PMT16-02076 City of Menifee Permit No.: PMT16-02076
29714 HAUN RD.
<Accll L1l7. MENIFEE, CA 92586 Type: Residential Addition
MENIFEE Date Issued: 09/14/2016
PERMIT
Site Address: 29735 KEMPE CIR, MENIFEE, CA 92584 Parcel Number: 372-170-002
Construction Cost: $23,663.36
Existing Use: 1 &2 Family Residence Proposed Use:
Description of 28'X 32'(896 SO FT) DETACHED ACCESSORY BUILDING NO ELECTRICAL
Work:
Owner Contractor
DAVID&RAELEAN SHIELDS
29735 KEMPE CIR
MENIFEE, CA 92584
Applicant License Number:
MENIFEE, CA
Phone:9516344318
Fee Description QtV Amount l$)
Building Permit Issuance 1 27.00
Inspections not specified 387 387.21
Additional Plan Review Building 63 63.39
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 4.00
New Construction Permit Fee 1 108.85
General Plan Maintenance Fee- New 1 5.44
Construction
$596.89
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_Pennit_Template.rpl 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 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 l must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I
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 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 website:
by Section 3700 of the Labor Code,for the performance of work for which
this permit is issued. ww.l� inf . v cola tml. Date �� Zb(ly
++
Policy# �`4
❑I have and will maintain worker's compensation Insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work forwhich ❑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 an 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 relatingto
building construction.I authorize representatives ofthis 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 far 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,
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,1 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 Dyes 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 ❑Yes ❑Na
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 ❑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 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,after,Improve,demolish or repair anystructure,priorto 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 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 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 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 rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
j':
,Menifee
DATE PERMIT/PLAN CHECK NUMBER ' Opv �Q
TYPE: O COMMERCIAL *RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
ONEW OPLUMBING ORE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
al. cCCS �r
PROJECTADDRESS CA 9-LSZli.
y ASSESSOR'S PARCEL NUMBER -``712- L'1 O -oa-Z - (a LOT O r11 TRACT
OWNER NAME
ADDRESS ugh •D-e-e `CA ?-S
PHONE gg1l- *-,k3u6 9S•t-1o34-`L3t9 EMAIL ,eLn S
APPLICANT NAME
ADDRESS 01735' Kem pe C.rC vAe- ; e Q.P Z.S'�
PHONE 9S', -b3`(- l8 EMAIL
CONTRACTOR'S NAME *'U r l= OWNERBUILDERP OYES ONO
BUSINESSNAME —�u�rC^St•�E
ADDRESS
PHONE 9 B'S EMAIL
CONTRACTOR'S STATE LIC NUMBER 6k0kL,(0uA LICENSE CLASSIFICATION GT
VALUATION$ 'G3 blo7.� SO FT qA L SQ FT
APPLICANT'S SIGNATURE DATE t J-•-L Za i(p
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT .� 0CASH 0CHECK# OCREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0 CHECK 4 OCREDIT CARD VISA/MC
OWNER BUILDERVERIFIED OYES O NO DLNUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. IVlenifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
Menifee PMT16-02076 sa+-1
7/12/16
[DO NOT PAY— THIS IS NOT AN INVOICE]
VALUATION AND PLAN CHECK FEE
JURISDICTION: Menifee PLAN CHECK NO.: PMT16-02076
PREPARED BY: Tamara Fischer DATE: 7/12/16
BUILDING ADDRESS: 29735 Kempe Circle
BUILDING OCCUPANCY: U
BUILDING AREA Valuation Reg. VALUE ($)
PORTION ( Sq. Ft.) Multiplier Mod.
Garage 896 36.40 32,614
Air Conditioning
Fire Sprinklers
TOTAL VALUE 32,614
Jurisdiction Code mnf Manual Input
Bldg.Permit Fee by Ordinance
Plan Check Fee by Ordinance
Type of Review: ❑+ Complete Review ❑ Structural Only
❑Repetitive Fee ❑ Other
Repeats ❑ Hourly Hr. @ "
EsGil Fee $63.39
Comments: Esgil Fee" = .65 (.0046 x $32,614 x.65) _ $63.39
'The fee may change if electrical is to be installed in the garage (TBD).
Sheet 1 of 1
macvalue.doc+
V - z