PMT16-01295 City of Menifee Permit No.: PMT16-01295
29714 HAUN RD.
�CCECA'J MENIFEE, CA 92586 Type: Commercial Alteration
MENIFEE Date Issued: 06/10/2016
PERMIT
Site Address: 27587 LA PIEDRA RD, MENIFEE, CA Parcel Number: 360-110-020
92584 Construction Cost: $50,000.00
Existing Use: Proposed Use:
Description of REVISION TO APPROVED PRECISE GRADING PLAN WHICH INCLUDES ADA
Work:
Owner Contractor
SANTA ROSA ACADEMY COMPETITIVE EDGE CONSTRUCTION INC
27587 LA PIEDRA RD 27250 VIA INDUSTRIA AVE STE B
MENIFEE, CA 92584 TEMECULA, CA 92590
Applicant Phone:9512961699
DAVE CHRISMAN License Number:492663
COMPETITIVE EDGE CONSTRUCTION INC
27250 VIA INDUSTRIA AVE STE B
TEMECULA,CA 92590
Pee Description Qtt( Amount 151
Building Permit Issuance 1 27.00
Additional Plan Review Building 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 carried on thereunder when in vialation 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_BIdg_Perrnit_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 Division 3 of the Business and a I am exempt from licensure under the Contractors State License Law for
Professions Cade and my license is in full force and effect. the following reason:
License Class C677-,i 02.4cr5 License No. % o 6 3 By my signature below I acknowledge that,except for my personal residence
Expires y4—� ,-�Ql 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
a 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 www.leeinfo.ca.eov/calaw.html.
this permit is issued.
Policy# 2ff2!22 Date
PROPERTY OWNER OR AUTHORIZED AGENT
❑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: application and the information I have provided is correct.I agree to comply
with all applicable city and county ordinances and state laws relating to
Carrier Z'— r'YI7•rg7 �rr/l� building construction.I authorize representatives of this city or county to
Policy# 96!y G63(o Expires enter the above identified property for Inspection purposes.
(This section need not to he completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
a 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 subjectto the CITY BUSINESS LICENSE#
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation rovisions of Section 3700 of the Labor
Code,I shall forth iH c yw- ose provisions. Will the applicant or future building occupant handle hazardous material or
Applica 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 Oo
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)7 See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguid�ilines
CONSTRUCTION LENDING AGENCY DYes pVOO
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) D Yes )00
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that 1 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 r art
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 TIAIFS
Business and Professions Code).Any city or county that requires a permit to T1 Date 4o
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY NER O A HORIZED 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
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.eoa.aov/lead or contact the National Lead Information Center at
not intended or offered forsale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code,The Contractors State License Law does not apply to an owner of a o 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. a No EPA Lead-Safe Certified Firm is required for this project because:
D 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.
BUILDING & SAFETYPERMIT/PLAN APPLICATION
.
Menifee
DATE 0 412 5/2 01 6 PERMIT/PLAN CHECK NUMBER P -T(to- O a-0 J
TYPE: ✓❑COMMERCIAL ❑RESIDENTIAL []MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA []SIGN
SUBTYPE: [—]ADDITION ❑ALTERATION []DEMOLITION ❑ELECTRICAL ❑MECHANICAL
[-]NEW [-]PLUMBING [:IRE-ROOF-NUMBEROFSQUARES
DESCRIPTION OF WORK Revision to approved precise grading plan (approved project no.GP15-0022)
PROJECT ADDRESS 27587 La Piedra Road
ASSESSOR'S PARCEL NUMBER 360-110-020 LOT TRACT
PROPERTY OWNER'S NAME Santa Rosa Academy
ADDRESS 27587 La Piedra Road
PHONE (951)296-1447 EMAIL Ibadillo@sra.mn
APPLICANT NAME Santa Rosa Academy
ADDRESS 27587 La Piedra Road
PHONE (951)296-1447 EMAIL Ibadillo@sra.mn
CONTRACTOR'S NAME Dave Chdsman OWNER BUILDER? ❑YES❑✓NO
BUSINESS NAME Competitive Edge Construction
ADDRESS 27250 Via Industria,Suite B,Temecula,CA 92589
PHONE (951)296-1699 EMAIL davec@competitiveedgeconstruction.com
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ SO FT L SQ FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP
INVOICE -IA PAIDAMOUNT
AMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDITCARD VISAIMC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Hour;Rd. Menifee, CA 92586 951-672-6777
www.citvofinenifee.us Inspection Request Line 951-246-6213