PMT16-01677 City of Menifee Permit No.: PMT16-01677
_ 29714 HAUN RD.
4 C A7 MENIFEE, CA 92586 Type: Commercial Demolition
i
MENIFEE Date Issued:
O6/01I2016
PERMIT
Site Address: 26701 MCCALL BLVD, MENIFEE,CA Parcel Number: 335-172-008
92586 Construction Cost: $700.00
Existing Use: Proposed Use:
Description of DEMOLITION OF BLOCK WALL"MONUMENT SIGN'
Work:
Owner Contractor
MENIFEE UNITED CHURCH OF CHRIST
26701 MCCALL BLVD
MENIFEE, CA 92586
Applicant License Number:
MENIFEE UNITED CHURCH OF CHRIST
CA
Fee Description 0tv Amount($)
Building Permit Issuance 1 27.00
Demolition Permit 1 140.00
GREEN FEE 1 1.00
$168.00
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications orfrom preventing builiding operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise stated,a permit for construction under which no work is commenced within six
months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA 6ldg_Permit_Templale.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 contractor(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 o I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class License No. By my signature below I acknowledge that,except for my personal residence
Expires Signature in which I must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
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 www.leainfo.ca.eov/calaw.html.
this permit is issued.
Policy#
Date
o I 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 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
num her 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 ( CC-LX-- / k. /"�-�"" Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
o I certify that in the performance of the work for which this permit is issued,
I shall not emaloy any persons in any manner so as to become subject to the COY BUSINESS LICENSE#
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date mixture containing a hazardous material equal to argreater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes ONO
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(SCAQM D)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY ❑Yes ONO
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 ONO
OWNER BUILDER DECLARATIONS 1 have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
California Health&Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oYes o No
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,priorto its PROPERTY OWNER OR AUTHORIZED AGENT
issuance,also requires the applicantforthe 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 LRRPL
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
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.zov/lead or contact the National Lead Information Center at
not intended or offered forsale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code,The Contractors State License Law does not apply to an owner of a o An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. o No EPA Lead-Safe Certified Firm is required for this project because:
o 1,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 rill out the RRP
Acknowledgement.
BUILDING i SAFETY PERMIT/PLAN CHECK APPLICATION
Y� *
0-Menifee
DATE !'fq PERMIT/PLAN CHECK NUMBER 1 (O' V lo /I
TYPE: ❑COMMERCIAL ❑RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ®SIGN
SUBTYPE: []ADDITION ❑ALTERATION ®DEMOLITION ❑ELECTRICAL [—]MECHANICAL
[:]NEW,l ❑PLUMBING El RE-ROOF-NUMBER OF SQUARES
c DESCRIPTION OF WORK e—W011 '�IOYL O� ✓j0C,�- 1Na.. vn 0 ri U wn 71 15 On
our ro a(a74I Mc CJ .
PROJECTADDRESS 7Q Me-04J1 .ejvd. MC.ni-fccCA v5-0-6
ASSESSOR'S PARCEL NUMBER 4e� � UG 8 LOT TRACT
PROPERTY OWNER'S NAME MC41j7CG United C'hu o-r Chvist
ADDRESS 761 MCC"I Z IV d. k4cii4Cc- 1,5uri C1f CA
PHONE (95i) (o79- 114g EMAIL
APPLICANT NAME $a-Me_ QS cboVC
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME P OWNER BUILDER? ❑YES®.NO
BUSINESS NAME o c�'� IS orne m a I --en o C + e- OL I r
ADDRESS Jc 2 OO r Q qma 586
PHONE `�_5 I - �' -37.�( EMAIL 2
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION $ 70000 SQFT r.),5 -4 Jona X I -P� w�4SQFT Plus , aR ff,L
APPLICANT'S SIGNATURE DATE
� r y
DEPARTMENT DISTRIBUTION 0v CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT
�:
AMOUNT O CASH O CHECK p CREDIT CARD 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.citvofmenifee.us Inspection Request Line 951-246-6213
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