑Nc 7 q
Business and Professions Code).Any city or county that requires a permit to Date / C
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER O 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(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 or she 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
❑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.eoa.Rov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-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:
❑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.
REQUEST FOR PERMIT ISSUANCE '= Menefee
CITY OF : SAFETY DEPARTMENT
Prior to issuance of new residential Building Permits, approvals from the
departments listed below are required. Approval shall be designated by the
original signature of the appropriate department staff. When all appropriate
signatures are obtained, please return permit issuance form to the Building &
Safety department. Please allow up to 48 hours for processing of building
permits. p
Permit Number: 1 MT- 1 1p - 0 1 1 1-1
Tract Name:
Tract: -1 Lot:
Address: 3�J�1 1 POII ll R • MPinie-e , GAr
Custom Home: YES (v/ NO Model Home: YES NO
Condo/Apt: YES NO Tract Repetitive: YES NO
DEPARTMENT DATE I f APPROVAL SIGNATURE
1
ENGINEERING �' / ' -7 ('j^T'f do
PLANNING
RIVERSIDE COUNTY FIRE By Email
BUILDING I as
ts
List of required items to obtain signatures for Permit Issuance:
Engineering-Grading Plan Approved, Rough Grade Certification, Soils Compaction
Planning- Payment of School Fees, provide receipts,Compliance with all prior conditions, including
approval of Minor Plot Plan applications
Riverside County Fire- Please contact Riverside County Fire 951-955-4777
Building- Payment ment of Permit and Plan Check fees verification of all re uired si natures city of Menitee
9 9
Building & Safety Dept.
CITY OF
Received,
t.
SUILMNIS&-tAFETY . V d APPOCAMON yN
sq.
DATE 04/12/2016 PERMIT/PLAN CHECK NUMBER
TYPE: El COMMERCIAL ❑✓ RESIDENTIAL MULTI-FAMILY ❑MOBILEHOME POOL/SPA []SIGN
SUBTYPE: []ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑MECHANICAL
❑✓ NEW []PLUMBING [IRE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Construction of anew single family detached home.
PROJECT ADDRESS 33581 Daily RD. Menifee CA 92584
ASSESSOR'S PARCEL NUMBER 384-020-005 LOT TRACT
PROPERTY OWNER'S NAME Rocky J. Meyer
ADDRESS 29344 Lake Hills DR., Romoland CA 92585
PHONE (951)663-5728 EMAIL Jmeyer6@yahoo.com
APPLICANT NAME Rocky J. Meyer
ADDRESS 29344 Lake Hills DR., Romoland CA 92585
PHONE (951)663-5728 EMAIL jmeyer6@yahoo.com
CONTRACTOR'S NAME OWNER BUILDER? ✓❑YES❑NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LICQNUUM�BER y LICENSE CLASSIFICATION
VALUATION $ P1 .75 y"'10.� SQ p 1�� L SO,FT
APPLICANT'S SIGNATURE _ DATE
DEPARTMENT DISTRIBUTION w/y�AID CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN I SMIP
INVOICE PAID AMOUNT
AMOUNT I O .� CASH OCHECK# Q CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER 0 YES NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92585 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-245-6213