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PMT16-01707 City of Menifee Permit No.: PMT16-01707 29714 HAUN RD. Type: Residential Demolition �ACCELA? MENIFEE, CA 92586 MENIFEE Date Issued: 06/03f2016 PERMIT Site Address: 27874 HILLPOINTE DR, MENIFEE, CA Parcel Number: 333-243-010 92585 Construction Cost: $1,000.00 Existing Use: Proposed Use: Description of DEMO UNPERMITTED PATIO COVER ROOM, 100 SO FT Work: Owner Contractor RUTH COWAN MICHAEL KAAKE CONSTRUCTION 27874 HILLPOINTE DR 28039 SCOTT ROAD STE D-393 MENIFEE, CA 92585 MURRIETA, CA 92563 Applicant Phone: 9512379558 MICHAEL KAAKE License Number. 819164 MICHAEL KAAKE CONSTRUCTION 28039 SCOTT ROAD STE D-393 MURRIETA, CA 92563 Fee Description Oft f Amount(5) 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 connection of errors in the plans and specifications or from preventing building operations being named on thereunder when in violation of the Building Cade or of any other ordinance of City of Menifee.Except as otherwise slated,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 (Expires CENSED DECLARATION property who builds or improves thereon,and who contracts forthe projects with a licensed contractor(s)pursuant to the Contractors State License Law). ereby affirm under penalty of perjurythat I am under provisions of apter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contractor's State License Law far ofessions Code and my license Is in full force and effect. ! the following reason: ense Class 3 License No.O/7 ICn`i By my signature below I acknowledge that,except for my personal residence L/'3 O /7 Signature t �j \ ,( t/L� � 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 OR KER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by o I reby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section havand will maintain a certificate of consent of self-insure for worker's 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 webshe: by Section 3700 of Labor Code,for the performance of work for which www.leAin1c,.ca.aov/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 number are: application and the information I have provided is correct.I agree to comply Carrier with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy# 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 certify that in the performance of the work for which this permit is issued,c , I shall not emoloV any persons in any manner so as to become subject to the Ill'BUSINESS LICENSE#_oofo�o workers compensation laws of California,and agree that if I should become (.Mccupa AZARDOUS MATERIAL DECLARATION subject to the workers compensation provisions of Section 3700 of the Labor ode,1 shall forthwith comp) with those provisions. ill the applicant or future building occupant handle hazardous material or a L _ j ixture containing a hazardous material equal to or greater that the plia Date , '-3 � mounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS Yes �ZNO UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ill the intended use of the building by the applicant or future building AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN nt 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 AT FEES for guidelines 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 agencyfor the performance of the work which this permit is issued outer boundary of a school? (Section 3097 Civil Code) o Yes <NNo OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm under penalty of perjury that l am exempt from the permitting checklist.I understand my requirements underthe State of California Health&Safety Code,Section 25505 and 25534 concerning Contractors License Law for the reason(s)indicated below by the hazardous material repo ng. checkmark(s)I have placed next to the applicable Rem(s)(Section 7031.S s o No Business and Professions Code).Any city or county that requires a permit to LJ Date �' 3� construct,alter,improve,demolish or repair any structure,priorto its ROPERTYO NER ORAUTHORIZED AGENT issuance,also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRPI License Law(Chapter 9(commencing with Section 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 llcensure 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 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.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 Contactors 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 fill out the RRP Acknowledgement. TY r rAPPLICATION ¢ . i _ en fee DATE - Z - /(a PERMIT/PLAN CHECK NUMBER I ' O- TYPE: 0 COMMERCIAL ) RESIDENTIAL O MULTI-FAMILY C MOBILE HOME C> POOL/SPA 0 SIGN SUBTYPE: 0, ADDITION 10 ALTERATION DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PLUMBING > RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK r✓! I� a fr✓L PROJECTADDRESS -7� ASSESSOR'S PARCEL NUMBER ��-ay-� ()LOT '2�0 TRACT OWNER NAME A ADDRESS i PHONE 79' 3 EMAIL IV I APPLICANT NAME u4 (_ ADDRESS ' PHONE 9yQ 793 - a777 EMAIL AaA CONTRACTOR'S NAME 14,214A,61 x~14(f OWNER BUILDER? O YES) NO BUSINESS NAME W 'z Gc 1�1..� ✓c+1 d ADDRESS Z S� VI 3 PHONE 9y9- ZQ3- 0773 EMAIL CONTRACTOR'S STATE LIC NUMBER el9/&q LICENSE CLASSIFICATION /3 L SO FT VALUATION$ 1660 . SO FT APPLICANT'S SIGNATUR ATE - Z-I6 a DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE `� PAID AMOUNT 0CASH OCHECKp C%CREDITCARD VISA/MC AMOUNT PLAN CHECK FEES PAID AMOUNT 0 CASH ,CHECK# CREDIT CARD VISA/MC OWNER BUILDER VERIFIED OYES G NO DLNUMBER NOTARIZED LETTER 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