PMT16-01491 City of Menifee Permit No.: PMT16-01622
29714 HAUN RD. Type: Residential Plumbing
<A_CCELA? MENIFEE, CA 92586
MENIFEE Date Issued: 05/24/2016
PERMIT
Site Address: 26807 WILKES DR, MENIFEE, CA 92586 Parcel Number: 331-471-010
Construction Cost: $700.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING 40 GAL WATER HEATER IN GARAGE
Work:
Owner Contractor
KENNETH CENTER INTER-CITY ENERGY SYSTEMS INC
26807 WILKES DRIVE 1175 N DEL PLACE
MENIFEE, CA 92586 ONTARIO,CA 917fi4
Applicant Phone:9097855075
TERESA DINTERMAN - License Number: 587709
INTER-CITY ENERGY SYSTEMS INC
1175 N DEL PLACE
ONTARIO, CA 91764
Fee Description City Amount ISI
Residential Water Heater 1 83.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 4.15
$115.16
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 staled,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
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 ❑I am exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class e ZA Ucep51.40. S U 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
n 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#
Date
,p -have and will maintain workers compensation Insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the tabor 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 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
Carrier rIY/f-"'l with all applicable city and county ordinances and state laws relating to
Cv3kl G��e 7 building construction.I authorize representatives of this city or county to
Policy# Expires enter the ab9A identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date Z
dollars($100)or less PR6FERTY OWNER OR AUTHORIZED AGENT
oIcertify that in the performance of the work for which this permit is issued, 2 .
I shall not employ any persons In any manner so as to become subject to the CITY BUSINESS LICENSE# V r]J ( 0/
0
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 co y with those pro ions. / Will the applicant or future building occupant handle hazardous material or a
Applicant �- Oate mixture containing a hazardous material equal to orgreater that the
amounts speofi on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVE G IS oyes a UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will themtended 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 forguidelines/
CONSTRUCTION LENDING AGENCY aYes of16
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 bounda>of a school?
(Section 3097 Civil Code) o Yes ❑yo'
OWNER BUILDER DECLARATIONS I have read the Haza us Material Information Guide and the SCAQMD
permitting chi 1 t.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the California th&Safety Code,Section 2SSOS and 25534 conceming
Contractors License Law for the reason(s)indicated below by the hazard s material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 DYes In 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 OWNER 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(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.eoy/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 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. D No EPA Lead-Safe Certified Firm is required for this project because:
o 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 RAP rule please fill out the RRP
Acknowledgement.
CITY OF MENI FEE
PLC NNo: P it o:
29714 Haun Road -0
Menifee, CA 92586 Data Date:
Phone: (951)672-6777 AmountAmount: el' Menifee
Fax:(951)679-3843 n9 atY Dept.
Iu
Ck#: Ck#
M
Building Combination Permit MAY 4 2016
Legal oasenpgon:
To Be Completed By Applicant rohlec
Plannin Case:
g R L: Rt: R:
Property gddre - Assessors Parcel Number.
ProjecUTenant Name: /A� /�- Unit ik - oFloor*
[Ad
ame: �i Ph a No. Fax No.
Property re s:Owner ` � Unit Number .Tip Codemail Address: /
Na
Phone No. - � Fax Na
� 7
Applicant A tlress:
S ee t� Unit Number Zip
Code n/7�
mail Address: 7
Name• Phone No. ax No.
S p -Sb7j
Contractor Atldre •ty Stet _Tip Code
d L ✓ ! �o
Contractors C Busrn s Ueense No. Contractors Cr late of¢al omia license No. Classificallon:
Number of Squares:
CJ
Square Footage
Description of Work: � raG r/
7 0 p,/,Z�-y.t- ✓ /.>!L //k Cl� Cost of Wodc$ OG
AppllcanCS Signature
Tq Be Compieted By:Citytitaff Only.;
Indicate As R-Recebred or NIA-Not Applicable
5 Compleles sets of fully dimensioned,dreym to sale plans which include: satofdocumentswhichinclude
❑ Title Sheet ❑ Elevations ❑ Bectrical Plan ❑ Geo Tech/Solis Report(on cd only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Machanioal Plan ❑ Title 24 Energy(on 8'b Y t1)
❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Struchual Calculations
❑ Floor Plan ❑ Structure]Framing Plan&Mile ❑ Shoring Plan ❑ Single Liner -Re for elec.services over 4g0 AMP
❑ Sound Report-Red de
Class Code: Indicate I lNew Construction Alteration' Addition' Means/Methods
Work-lypa. Repair Retrofit Revisio g n to Ewfin FiendRequired? YES NO
Proposed Building Use(s): Existing Building Use(s):
#Buildings: #Units: #Stories: Will the Building Have a Basement?
Y of N
Bldg.Code Occupancy Group Indicate indfCdle it YES or NO 1^1k:ate sit Geo-tech.Haz Zone
At Project Sprinklerad that a
Completion: Construction Pply: Coastal Zone
TYpe(s): C of O YES or NO Noise Zone
Requfred? I isled on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board Landmark Comm. I IPlanning Comm.Zoning Administrator
Fee Exempt: City Project I Elec.Vehicle Charger Landmark Seismic Rebofil spetlaf Gazin.mug.
tlPicnl Ao vat
Expedite Project(s): Child Care City Pmject Green Building Landmark AffeNahfe Ho�afng
For Staff-Use Only
6uildinplSalely Pemril Spet9afisl Cily Planning Ciml Engineering EPWM-Admin Trans portalion h Renl Control
THANK YOU FOR HELPING US CREATE ABETTER COMMUNITY
"i,op CITY OF MENIFEE City of Menifee
0' Building & Safety Dept.
pia1, Department of Building and Safety
MENIFEE`
\ � Contractor Declaration MAY 2 4 2016
F eceived
LICENSED CONTRACTORS DECLARATION: I hereby affirm under penalty of perjury that I am licensed under the provisions of Chapter 9
(connecting with Section 7000)of Division 3 of the Business and Professions code and my license is infull force and effect.
License Class: License No: y� 8�1 /7D�'"/� 1 Exp.Date i,(-/a—C 7S� 7-O/gl Contractor:�Y1 12✓'( ,�L/ C-Yfpy' i T-t'vl'a,�
❑ OWNER BUILDER DECLLAARRATION�:�II hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the
following reason: (Sec 7031.5 Business and Professions code. Any City or County which requires a permit to construct,alter,improve,
demolish or repair any structure prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she
is licensed pursuant to the provisions of the Contractors License Law(chapter 9[commencing with Section 7000]of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500.00]:
(] I,as the owner of the property,or my employees with wages as their sole compensation,will be the work,and the structure is not Intended
or offered for sale(Sec.7044, Business and Professions code: The Contractor License Law does not apply to the owner of property who
builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such
Improvements are not intended or offered for sale. If,however,the building or improvement is sold within one year of completion,the
owner-builder will have the burden of proving that he/she did not build or improve for the purpose of sale).
I,as owner of the property,am exclusively contracting with license contractors to construct the project(Sec.7044 Business and
Professions Code: The Contractor License Law does not apply to an owner of property who builds or improves thereon,and who
contracts for such projects with a contractor(s)license pursuant to the Contractors License Law).
❑ 1 am exempt under Sec. B S P.C.for the reason
Date: Owner:
WORKERS COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self-insure for worker compensation,as provided for by Section 370 of the Labor Code,
���... for the performance of the work for which this permit is issued
///
l� 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 this permit is issued. My Workers Compensation Insurance carrier and policy Number are: ,9
Carrier: �jzeicli llmt,J-k42 t Qol-i.o Policy Number: j,2 e- 02 fl6 yG 00
(This section need not be completed if the permit is for one hundred dollars($100.00)or less.
I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become
subject to the workers compensation laws of California,and agree that if I should become subject to the workers compensation provisions of
Sec.3700 of the Labor Code,I shall forthwith comply with those provisions.
Date: < .)- I Applicant:
WARNING: FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO
CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF
COMPENSATION,DAMAGES AS PROVIDED FOR IN SEC.3706 FOR THE LABOR CODE,INTERST,AND ATTORNEY FEES.
CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there is a construction-lending agency for the performance
of the work for which this permit is issued(Sec.3097,Civic C.).
Lender's Name:
Lender's Address:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify that I have read this application and state that the above
information is correct. I agree to comply with all City ordinances and state laws relating to building construction,and hereby authorize
representatives of the City to enter upon the above mentioned property for inspection purposes.
x
Signature of Applicant/Agent Print Applicant/Agent Name Date
INSPECTION INFORMATION:Work may proceed only at the direction of the field inspector- To request an inspection of work completed,call
the number(951)672.4777. Inspection request must be called in the day before to assure next day inspections.
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City of Menifee Permit No.: PMT16-01620
29714 HAUN RD. Type: Residential Addition
<ACCELA__? MENIFEE, CA 92586
MENIFEE Date Issued:
05124/2016
PERMIT
Site Address: 32795 KENDAL CT, MENIFEE, CA 92584 Parcel Number: 372-310-002
Construction Cost: $3,200.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 15'x 25'SOLID ALUMAWOOD PATIO COVER WITH 1 FAN
Work:
Owner Contractor
RYAN NEWPORT GUTTERS N COVERS CONSTRUCTION INC
32795 KENDAL COURT 19069 VAN BUERN BOULEVARD#114
MENIFEE, CA 92584 RIVERSIDE, CA 92508
Applicant Phone: 9516728022
REBECCA HALL License Number:W962
GUTTERS N COVERS CONSTRUCTION INC
19069 VAN BUERN BOULEVARD#114
RIVERSIDE,CA 92508
Fee Description City, Amount ISl
Receptacle,Switch, Outlet&Fixture 1 116.00
Building Permit Issuance 1 27.00
Deck/Patio, non-standard 1 133.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 1.00
General Plan Maintenance Fee-Building 1 6.65
General Plan Maintenance Fee-Electrical 1 5.80
$290.45
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 staled,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.rpl Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or Improves thereon,and who contracts for the projects
with a licensed contmctor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and D I am exempt from licensure under the Contractors State License Law for
Professions Code and my license Is in full force and effect. the following reason:
License Class Z Uc s No. �S (O Z By my signature below I acknowledge that,except for my personal residence
Expires 6-1-30-i k 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
D I hereby affirm under penalty of perjury one ofthe 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 ww i6Vo.c4ovfcaIaw.htmL
this permit is issued.
Policy# Date
1 have and will maintain workers compensation insurance,as required by PRO OWNER OR AUTHORIZED AGENT
section 3700 ofthe Labor Code,for the performance ofthe work for which D By my signature below I certify to each ofthe following:I am the property
this permit is issued.My workers compensation Insurance carrierand 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
r with all applicable city and county ordinances and state laws relating to
Carrier .Ltl buildin cant cdon.I authorize representatives of this city or county to
Policy# Expires 1-Z—iitn ent he bol id tified property for inspection purposes.('this section need not to be completed is the permit is for one-hundred Date �' I
dollars($300)or less PROPERTY OWNER OR AUTHORIZED AGENT
o I certify that in the performance of the work for which this permit is issued,
Ishallnotemolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
workers compensation I ws of California,and agree that If I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers mpensation provisions of Section 3700 ofthe Labor
Code,I shall rt ply with those provisions. Will the applicant or future building occupant handle hazardous material or a
^_V- A mixture containing a hazardous material equal to or greater that the
Applicant Date amounts s ecified on the Hazardous Materials Information Guide?
WARNING:FAILU o SECURE WORKER'S COMPENSATION COVERAGE IS ❑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)7 See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY DYes �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) a Yes 0No
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 California Health&Safety Cod 5ection 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the hazardous materia ort g.
checkmark(s)I have placed next to the applicable items)(Section 7031.5 c�WY (�
Business and Professions Code).Any city or county that requires a permit to T�� a No Date J IJU
construct,alter,improve,demolish or repair any structure,prior to its PROPERTYOWNER' IZE ENT
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 ofthe 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
a 1,as owner ofthe 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.eav/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:
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.
BU
ILDING i SAFETY PERMIT/PLAN CHECK APPLICATION
y i
_.
Menifee
DATE 05/23/2016 PERMIT/PLAN CHECK NUMBER
TYPE: []COMMERCIAL QRESIDENTIAL []MULTI-FAMILY ❑MOBILEHOME EIPOOLISPA []SIGN
SUBTYPE: ❑✓ ADDITION []ALTERATION []DEMOLITION []ELECTRICAL []MECHANICAL
[-]NEW []PLUMBING ❑RE-ROOF-NUMBEROFF�S�d R
DESCRIPTION OF WORK ALUMINUM PATIO COVER,SOLID,375 SOFT.W71{Ig&§"Rept.
MAY 2 4 2016
PROJECTADDRESS 32795 KENDAL CT.MENIFEE,CA 92584
ASSESSOR'S PARCEL NUMBER 5Q-COD LOT TRACT
PROPERTY OWNER'S NAME RYANNEWPORT
ADDRESS 32795 KENDAL CT.MENIFEE,CA 92584
PHONE (928)379-0001 EMAIL
APPLICANT NAME RE13ECCA HALL
ADDRESS 19069 VAN BUREN BLVD#114-247,RIVERSIDE,CA 92508
PHONE (951)672-8022 EMAIL
CONTRACTOR'S NAME SEANDARE OWNERBUILDER? ❑YESQNO
BUSINESS NAME GUTTERS N COVERS CONSTRUCTION INC.
ADDRESS 19069 VAN BUREN BLVD.#114-247, RIVERSIDE,CA 92584
PHONE (951)672-8022 EMAIL
CONTRACTOR'S STATE LIC NUMBER 945962 LICENSE CLASSIFICATION B
VALUATION $ $3,200.00 SO FT 375 L SO FT
APPLICANT'S SIGNATURE DATE
dL 1 Vito-, .6�7>•. +1 ojt�n}$t dap, </ �.�v, �l 1 � �i {,mf -fii S"f �� + � b`E'i'"'Kc) � y� 'Sf �+
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DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BURRING PLANNING ENGINEERING FIRE GREEN — SM1P
INVOICE �yy PAID AMOUNT /� 1
AMOUNT �O• n.LAS '✓CASH ' CHECK# OCREDITCARD VISAIMC
PLAN CHECK FEES PAID AMOUNT 6 CASH ='CHECK# '%�CREDITCARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DL NUMBER NOTARIZED LETTER .0 YES �%' NO
City of Iblenifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request line 951 246-6213
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q0 Building & Safety PECTION REQUIRED
MAY 2 4 2016 W
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Received U.
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CITY OF MENIFEE 7 C \
BUILDING AND SAF TYDEFARTMENT
PLAN APPROVAL
REVIEWED BY )Ito
DATE
'Approval of these plans shall not le construed o be a perma for,or an
approval of,any violation of any pr visions of th federal,state or city V
regulations and ordinances. This s t of approve plans must be kept on tt}� 1
jobsite until completion.
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City of Menifee Permit No.: PMT16-01621
29714 HAUN RD. Type: Residential Addition
<A_CCFR:A_ MENIFEE, CA 92586
MENIFEE Date Issued: 05/24/2016
PERMIT
Site Address: 29098 MISTY POINT LN, MENIFEE, CA Parcel Number: 333-330-022
92585 Construction Cost: $2,400.00
Existing Use: 1 &2 Family Residence Proposed use:
Description of INSTALL 12'x 20'SOLID ALUMAWOOD PATIO COVER WITH 1 FAN, 1 OUTLET, 1 SWITCH
Work:
Owner Contractor
MELINA SARTY GUTTERS N COVERS CONSTRUCTION INC
29098 MISTY POINT LANE 19069 VAN BUERN BOULEVARD#114
MENIFEE, CA 92585 RIVERSIDE, CA 92508
Applicant Phone:9516728022
REBECCA HALL License Number:945962
GUTTERS N COVERS CONSTRUCTION INC
19069 VAN BUERN BOULEVARD#114
RIVERSIDE, CA 92506
Fee Description Oft Amount I51
Receptacle,Switch, Outlet&Fixture 3 126.00
Building Permit Issuance 1 27.00
Deck/Patio, non-standard 1 133.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 1.00
General Plan Maintenance Fee-Building 1 6.65
General Plan Maintenance Fee-Electrical 1 6.30
$300.95
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 staled,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
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 Iicensure under the Contractors State License Law for
Professions Code and my license Is in full force and effect. the following reason:
License Class Lic s o. KX4 5 (D Z By my signature below 1 acknowledge that,except for my personal residence
Expires 6'1-3O-) 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
in 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. coca i o.c o y/calaw.html.
Date
Policy If PRO
Z -)
PRO 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 o By my signature below 1 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.1 have read this
number are: application and the information I have provided is correct.I agree to comply
r with all applicable city and county ordinances and state laws relating to
Carrier -[rl buildin constr ct'on.I authorize representatives of this city or county to
Policy# Expires 7-Z3- 1LO ente he bo fd tified property for inspection purposes.
N (v
(This section need not to he 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,
1 shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE If
workers compensation I cos of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers mpensation provisions of Section 3700 of the Labor
Code,I shall rt ply with those_provisions. Will the applicant or future building occupant handle hazardous material or a
A licant Date �' 2.� A mixture containing a hazardous material equal to or greater that the
PP I�Jamountr s ecified on the Hazardous Materials Information Guide?
WARNING:FAIL to SECURE WORKER'S COMPENSATION COVERAGE IS Oyes ANo
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 forguldellnes
CONSTRUCTION LENDING AGENCY o 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) D Yes )6,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 Cod 5ectfon 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below bythe hazardous mated ort g.
checkmark(s)I have placed next to the applicable ftem(s)(Section 7031.5
Business and Professions Code).Any city or county that requires a permit toes ONO Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER' H IZE ENT
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 MRPI
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Busfness and Professions Code)or that he or she is exempt from 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
o I,as owner of the property,or my employee with wages as theirsole 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.eov/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 D 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. u No EPA Lead-Safe Certified Firm is required for this project because:
o 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 & SAFETY • APPLICATIONri
A c".
S-
$SI€e if
DATE 05/23/2016 PERMIT/PLAN CHECK NUMBER ^
TYPE: ❑COMMERCIAL ❑✓ RESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA []SIGN
SUBTYPE ✓❑ADDITION []ALTERATION [-]DEMOLITION []ELECTRICAL [-]MECHANICAL
[-]NEW []PLUMBING [:]RE-ROOF-NUMBEROFSQUARES
DESCRIPTION OF WORK ALUMINUM PATIO COVER,SOLID,240SQ.FT.W/1 CEILING FAN,1 OUTLET, 1 SWITCH
PROJECT ADDRESS 29098 MISTY POINT LN.MENIFEE,CA 9258E
ASSESSOR'S PARCEL NUMBER .3'fj3 - _)['}�'��aLOT TRACT
PROPERTY OWNER'S NAME MELINA SARTY City of Menifee
ADDRESS 29098 MISTY POINT LN.MENIFEE,CA 92584
PHONE (951)219-0139 EMAIL
APPLICANT NAME RE13ECCA HALL Received
ADDRESS 19069 VAN BUREN BLVD#114-247,RIVERSIDE,CA 92508
PHONE (951)672-8022 EMAIL
CONTRACTOR'S NAME SEAN DARE OWNER BUILDER? []YES ✓❑NO
BUSINESS NAME GUTTERS N COVERS CONSTRUCTION INC.
ADDRESS 19069 VAN BUREN BLVD.#114-247,RIVERSIDE,CA 92584
PHONE (951)672-8022 EMAIL
CONTRACTOR'S STATE LIC NUMBER 945962 LICENSE CLASSIFICATION B
VALUATION$ $2,400.00 SO FT 240 L SO FT
APPLICANT'S SIGNATURE DATE
wg �p` '�^ qI'@ ' i y�', �y ��+,+. ;� �A II`l�"' ,m t ,}
-'V 'fll`1 er � 'v"u . �,. J�titjr i$ is_,y s_`.en v.1�i.Y';vx ,�.i,�4 �tl'.�`d , �'i 'yPlYir�. ' ' tS.r ut 3,,...... ?si � �,
'DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE pglD AMOUNT ��]]
AMOUNT 3 .-IS CASH uCHECK# CREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT CASH CHECK# 3 CREDITCARD LNO
OWNER BUILDER VERIFIED '=YES =` NO DL NUMBER NOTARIZED LETTER YES
City of IVienifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-5777
WWW.cityofinenifee.us Inspection Request Line 951-246-6213
city of Menifee (L
Building & Satety DePt.
MAY24MS U
��r�l � TRACK W
Lf D'_:,.`, '" Received U
INSPEC+3D=+ RWWRED U.
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p
�5 5 -4
CITY OF MENIFEE
BUILDING AND SAFETY DEPARTMENTPLANAPR
9
O
REVIEWED BY-jigot oiaqllV
DATE
`Approval of these plans shal not ce ccnstrned to be a permit for,or z
approval of,any violation of a w provisions of the federal,state or city
regulations and ordinances. T is St t o approved p ans must be kep on the
jobsite until completion.
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City of Menifee Permit No.: PMT16-01619
29714 HAUN RD. Type: Residential Re-Roof
<—ACCELA-> MENIFEE, CA 92586
MENIFEE Date Issued: 05/24/2016
PERMIT
Site Address: 28790 OLYMPIA WAY, MENIFEE, CA Parcel Number: 337-385-034
92586 Construction Cost: $10,000.00
Existing Use: Proposed Use:
Description of REMOVE EXISTING SHINGLE LAYERS, INSTALL NEW COOL ROOF SHINGLES
Work: "CRRC0668-0078'"
Owner Contractor
ELTON BORTON HOUSETOP ROOFING
28790 OLYPMIA WAY 31760 BRIGGS ROAD
MENIFEE, CA 92586 MENIFEE, CA 92584
Applicant Phone:9516798369
RICH CARROLL License Number:371783
HOUSETOP ROOFING
31760 BRIGGS ROAD
MENIFEE, CA 92584
Fee Description Oft. Amount($1
Building Permit Issuance 1 27.00
Inspections not specified 98 98.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Building 1 4.90
$130.90
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 otherwilse 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_Permit_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).
1 hereby affirm under penalty of perjurythat I am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. ^7 the following reason:
License Class License No. 7�/%� By my signature below I acknowledge that except for my personal residence
Expires Signature Ur in which l must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot IegallKsell a structure that I
WORKER'S COMPENSATION DECLARAT1 have built as an owner-builder if it has not been constructed in Its entirety by
D 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.Ieeinfo.ca.eov/calaw.html.
this permit is issued.
Policy# Date
have and will maintain workers compensation Insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which V'By my signature below l 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-
�_ r application and the information I have provided Is correct 1 agree to comply
Carder /'7O'�/ /may-dlir/< with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# _71G Z Expires�7 enter the above identified property for inspectionpurposes.
(This section need not to be completed is the permit is for one-hundred �A I . iU/ Date 24�
dollars($30D)or less PRIB RTY 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# o 34 s7`/
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
/ mixture containing a hazardous material equal to or greater that the
Applicant , Date J Z amounts specified on the Hazardous Materials Information Guide?
WARNING:ULLIRE TO SECURE WORKER'SCOMPENSATION COVERAGE IS DYes A.
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 forguidelines
CONSTRUCTION LENDING AGENCY ❑Yes 1,131"lo
1 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 boun ary ofaschool?
(Section 3097 Civil Code) o Yes ro
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 California Health&Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the h��ayzardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 7 D 1
dzBusiness and Professions Code).Any city or county that requires a permit to Date 2
construct,alter,improve,demolish or repair any structure,prior to its PROPWof OWNER 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 R NOVATION.REPAIR AND PAINTING(RRPI
License Law(Chapter 9(commencing with Section 700D)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 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.eua.aov/lead 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 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:
o 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.
J
s BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
A. Menifee
DATE /z / PERMIT/PLAN CHECK NUMBER - -
TYPE: J COMMERCIAL 4 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 *-IrE-ROOF-NUMBER OF SQUARES 9
DESCRIPTION OF WORK 1-wzl� a�?/JT7AvW, s
//aoG Gfil� ePGGofiv- �j/.���/so�.r2s
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME � /� / n� City of Menifee
Building & Safety Dept.
ADDRESS p7
PHONE Q_� - La-z- EMAIL
APPLICANT NAME /CC/ e,6elLOG L Received
ADDRESS p- 11 G " Aj ' /
PHONE pfJ, /�// EMAIL �� //is�/. $� /0./Bjwf/L Cd
CONTRACTOR'S NAME 0z e, OWNER BUILDER? OYES900
BUSINESS NAME
ADDRESS
PHONE EMAIL � /Y /C9 40rlf Alz Gamey
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION e-
VALUATION$ /(J, -4190 SQ FT �ZZ*DV L SQ FT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP PC
INVOICE . PAIDAMOUNT qO
AMOUNT -\� 0CASH 0CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# 0CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZED LETTER O YES 0 NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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City of Menifee Permit No.: PMT16-01618
29714 HAUN RD. Type: Residential Re-Roof
<ACCr= A_T MENIFEE, CA 92586
MENIFEE Date Issued:
05/24/2016
PERMIT
Site Address: 26038 RIDGEMOOR RD, MENIFEE, CA Parcel Number: 337-140-016
92586 Construction Cost: $4,000.00
Existing Use: Proposed Use:
Description of INSTALL SINGLE LAYER COOL ROOF SHINGLE OVER EXISTING SINGLE LAYER
Work: ••CRRC#0668-0058"
Owner Contractor
CARLFUESS
33824 HARVEST WAY
WILDOMAR, CA 92595
Applicant License Number:
CARLFUESS
33824 HARVEST WAY
WILDOMAR, CA 92595
Phbne:9512441947
Fee Description City. Amount fsl
Building Permit Issuance 1 27.00
Inspections not specified 98 98.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Building 1 4.90
$130.90
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 Permit_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 contractors)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjurythat I am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure underthe 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 1
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if R has not been constructed in Its entirety by
D 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 ww,w.leeinfo.ca.eov/calaw.htmL
this permit is issued.
Policy#
Date
o l have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Cade,for the performance of the work for which o 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 building construction.I authorize representatives of this city or county to
Policy# Expires enter the above identified property for Inspection purposes.
(This section need not to be completed is the permit is for one-hundred P � _n_ V Date !�IG
dollars($100)or less PROPER 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
Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
Applicant Date amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes o 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 agencyfor the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) o Yes o 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 al Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)Indicated below by the
hazardous material reporting.
checkmark(s)I have placed next to the applicable item(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 OWNER 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 IRRP)
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.S 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 doN all of or tApartion of the work,and the structure is www.eoa.eov/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 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. o No EPA Lead-Safe Certified Firm is required for this project because:
o 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 & SAFETY PERMIT/PLAN CHECK APPLICATIONysC:'a
Menifee
DATE /14`' PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOUTION O ELECTRICAL O MECHANICAL, City of Me Wee
O NEW O PLUMBING 0 RE-ROOF-NUMBER OF SQUARES iG Building & Bell Ay Dept.
DESCRIPTION OF WORK vo7 002�j-- d t.c" X. ,Qv lE /n/ MAY 2 Ii 2016
i
CD - �b Recei /ed
PROJECT ADDRESS "6 O Cc'P,E I0;v
ASSESSOR'S PARCEL NUMBER IL AO- LOT TRACT
OWNER NAME , G (^ JU L S
ADDRESS I xt 1YA A J " 7- 1, ! L` U �J
PHONE ;4iif 11 '1 EMAIL
APPLICANT NAME ,n, A /n C V C S S
ADDRESS 3 3 V OO 9 >>AV N S! (A)+C�L`
PHONE f C-L15" ydg,� EMAIL
CONTRACTOR'S NAME OWNER BUILDER? YES O NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ �/ U-''' SQ FT S/00 Sa L SQ FT
APPLICANT'S SIGNATURE /•' /7 DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE N UMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP K
INVOICE /jam �y/� PAIDAMOUNT
AMOUNT `JLJ qc) I , OCASH 0CHECK# 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH 0CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED C YES 0 NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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City of Menifee Permit No.: PMT16-01491
_ L 29714 HAUN RD. Type: Mobile Home
�CCEA—> MENIFEE, CA 92586
`-1.1""'"" MENIFEE Date Issued: 05/11/2016
PERMIT
Site Address: 25850 GARBANI RD, MENIFEE, CA Parcel Number: 358-240-044
92584 Construction Cost: $2,950.00
Existing Use: Proposed Use:
Description of ADD PERMANENT FOUNDATION TO EXISTING MANUFACTURED HOME 1248 SO FT
Work: SERIAL#22720225BR,02720225AR INSIGNIA#226188,226187
Owner Contractor
LETICIA JIMENEZ PERMA-BRACE CONSTRUCTION
25850 GARBANI RD 21690 VINE ST
MENIFEE, CA 92584 WILDOMAR, CA 92595
Applicant Phone: 9512459373
WENDY BRACE License Number:636757
PERMA-BRACE CONSTRUCTION
21690 VINE ST
WILDOMAR,CA 92595
Fee Description 01 Amount(S)
Manufactured Permanent Foundation 1 240.72
Permit Fee 1 27.00
$267.72
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_Permit_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 contractors)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjurythat I am under provisions of
Chapter9(commencing with section 7000)of Division he Business and o I am exempt from Iicensure under the Contractor's State License Law for
Professions Code and my license is in full forceapd ect the following reason:
License Class �� U nse' .�v 7 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 DE[ 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 www.le¢info.ca.eov/calaw.html.
this permit is issued.
Policy Jt
Date
I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
ction 3700 of the Labor Code,for the performance of the work for which o By my signature below I certify to each of the following:1 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
Carrier /I</-T� r"'r with all applicable city and county ordinances and state laws relating to
.p building construction.I authorize representatives of this city or county to
Poliryp 90f 79 12 Expires / 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 w, ,
o I certify that in the performance of the work for which this permit is issued, �51 — 1
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE p
worker's compensation I —sot oot California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the wp Ce cons ensation provisions of Section 3700 of the Labor
Code,I shall dr hx! co ply ith th a provisions. Will the applicant or future building occupant handle hazardous material or a
.� ��� mixture containing a hazardous material equal to or greater that the
Applicant/ Date h 7 amounts specified on the Hazardous Materials Information Guide?
WARS J ETOS CU WORKER'S COMPENSATION COVERAGE IS ❑Yes c/gNo
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 forguidelines
CONSTRUCTION LENDING AGENCY o Yes 7 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 17No
OWNER BUILDER DECLARATIONS 1 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 Californi alth fety Code,Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the hazer 6us��T� ri rep ffing.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5
Business and Professions Code).Any city or county that requires a permit to % Date WPS
construct,alter,improve,demolish or repair any structure,prior to its 0 OWNER R A 'fHORIZED 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 IRRP)
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 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
❑I,as owner of the property,or my employee with wages as their sale 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 1-800-424-LEAD(5323).
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
propertywho,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. in 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 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
BU I LDING & SAFETY PERM IT/PLAN CHECK APPLICATION
Menifee
DATE PERMIT/PLAN CHECK NUMBER P 1 049 (
TYPE: '.-, COMMERCIAL iV RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA G 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 r.Y jna0?ert
PROJECTADDRESS K5D
ASSESSOR'S PARCEL NUMBER rr�cSp — eZ yD— D V-�T �� TRACT
OWNER NAME L- 'e'y- I C/ '-3-1 h) yy
ADDRESS �S�SD rJ�n /L .lJ f� Roa MO- (--�•2
PHONE (7,5�)U q 05 "' �/ `� 3 EMAIL j Im -2r)e Z l C4-/ Q/off Va a
APPLICANT NAME 1,t lwdq12�y"oC:�=
ADDRESS a
PHONE EMAIL
CONTRACTOR'S NAME P6yZM OWNER BUILDER? OYES ,,NO
BUSINESS NAME / _ /tocm n I
ADDRESS a (0` C) i()I t b l/7.,-
PHONE l gJrl� 2V'S�. 7 3 EMAIL p^ GP �n ve- ,corn
CONTRACTOR'S STATE�LIC NUMBER fcO 7�/ r L��LICENSE CLASSIFICATION C�� 7
VALUATION$ 2�LSC) SQFT 7 Q LSQFT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CI OF MENIFEE BU$IryE55 LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP 0�6 (�1
INVOICE /� PAIDAMOUNT
AMOUNT ! O CASH OCHECKW OCREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECKH 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
THIS SPACE FOR RECORDER USE ONLY
GDEPARTIVIENT
STATE OF CALIFORNIA
BUSINESS,TRANSPORTATION AND HOUSING AGENCY
OF HOUSING AND COMMUNITY DEVELOPMENT
DIVISION OF CODES AND STANDARDS
MANUFACTURED HOUSING PROGRAM
RECORDING REQUESTED BY:
WHEN RECORDED MAIL TO:
NAME
Leticia Jimenez
ADDRESS
25850 Garbani Rd.
CITY,STATE,ZIP CODE
Menifee CA 92584 ONLY THE ENFORCEMENT AGENCY MAY RECORD THIS DOCUMENT
NOTICE OF MANUFACTURED HOME, MOBILEHOME OR COMMERCIAL MODULAR —
INSTALLATION ON A FOUNDATION SYSTEM
Recording of this document by the enforcement agency indicates compliance with California Health and Safety Code Section 18551(a). This document is
evidence that the enforcement agency has inspected the installation and issued a Certificate of Occupancy,form HCD 513C,for the unit described herein,upon
the real property described with certainty below, as of the date of recording. When recorded, this document shall be indexed by the county recorder to the
named owner of the real property and shall be deemed to give constructive notice as to its contents to all persons thereafter dealing with the real property.
ALL INFORMATION BELOW MUST BE ENTERED BY THE ENFORCEMENT AGENCY
PROPERTY INFORMATION ENFORCEMENT AGENCY INFORMATION
Leticia Jimenez City of Menifee
REAL PROPERTY OWNER NAME(S) ENFORCEMENT AGENCY ISSUING PERMIT and CERTIFICATE OF OCCUPANCY
25850 Garbani Rd. 29714 Haun Rd.
MALLINGADDRESS MAILINGADDRESS
Menifee Riverside CA 92584 Menifee Riverside CA 92586
CITY COUNTY STATE ZIP CODE CITY COUNTY STATE ➢PCODE
SAME PMT16-01491 ( 95 ) 672-6777
INSTALLATION ADDRESS(If ddferen) BUILDING PERMIT NO. TELEPHONE NUMBER
❑-' EVIDENCEOFUNIT NH LDER(S)RELEASE,OR CONSENTTO INSTALLATION
CITY COUNTY STATE ➢PCODE PROVIDEDIA: E — EREVERSE
SIGNATURE OF ENFORd"EMEW AGENCY OFFICIAL DA1TE
OWNER INFORMATON DEALER INFORMATION
SAME
UNIT OWNER(If also p'epeny wm¢r,write SAME) DEALER NAME(If rwt a dealer sale,write'NONE)
MAILINGADDRESS DEALER LICENSE NUMBER
CITY COUNTY STATE ZIP CODE DEALER BUSINESS ADDRESS
CITY COUNTY STATE ➢PCODE
MANUFACTURED HOME/MOBILEHOMEICOMMERCIAL MODULAR UNIT DESCRIPTION
90002 Skyline AL L0818 Hillcrest 09/11/1981
MANUFACTURER'SNAME MODEL NAME I NUMBER MANUFACTUREDATE
02720225BR, 02720225AR
SERIALNUMBER(S)
56'x 24' 226188, 226187
LENGTH X WIDTH CA INSIGNM(SYHUD LABEL NUMBER(S)
358-240-044 LAC7368
ASSESSOR'S PARCEL NUMBER NCO REGISTRATION DECAL NUMBER MCO NUMBER Mew MH only)
REAL PROPERTY LEGAL DESCRIPTION
Pareel 3 and Lettered Lot E) of Parcel Map 9221 on Ille in Book-, '5 Page 24 of Maps, Recoj ds ol Riverside-�,
recorded February 11,1980
DISTRIBUTION—Original to County Recorder,One Copy to HCD;One Copy to Applicant;One Copy to Enforcement Agency
HCD 433A(Rev.10/2011) GENERAL GUIDE AND INSTRUCTIONS ON REVERSE
THIS SPACE FOR RECORDER USE ONLY
GDEPARTIVIENT
STATE OF CALIFORNIA
BUSINESS,TRANSPORTATION AND HOUSING AGENCY
OF HOUSING AND COMMUNITY DEVELOPMENT
DIVISION OF CODES AND STANDARDS
MANUFACTURED HOUSING PROGRAM
RECORDING REQUESTED BY:
WHEN RECORDED MAIL TO:
NAME
Leticia Jimenez
ADDRESS
25850 Garbani Rd.
CITY,STATE,ZIP CODE
Menifee CA 92584 ONLY THE ENFORCEMENT AGENCY MAY RECORD THIS DOCUMENT
NOTICE OF MANUFACTURED HOME, MOBILEHOME OR COMMERCIAL MODULAR —
INSTALLATION ON A FOUNDATION SYSTEM
Recording of this document by the enforcement agency indicates compliance with California Health and Safety Code Section 18551(a). This document is
evidence that the enforcement agency has inspected the installation and issued a Certificate of Occupancy,form HCD 513C,for the unit described herein,upon
the real property described with certainty below, as of the date of recording. When recorded, this document shall be indexed by the county recorder to the
named owner of the real property and shall be deemed to give constructive notice as to its contents to all persons thereafter dealing with the real properly.
ALL INFORMATION BELOW MUST BE ENTERED BY THE ENFORCEMENT AGENCY
PROPERTY INFORMATON ENFORCEMENT AGENCY INFORMATION
Leticia Jimenez City of Menifee
REAL PROPERTYCWNER NAME(S) ENFORCEMENTAGENCY ISSUING PERMIT and CERTIFICATE OF OCCUPANCY
25850 Garbani Rd. 29714 Haun Rd.
MAILINGADURESS MMUNGADDRESS
Menifee Riverside CA 92584 Menifee Riverside CA 92586
CITY COUNTY STATE ZIPCODE CITY COUNTY STATE ZIP CODE
SAME PMT16-01491 95 ) 672-6777
INSTALLATION ADDRESS(ifdiBe.1) BUILDING PERMIT NO. TELEPHONE NUMBER
❑� EVIDENCE MOFENHOLDER(SI RELEASE,OR CONSENTTO INSTALLATION
CITY COUNTY STATE ZJPCOOE PROVIDEDSEE REVERSE
SIGNATURE OF ENFORCEMENT AGENCY OFFICIAL DATE
OWNER INFORMATON DEALER INFORMATION
SAME
UNIT OWNER(Ifalw properly owner,wnle'SAME') DEALER NAME(Knot a dealervle,w ite'NONE)
MAILING ADDRESS DEALER LICENSE NUMBER
CITY COUNTY STATE ZIP CODE DEALER BUSINESS ADDRESS
CITY COUNTY STATE ZIPCOOE
MANUFACTURED HOMEIMOBILEHOME/COMMERCIAL MODULAR UNIT DESCRIPTION
90002 Skyline AL L0818 Hilicrest 09/11/1981
MANUFACTURERS NAME MODEL NAME I NUMBER MANUFACTURE DATE
02720225BR, 02720225AR
SERIAL NUMBER(S)
56' x 24' 226188, 226187
LENGTH x VADTH CA INSIGNLA(S)IHUD LABEL NUMBER(S)
358-240-044 LAC7368
ASSESSOR'S PARCEL NUMBER HCD REGISTRATION DECAL NUMBER Moo NUMBER(New MH any)
REAL PROPERTY LEGAL DESCRIPTION
Pareel 3 and Lettered Lat D of Pareel Map 9221 on file Book 75 Page 24 Of Maps, Records of Riverside Gounty, ealifbfinia
recorded Fehruary 11 1980.
DISTRIBUTION—Original to County Recorder;One Copy W HCD;One Copy to Applicant;One Copy to Enforcement Agency
HCD 433A(Rev.10/2011) GENERAL GUIDE AND INSTRUCTIONS ON REVERSE
STAE OF CM.IFORNIA-BUSINESS CONSUMER SERNCES,M!D HOUSING M3ENCY MOUND G.BROWN JR.Governor
DEPARTMENT OF HOUSING AND COMIIIJNITYDEVELOPMENT SING try
Division of codes and Slandards �`t' O�
O a rr Z
,rr W
3 c£
Title Search
Date Printed: 05/09/2016
Decal#: LAC7368 Use Code: SFD
Manufacturer: 90002 SKYLINE Original Price Code: AHX
Tradename: HILLCREST Rating Year:
Model: ALL 0818 Tax Type: LPT
of Merifee
Manufactured Date: 09/11/1981 Last ILT Amount: din &Safety Dept.
Registration Exp: Date ILT Fee Paid: Building
First Sold On: 08/23/1982 ILT Exemption: NONE MAY 11 2016
Serial Number HUD Label/Insignia Length Width R e C e i ve d
02720225BR 226188 56' 12'
02720225AR 226187 56' 12'
Registered Owner:
LETICIA JDAENEZ
25850 GAR13ANI RD
MENIFEE,CA 92584
Last Title Date: 03/10/2006
Last Reg Card: 03/10/2006
Sale/Transfer Info: Price$10,000.00 Transferred on 10/01/2000
Situs Address:
25850 GAR 3ANI RD
MENIFEE,CA 92584
Situs County:RIVERSIDE
*** END OF TITLE SEARCH ***
Branch:S06,User:4001 Comment: Station Id:AYM7
DQC 23 200S-0372S22
05/11/2005 08:0a Fee:7.00
Page i of t
RECORDING REQUESTED ay Recorded In Official Records
County of Riverside
II 11 1BI Larry
U. IfllyardAND WHEN 'nn'IIIII 1111 25850Leticia R Garbonl ez
RoadRDED To. IIIIIII III�III III�IIII�III�II III�IIII�I III�11lIIIII IIII
Menefee, CA 92584
M s fL
P.
A.P.N:356-240-044-6 TRA No; 0 1 1
3 SN 10
A a oorr ariso roe I ors I _
INTERSPOUSAL TRANSFER GRANT DEED G,
(Excluded from reappraisal under California Constitution Act 13 A 1.et seq.)
//) `)H
DOCUMENTARY TRANSFER TAX$
This is an Interspousal Transfer and not a change in ownership under §63 of the Revenue and Taxation code
and Grantorts) hasfhave) checked the applicable exclusion from reappraisal:
1 I From Joint Tenancy to Community Property
[ I From One Spouse to Both Spouses
[ X I From One Spouse to the Other Spouse
[ I From Both Spouses to the Other Spouse
[ I Other-
GRANTOR Luis Alejandro Duarte Rivera,Spouse of the Grantee
hereby GRANT(S)to Leticia R.Jimenez,A married woman as bar sole and Separate Property
the real property in the City of Menifae , County of Riverside State of California, described as:
Parcel 3 and Lettered Lot D of Parcel Map 9221 on file in Book 75 Page 24 of Maps, Records of Riverside
County,California recorded February 11, 1980.
It is the express intent of the Grantor,being the spouse of the Grantee,to convey all right, title and interest of
the Grantor, community or otherwise, in and to the herein described property to the Grantee as his/her sole and
separate property.
Document Date: February 1. 2005 ll77
1 .5 A I e3cAdYo 3L,%v4 IS .
Luis Alejandro Duarte Rivera tyre-sate.
ID.PPT. COLOMBIA"CC13460438 CSaIe NJMLSCa .
oral cvsmapre SS-
e a ar aw
tl"nrs na Amwfca
on this 5th day of April 2005 before me, the undersigned
personalty aPpeared LUIS ALEJANDRO DUARTE RIN ERA
Personally(mown to me for proved to met on the basis of setts/aotory evidence)to be the parsoMs)whose neme(sl is/are subscribed to the ,
within Irlsoumerm aatl s)on the ir,,,m me Net Mlsh8ft exec paciry(' I and that by
ey executed the soma in a P811rhhe'v who"
"M ea is his/herhhair signatures)on the irovumam the Ixrmnfsl or the entity upon behalf of which the peraan(s) acted, executed the instrument.
WITNESS myyhhaannnd,and official seat.
Signatu
. .l oast below is for official notarial seal.
re Q-Y ., =.±
Thomas E.Brown i, ;°Pa'
vlmNmnree u,rvdwmaAamlu =/l`��.c-,�.'.�'.f E�Yr•`��"'a a/,'• :'
Mail Tax S>atemems ta: Same as Above or Address Notetl
RIVERSIDE,CA Pa.-el of I Printed on 121/2016 12:3420 PM
Document:DD 2005.372822
5/10M16 Online Services MasterPage
RIVERSIDE COUNTY choose a department . . . o
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MENU
BUILDING PERMIT INFORMATION FOR BMRS91316 online Services
Results for BMR991316 as of 5/10/2016 6.28:26 PM
Basic Case Information
PERMIT NUMBER: BMR991316
PERMIT STATUS: FINAL
APPLIED DATE: 08/19/1999
ISSUED DATE:
CLOSED DATE: 05/10/2016
EXPIRATION DATE: 04/29/2001
DESCRIPTION: NEW MOBILEHOME INSTALLATION
TYPE DESCRIPTION: NEW MOBILE HOME
SITUS CITY: MENI
SITUS: GARBONI RD 025850
GENERAL LOCATION: TBM 868 136
http://orAineservices.rcflma.org/contenUW[d-Wmit irftmpx?permi[Number=bmr931316 1/2
5102O16 Ordine Services MasterPage
APN: 358240044 Click to view in Map My County
APPLICANT: DUARTE LUIS
ADDRESS I: 25850 GARBONY RD
ADDRESS 2: MENIFEE CA I
ADDRESS 3:
ZIP: 92595
Fee Information
TOTAL FEES $121.80
TOTAL PAYMENTS: $121.80
BALANCE DUE: $0.00
Valuation Information
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BUILDING PERMIT INSPECTION HISTORY FOR BMR991316
Online Services
Results for: BMR991316 as of 5/10/2016 6:31:04 PM
INSPECTION DATE DESCRIPTION STATUS
05/10/2016 PERMIT FINAL APPROVED
10/31/2000 BUILDING GAS TEST APPROVED
08/23/2000 CONDUIT APPROVED
08/23/2000 GROUNDING AND BONDING APPROVED
08/23/2000 SERVICE PANEL APPROVED
08/23/2000 SEWAGE DISPOSAL APPROVED
08/23/2000 WATER SERVICE APPROVED
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SITE PLAN
PERMIT NO:
NAME: JIMENEZ, LETICIA PHONE:
SITE ADDRESS: 25850 GARBONI ROAD CITY: MENIFEE
ASSESSOR'S PARCEL NUMBER: 358-240-044-6
city of Menitee
I 140'
Building 8 Safety Dept. ZGS' AMAY 1 1 2016 N
Received
EXISTING
DOUBLEWIDE
MANUFACTURED
C!i Y OF M NIFEE HOME
BUILDING AND SAFETY DEPARTMW
32'
K."A APPR VAL W
W
ho
REVIEWED BY oil
D,'� E
�
*kproval of these plans shall not be construed to be a permit for,or an 52'
ap, oval of,any violation of any provisions of the federal,state or city 6
red Rations and ordinances. This set of approved plans must be kept on tire
lo.Zite until completion. ft
GARRANIROAR
FRONT FROFERt'Y LINE -
Manufactured Home on a Permanent Foundation System on a lot zoned for conventional single-family residential
dwelling must comply with the following requirements:
A. Roofing Material.Any roof material permitted under Ordinance 457.90, except metal roofing,maybe utilized.
B. Siding Material.Any siding material permitted under Ordinance 457.90,except metal siding maybe utilized.
C. All Manufactured homes shall be no less than 750 square feet.
D. The requirements of this section shall not apply if the manufactured home is already in place on lot.
Tait&Associates,Inc. rifle Menifee Town Center Page: ,_,_
701 N.Parkcenter Dr. Job# SP7638 Dsgnr. JV Date: 18 MAY 2016
Santa Ana,CA 92705 Description....
- Phone 714 660-8200 Bic Basin wall design with BW W surcharge
Fax 714 560.8211
This Wall in its:k:\Draw1ngsiSP1SP7638-MenifeelDocMello basin wall calcdsp7638 biobasin.RPX
RetainPro 10(pcs)�15988�274--255014, Build 10.14.12.11
License:tcW-WENDELL GAYER Cantilevered Retaining Wall Design %ode:CBC 2013,ACI 318-11,ACI 530-11
1.t'ense To
Criteria A I Soil Data
Retained Height = 4.67 it Allow Soil Bearing = 3.000.0 par i
Wall height above soil = 0.00 ft Equivalent Fluid Pressure Method
IpM- eCh CC Heel Active Pressure - 36.0 psf!ft
C1t gVrM4fe1-E 48.00 in Passive Pressure = 400.0 psflft
BLrI'tl[StPlf�aOAM SAFE�YbEPAR =Heel = 120.00 pcf
/� Toe = 80.00 pcf
PLAN! APPR®V&L Soil height tl Ignore
0.250 —
�'' r Soil height to Ignore
) for passive pressure 36.00 in
yt � 1�
REW&WF9 gYds- a ` 1. Lat Joad Applied to Stem Adjacent Footing Load
Surcharge Over Heel = 0.0 Par Lateral Load um - 0.0 WR Adjacent Foollng Load = 2,000.0 Ibs
Used To Resist Sliding&Overturning ...Height to Top = 0.00 ft Footing Width = 1.00 ft
Surcharge Over Toe = 0.0 pelf ...Haight to Bottom = 0.00 ft Eccentricity = 0.00 In
*k'F rusA"99IP11 A-C.'N 41'b%construed r-he load Wall to Fig CL Dist = 2.75 ft
arc_Axis.hdaag tRF11ke51,fA,gggp&, „�,ti has 666H increased 1.00 Footing Type Line Load
eder@Pytaf@%IP[iq Base Above/Below Soil _ _1.0R
re.'ii L dnces. Is set J��bved plal1SftA%W6p. Qem= 0.0 par at Back of Wall
jok.t4�YMft ricity = 0.0 in Poisson's Ratio = 0.300
I,,AA
l2.
-t ,A," .12, Eze�r/
�4@EoO�VgSN�'V9� Din GJ..2 � Zc,�j /°s r cove, �=�j.rC
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Taft&Associates,Inc. Title Megifee Town Center Page:
701 N.Parkcenter Dr. Job# SPi638 Dsgnr: JV Date: 18 MAY 2016
Santa Ana,CA 92705 Description....
TA 1 T Phone 714 5604200 Blo Basin wall design with BVWV surcharge
'y ......."", Fax 714 560-6211
This Wall in File:k:lDmvrings%SP\SP7638-MenifeelDoes%Bio basin wall calc%sp7638 biobasin.RPX
RetalnPro 10(c0)p1g98y7711-225014. Build 10.14.12.11
Lieense:)(W4INENDELL GAYER Cantilevered Retaining Wall Design :ode:cec zo13,AC13t8-11,AC1531}11
Lieense 10:WE
Summary of Overturning&Resisting Forces&Moments r
.....OVERTURNING..... .....RESISTING.....
Force Distance Moment Force Distance Moment
Item Ibs it ft-# Ibs It ft-#
Heel Active Pressure = 630.8 1.97 1.244.8 Soil Over Heel = 326.9 2.71 885.4
Surcharge over Heel = Sloped Soil Over Heel =
Surcharge Over Toe = Surcharge Over Heel =
Adjacent Footing Load = 404.3 2.05 828.7 Adjacent Fooling Load = 52.4 2.92 152.9
Added Lateral Load = Axial Dead Load on Stem=
Load @ Stem Above Soil= •Axial Live Load an Stem =
Soil Over Toe = 560.0 0.88 490.0
Surcharge Over Toe =
Total 1,035.2 O.T.M. 2,073.5 Stem Weight(s) = 364.3 2.08 758.9
Earth @ Stem Transitions=
_ = Footing Weight = 562.5 1.50 843.8
Resisting/Overturning Ratio = 1.51 Key Weight =
Vertical Loads used for Soil Pressure= 1,866.1 Ibs Vert.Component =
Total= 1.866.1 Ibs R.M.= 3.130.9
°Axial live load NOT Included in total displayed,or used for overturning
resistance,but is included for soil pressure calculation.
Tilt
Horizontal Deflection at Toss of Wall due to settlement of soil
(Deflection due to wall bending not considered)
Soil Spring Reaction Modulus 250.0 pci
Horizontal Dell @ Top of Wall(approximate only) 0.095 in
The above calculation is not valid if the heel soil bearing pressure exceeds that of the toe,
because the wall would then tend to rotate into the retained soil.
CITY OF MENIFEE
BUILDING AND SAFETY DEPARTMENT
PLAN APPROVAL
REVIEWED B MAY 2 3 2016
DATE
'Approval of these plans shall not be construed to be a permit for,or an
approval of,any violation of any provisions of the federal,state or city
regulations and ordinances. This set of approved plans must be kept on the
jobsite until completion.
Tait&Associates,Inc. Title Menifee Town Center Page:
701 N.Parkcenter Dr. Job# SP7.638 Dsgnr: JV Date: 18 MAY 2016
Santa Ana,CA 92706 Description....
I A 0 T Phone 714 560-8200 Bio Basin wall design with BWW surcharge
""°'"""" Fax 114 560-8211
This Wall in File:k:\Drawings\SP\SP7638-Menifee\Docs\Bio basin wall calc\sp7638 biobasin.RPX
RetainPro 10(c)1987.2014, Build 10.14.12.11
Ocenae:Kw-0805e2A5�LL GAYER Cantilevered Retaining Wall Design ;Ode:CBC 2013,ACI 318-11,ACI 530-11
License To:WWEEfN4UD
li
Design Summary ' Stem Construction Bottom
Stem OK
Wall Stability Ratios Design Height Above Fig it= 0.00
Overturning = 1.51 OK Wall Material Above"Hr = Masonry
Sliding = 2.85 OK Design Method = ASD
Thickness = 8.00
Total Bearing Load = 1,866 Ibs Reber Size = # 5
...resultant ecc. = 11.20 in Reber Spacing = 16.00
=
Soil Pressure @Toe = 2,196 psf OK Design Data --Reber Placed at Edge
- -- -- - - - - - - --
Soil Pressure @ Heel = 0 psf OK fb/FB+fa/Fa = 0.546
Allowable = 3,000 psf Total Force @ Section
Soil Pressure Less Than Allowable
ACI Factored @ Toe = 2,659 psi
Service Level Ibs= 694.4
ACI Factored @ Heel = 0 psf Strength Leve Ibs=
Footing Shear @ Toe = 3.8 psi OK Moment...Actual
Service Level ft-#= 993.6
Footing Shear @Heel = 3.8 psi OK Strength Leve it-#=
Allowable = 75.0 psi phiMn or MallOwable = 1,812.8
Sliding Calcs (Vertical Component NOT Used) Shear.....Actual
Lateral Sliding Force = 1.035.21bs
less 67%Passive Force = - 2,487.4 Ibs Service Level psi= 11.0
less 100%Friction Force = - 466.5 lbs Strength Leve psi=
Added Force Req'd = 0.0 Ibs OK Vallowable/(bd) psi= 44.8
....for 1.5: 1 Stability = 0.0 Ibs OK Wall Weight = 78.0
Rebar Depth 'd' In= 5.25
Masonry Data
fm psi= 1,500
Load Factors Fs psi= 20,000
Building Code CBC 2013,ACI Solid Grouting = Yes
Dead Load 1.200 Modular Ratio'n' = 21.48
Live Load 1.600 Short Tenn Factor = 1.000
Earth,H 1.600 Equiv.Solid Thick. in= 7.60
Wind,W 1.000 Masonry Block Type = Medium Weight
Seismic,E 1.000 Masonry Design Method = ASD
Concrete Data
fe psi=
Fy psi=
Footing Dimensions &Strengths ' Footing Design Results
Toe Width = 1.75 it I Toe Heel
Heel Width = _ _ 1.25 Factored Pressure = 2,659 0 psi
Total Footing Width = 3.00 Mu':Upward = 2.715 0 it-#
Footing Thickness = 15.00 In MY:Downward = 175 240 ft-#
Mu: Design = 2,540 240 ft-#
Key Width = 0.00 in Actual 1-Way Shear = 3.79 3.79 psi
Key Depot = 0.00 in Allow 1-Way Shear = 75.00 75.00 psi
Key Distance from Toe = 0.00 it Toe Reinforcing = None Speed
fc = 2,500 psi Fy = 60,000 psi Heel Reinforcing = None Speed
Footing Concrete Density = 150.00 pcf Key Reinforcing = None Speed
Min.As% = 0.0018 Other Acceptable Sizes&Spacings
Cover @ Top 3.00 @ Btm. 3.00 In Toe: #4@ 7.41 In,#5@ 11.48 In,#6@ 16.30 In,#7@ 22.22 in,#8@ 29.26 In,#9@ 37
Heel:Not req'd,Mu<S'Fr
Key: No key defined
Tait&Associates,Inc. Title Menifee Town Center Page:
I 701 M.Parkcenter Dr. Job# SP7.638 Dsgnr. JV Date: 18 MAY 2016
Santa Ana,CA 92705 Description....
A 0 T Phone 714 560-8200 Bio Basin wall design with BVVW surcharge
Fax 714 560-8211
This Wall in File:k:\Drawings\SP\SP7638-Menifee\Docs\Bio basin wall cal6sp7638 biobasin.RPX
LicenserKlYOU(06099e827q-29014, Build 10.14.12.11 Cantilevered Retaining Wall Design :ode:CBC 2013,ACI 318-11,ACI 530-11
License To:WEV61LL GAYER
WaI113 Concrete Ij Masonry Allowable Moment Lines: Ej Concrete Masonry
Designer to determine bar cutoff IocaVons
200.0 ft-# 600.0 ft-# 1,000.0 ft-tf 1,400.0 ft-# 1,600.0ft-#
0.0 Rol 400.0 ft-# 800.0 ft-# 1,200.0 ft-# 1.600.0 ft-#
] t 'Fer,ee6'ai
I
1
Applied Moment Diagram Mu= 991.E
MnPhi= 1 812.8ft-#\
ow t
�I Tait✓i Associates,Inc. Title Meplfee Town Center Page:_
1 701 R.Parkcenter Dr. Job# SP7638 Dsgnr: JV Date: 18 MAY 2016
Santa Ana,CA 92705 Description....
T 9 Phone 714 560.8200 Bio Basin wall design with BW W surcharge
Fax 714 560-8211
This Wall in File:k:\Drawings\SMSP7638-Menifee\Dots\Bio basin wall calc\sp7638 biobasin.RPX
RetalnProK10 c)196877-22014. Build 10.14.12.11
License To li"' ALL GAYER Cantilevered Retaining Wall Design erode:CBC 2013,ACI 318-11,ACI 530-11
WE
vall:13 Concrete Masonry
Designer to delemllne bar cutoff localions
70.01be 210.0 Ibs 350.0 lbs 490.0 Ibs 630.0Its
0.0Ibs 140.0 ibs 280.0 Ibs 420.0]be 560.0 Ibs
Sail
4.b7 t
r
i
i
I
Applied Shear Diagram
o.a t
Tait&Associates,Inc. Title Menifee Town Center Page:
701 N.Parkcenter Dr. Job# SP7.638 Dsgnr. JV Date: 18 MAY 2016
Santa Ana,CA 92705 Description....
Phone 714 560.8200 Bio Basin wall design with BW W surcharge
` Fax 714 560-8211
This Wall in File:k:\Drawings\SP\SP7638-MenifeeWocslBio basin wall talc\sp7638 biobasln.RPX
RetainPro 10(c)15598g8777q-225014, Build 10.14.12.11
Lame:To-060ENDELL GAYER Cantilevered Retaining Wall Design ;ode:CBC 2013,ACI 318-11,ACI 530-11 cense
Adj Ftg Load=2000#
1 Ecc.=0 from CL
,u
Pp= 2937.38#
219E.Egpsf
Tait&Associates,Inc. Titre Menifee Town Center Page:
701 N.Parkeenter Dr. Job# SP7.638 Dsgnr. JV Date: 18 MAY 2016
Santa Ana,CA 92705 Description....
TA I T Phone 714 560.8200 Bio Basin wall design with BW W surcharge
'".1.1° - Fax 714 560-8211
This Wall in File:k:\Drawings\SP%SP7638-Menifee\Docs\Bio basin wall calc1sp7638 blobasin.RPX
RetalnPro 10(c)1987-2014, Build 10.14.12.11
License:KW-0 O6 567A5 DYER Cantilevered Retaining Wall Design :Ode:CBC 2013,ACI 318-11,ACI 530-11
License o•ROA
6 W1#50 16
Solid 'Fout
-8
4-0
1
1 -B 1
3-0
CITY OF MENIFEE
BUILDING AND SAFETY DEPARTMENT
PLAN APPROVAL
q�
REVIEWED 131r .- MAY 2 3 2016
DATE
F 427 42TC ` - 1427.12TC 14 7.38TC
bpval-0�thes isn"-cia-AiUiffloisloans
� _ can
1426.51 TC 1 1426.76RIMP of,any viola f t era state or city
1426.01 FL re ulations and ordina f approved fans m st be kept on the
1426.61TC 11 B nf�§� IfQ pp p p
1426.11 F 1426 a until completion.1426.84TC 15
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City of Menifee Permit No.: PMT16-01633
29714 HAUN RD. Type: Residential Addition
�A_CCfiLA-r?' MENIFEE, CA 92586
MENIFEE Date Issued: 0 512 512 01 6
PERMIT
Site Address: 29427 BENT CREEK CT, MENIFEE, CA Parcel Number: 340-240-041
92584 Construction Cost: $1,600.00
Existing Use: 1 &2 Family Residence Proposed use:
Description of INSTALL 128 SO FT LATTICE ALUMAWOOD PATIO COVER, NO ELECTRICAL
Work:
Owner Contractor
CORINNE SOLTIS CLASSIC ALUMAWOOD COVERS
29427 BENT CREEK CT 39450 BONAIRE WAY
MENIFEE, CA 92584 MURRIETA, CA 92563
Applicant Phone: 9516748533
DAVID ABEEL License Number:986793
CLASSIC ALUMAWOOD COVERS
39450 BONAIRE WAY
MURRIETA,CA 92563
Fee Description Oft Amount ISI
Building Permit Issuance 1 27.00
Deck/Patio, non-standard 1 133.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 1.00
General Plan Maintenance Fee-Building 1 6.65
$168.65
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 thereunderwhen 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_BIdg_Perrnit_Templale.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ I am exempt from licensure under the Contractors'State License Law for the
hereby affirm under penalty or perjury that I am licensed under provisions of following reason:
Chapter 9(commencing with section 7000)of Division 3 of the Business and By my signature below I acknowledge that,except for my personal residence in
Professions Code and my Jicense is in full force and effect. which I must have resided for at least one year prior to completion of
License Class 0-L q LI N . 8 6 79 improvements covered by this permit, I cannot legally sell a structure that I have
Expires �*-( � Signature built as an owner-building if it has not been constructed in its entirety by licensed
contractors. I understand that a copy of the applicable law, Section 7044 of the
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application is
submitted or at the following Web site:
❑ 1 hereby affirm under penalty of perjury one of the following declarations: htto:/lwww.leainfo.ca.cov/calaw.html.
I have and will maintain a certificate of consent of self-insure for workers'
compensation,Issued by the Director of Industrial Relations as provided for by Date
Section 3700 of the Labor Code, for the performance of work for which this
permit is issued. Property Owner or Authorized Agent
Policy# ❑ By my Signature below, I certify to each of the following: 1 am the property
23 1 have and will maintain workers' compensation Insurance, as required by owner or authorized to act on the property owner's behalf. I have read this
section 3700 of the Labor Code, for the performance of the work for which this application and the information I have provided is correct. I agree to comply
permit is Issued.My workers'compensation Insurance carrier and policy number are:. with all applicable city and county ordinances and state laws relating to building
A construction.I authorize representatives of this city or county to enter the above-
Carieroy,�L)'iRE 6411t�1Q 0-4v identifi car��Jparttyy fo�r,[(he inspection purposes. _
Policy#(}NJL7T2Z.31' Expires X- /7
Property Owner orAuthorized Agent C�
(This section need not be completed if the permit is for City Business License# 03 8 �J
one-hundred dollars($100)or less)
❑ 1 certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not emolov any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or a
workers'compensation laws of California, and agree that if I should become mixture containing a hazardous material equal to or greater that the
subject to the workers'compensation provisions of Section 3700 of the Labor amounts specified on the Hazardous Materials Information Guide?
Code,I shall ficAhwith comply with those provisions. G OYES t3 NO
, ^("tht.o Applican — Date; `Z`��r Will the intended use of the building by the applicant or future building
occupant require a permit for the construction or modification from South
WARNING: FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND OYES L9KO
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES OYES f3NO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAOMO
I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist.I understand my requirements under the Slate of
agency for the performance of the work which this permit is issued (Section California Health&Safety Code,Section 25505 and 25534 concerning
3097 Civil Code) hazardous materia reporting.
OWNER BUILDER DECLARATIONS 9?j'ES ON
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
Date 0 ZS= �p
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OWNER OR AUTHORIZED AGENT
next to the applicable item(s)(Section 7031.5.Business and Professions Code:
Any city or county that requires a permit to construct, alter,improve,demolish, EPA RENOVATION,REPAIR AND PAINTING(RRP)
or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
provisions of the Contractor's State License Law(Chapter 9 (commencing with receiving compensation for most work that disturbs paint in a pre-1978
Section 7000)of Division 3 of the Business and Professions Code)or that he or residence or childcare facility to be RRP-certified firms and comply with
she is exempt from licensure and the basis for the alleged exemption. Any required practices.This Includes rental property owners and property
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than($500).) employees.For more information about EPA's Renovation Program visit:
❑ I, as owner of theproperty, or m ern to employees with wages as their sole www.epa.govAead or contact the National Lead Information Center at
Y P y 9 1-800-424-LEAD(5323).
compensation,will do( )all of or( ) porting of the work, and the structure is
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractors State License Law does not apply to an owner of a property ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however, Certified Finn Name:
the building or improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that it was not built or improved for the Firm Certification No.:
purpose of sale).
❑ I, as owner of the property an exclusively contracting with licensed ❑No EPA Lead-Safe Certified Finn is required for this project because:
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors License Law does not apply to an owner of a property
who builds or improves thereon, and who contracts for the projects with a
licensed contractor(s)pursuant to the Contractors State License Law). If your project does not comply with EPA RRP rule please fill out the RRP
SAFETYBUILDING & PERMIT/PLAN CHECK APPLICATION
Y
Menifee
DATE ZS PERMIT/PLAN CHECK NUMBER I(D
TYPE: []COMMERCIAL PDRESIDENTIAL [-]MULTI-FAMILY ❑MOBILEHOME POOL/SPA ❑SIGN
SUBTYPE: []ADDITION []ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑MECHANICAL
F[NEWF]PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK L A ]T I C C' AL U/ka woe+> CmeJ E✓
PROJECT ADDRESS 2 / Lf Z ] 9&u7- C 94 C T rn&RJ
ASSESSOR'S PARCEL NUMBER �pZ-� f ' LOT I3 TRACT
PROPERTY OWNER'S NAME
ADDRESS Z 2-7 35-JT C,e-LK C /11 e^)*ef-
PHONE ZO 6 -Z.i 3 f( EMAIL
APPLICANT NAM/E )D cw E C A,Y -F L pp /
ADDRESS 2 6 PZ.s I! A-Z r C 9EIC- 1A M CT e-
PHONE 73''1Z,��•`` EMAIL
CONTRACTOR'S NAME T"1/v O-CaU e U&I m k QN OWNER BUILDER? ❑YES ANO
BUSINESS NAME C SS e C L U/11a a-06,0 C-0 U
ADDRESS .3 YJ n 1��c�����- U-)I- y
PHONE EMAIL n �/
CONTRACTOR'S STATE LIC NUMBER 7?J LICENSE CLASSIFICATION
VALUATION$ 6 Q� l SO FT 12 S L SQ FT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION r Cf1Y OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I SMIP
INVOICE ((���� (p pA1D AMOUNT
AMOUNT I�-+-• OCASH OCHECKR OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
�braar� r5 �
So i ' Lf}SS(C llta�tqu'-mac? Lain
3911S�
Z 95 2 '7 13CQ cRr-EK C-r rq ul,,At �-(a ��, 12Sa -3
NeNi-fec- Cc, Qzsig(l 95-1-67k/,
ity of t e LEDGER & TRACK
3uilginq & Saafefety Dept.
CITY OF MENIFEE
A1A.Y 2 5 2016 INSPECTION REQUIRED
r
BUILDING AND SAFETY DEPARTMENTReceived
PLAN APPROVAL
REVIEWED BY ATE'
u ermit for,or an
*ppprgvalDfihe s s fall not be construed to be a p
approval of,any violation of any provisions of the federal,state or cl on the
regulations and ordinances. this set of approved plans must be kept
lobsite until completion. V
i
JD
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ALUA4 ujoae)
L ArrICle � 6 ' '
Coved f 9
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City of Menifee Permit No.: PMT16-01421
29714 HAUN RD. Type: Residential Electrical
<ACCEL/+'. MENIFEE, CA 92586
MENIFEE Date Issued: 05/23/2016
PERMIT
Site Address: 30092 CARMEL RD, MENIFEE, CA 92586 Parcel Number: 336-143-012
Construction Cost: $9,747.00
Existing Use: Proposed Use:
Description of 5.13kW 19 PANELS W/19MICRO-INVERTERS
Work:
Owner Contractor
DANNY HARRIS VISION INSTALLATION
30092 CARMEL RD 5255 N EDGEWOOD DR_125
MENIFEE, CA 92586 PROVO, UT 84604
Applicant Phone:8887817074
KELLY BAKER License Number: 853582
VISION INSTALLATION
5255 N EDGEWOOD DR 125
PROVO, CA 84604
Fee Description Oft Amount 151
Solar, Residential or Small Commercial 1 252.00
Building Permit Issuance 1 27.00
Additional Plan Review Electrical 158 157.50
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 2.00
General Plan Maintenance Fee-Electrical 1 12.60
$452.10
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_Permit_Template.rpt Page 1 of 1
City of Menifee Permit No.: PMT16-01632
29714 HAUN RD.
�CCELA— MENIFEE, CA 92586 Type: Residential Alteration
MENIFEE Date Issued: 05/2512016
PERMIT
Site Address: 25869 CARAVAN CT, MENIFEE,CA Parcel Number: 358-512-023
92584 Construction Cost: $5,280.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of MOVE DRAIN LINE&WATER SUPPLY FOR NEW SINK LOCATION,ADD ONE ELECTRICAL OUTLET
Work:
Owner Contractor
ED ESTRADA AAA RESTORATION INC
25869 CARAVAN CT 29850 2ND STREET
MENIFEE, CA 92584 LAKE ELSINORE, CA 92532-2420
Applicant Phone:9514715828
LANCE REMINGTON License Number.834839
AAA RESTORATION INC
29850 2ND STREET
LAKE ELSINORE, CA
Fee Description r�yt Amount 1$1
Receptacle,Switch, Outlet&Fixture 1 116.00
Plumbing Fixtures and Vents,fixtures 1 116.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 5.80
General Plan Maintenance Fee-Electrical 1 5.80
$271.60
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_Permit_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 perjurythat 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 Contractors State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class O IQ' -F I C 3 3 Licens No. 3y�/" By my signature below I acknowledge that,except for my personal residence
Expires 3 SLgnatur alP v� 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
o 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 www.leeinfo.ca.eov/calaw.html.
tiis issued.
Policy# �J L ����R�o�f Date
PROPERTY OWNER OR AUTHORIZED AGENT
o 1 have and will maintain workers compensation insurance,as required by
section 3700 of the Labor Code,for the performance of the work for which o 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
/t WIGS i 54 J� —�5x1) t�•�•S with all applicable city and county ordinances and state laws relating to
Carrier !'T building construction.I authorize representatives of this city or county to
Policy 025 TSenn-714;/ Expires V10I JZr>17 enter thea ove!den' ed property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred 2' m� Date ?
dollars($100)or less P OPERiY DWNER R AUTHORIZED AGENT
o I certify that in the performance of the work for which this permit is issued,
1 shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE N
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 370D of the Labor
Code,I shall forth comp] ith those provisions. Will the applicant or future building occupant handle hazardous material or a
Appli :sue Date—'ST mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SE RE WORKER'S COMPENSATION COVERAGE IS 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 KNo
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) XYes o 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 Licensehave Law for the reason(s)indicated below by ion Wes
material repo/
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 //'
Business and Professions Code).Any city or county that requires a permit to Dated(v
construct,alter,improve,demolish or repair any structure,prior to its OPERTY OVA ER 0144KIMORIZED 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 IRRP)
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 70313 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 clothe paint-disturbing work themselves or through their
o 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.eov/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 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. o No EPA Lead-Safe Certified Firm is required for this project because:
o 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 role please fill out the RRP
Acknowledgement
Menifee
DATE PERMIT/PLAN CHECK NUMBER EMU- �J
TYPE: O COMMERCIAL KRESIDENTIAL 0 MULTI-FAMILY O MOBILE HOME U POOL/SPA O SIGN
SUBTYPE: O ADDITION 0 ALTERATION O DEMOLITION VELECTRICAL O MECHANICAL
O NEW A PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK a V e • �E Wc'� c,�[� fSr
PROJECTADDRESS 06 '� JGiyS i Cv-_ G v gy
ASSESSOR'S PARCEL NUMBER SSg 51a0P b LOT 5 TRACT
OWNER NAME
ADDRESS !� egTczJC�y� -bLci� N�rii� o?'Jr
PHONE EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL '/ '/
CONTRACTOR'S NAME t, K,f F rj,,nm1ER BUILDER? OYES NO
A BUSINESS NAME � }
ADDRESS yL �,26�5- a. a
PHONE '25/- y I) '��?� EMAIL
CONTRACTOR'S STATE LIC NUMBER 8,S//F,V LICENSE CLASSIFICATION
VALUATION$ SOFT L SO FT
APPLICANT'S SIGNATUR DATE �� J
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSIN SLIC NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN ` SMIP
INVOICE !^� PAIDAMOUNT C 1,
AMOUNT A .�O CASH 0CHECKN CREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0 CHECK If OCREDITCARD VISA/Mc
OWNER BUILDER VERIFIED C YES O NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-6 72-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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