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PMT16-02350 City of Menifee Permit No.: PMT16-02360 _ 29714 HAUN RD. Type: Residential Demolifion <-►CCEL/-> MEN IEEE, CA92586 MENIFEE Date Issued: 07/21/2016 E R M � T Site Address: 25870 TRUMBLE RD, MENIFEE, CA Parcel Number: 329-240-013 92585 Construction Cost: $3,500.00 Existing Use: Proposed Use: Description of DEMO EXISTING MOBILE HOME, 1848 SF Work: Owner Contractor PATRICIA GROB 25870 TRUMBLE ROAD MENIFEE,CA 92585 Applicant License Number: MENIFEE,CA Fee Description C1yt Amount ISl .�suance 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 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_BIdg Pernit Template.rpt Page i 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 D 1 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 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 Dlhereby affirm under penalty of perjury one of the fallowing deciarations:l 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 Cade,is available upon request when compensation,issued by the Director of Industrial Relations as provided for this applicatior S submitted or at the following website: by Section 3700 of the Labor Code,for the performance of work for which this permit is issued. www.le in v a w.html. Policy q Date P NOW ER❑I have and will maintain workers compensation insurance,as required by OR AUTHORIZED AGENT section 3700 of the Labor 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 with all applicable city and county ordinances and state laws relating to building con ruction.I authorize representatives of this city or ounty to Policy# Expires enterthe v defied property for inspection purposes. (This section need not to be completed is the permit is for one-hundred �d dollars($100)or less Date P OWNER OR AUTHORIZED AGENT ❑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 11 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 or greater that the amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes D 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($100,000),IN occupant require a permit for the construction or modification from South ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management the t(SCtionor odi permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES fo Coast Airlines Qua CONSTRUCTION LENDING AGENCY o Yes o No I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the lending agency for the performance of the work which this permit is Issued outer boundary of a school? (Section 3097 Civil Code) D Yes o No OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning checkmark(s)I have placed next to the applicable item hazardous material reporting.$)(Section 7031.5 oyes D 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 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 apre-1978 and the basis for the allegedexemption.Aicany nt loci of Section of not o residence or childcare facility to be RRP-certified firms and comply with than Applicant fora permit subjects the applicant toacivil penalty of not more required practices.This includes rental property owners and property than($500). managers who do the paint-disturbing work themselves or through their D I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit: compensation,will do( )all of or( )portion of the work,and the structure is www.eoa.eov/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 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. 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. L NOwl", 71►C ._iS�feAUJjIViIAW I1IMil[ti: 1al:�_,UUI11FAire]0j '' Menifee DATE PERMIT/PLAN CHECK NUMBER TYPE: O COMMERCIAL O RESIDENTIAL C MULTI-FAMILY O MOBILE HOME 0 POOL/SPA 0 SIGN SUBTYPE: O ADDITION O ALTERATION "W' 6EMOLITION O ELECTRICAL O MECHA&IICAL Ity of Menifee O NEW O PLUMBING O RE-ROOF-NUMBEROFSQUARES Buildin & S DESCRIPTION OF WORK PROJECTADDRESS SS O -r?.UM/t 15LI5 eri1&P R ASSESSOR'S PARCEL NUMBER LOT TRACT OWNER NAME 'r Q ADDRESS PHONE 95/- 7�- 6)�76 EMAIL APPLICANT NAME R4 ru rJ ,5i4N r' ADDRESS , 0 So - 7 C✓wa ✓1A//i C A4 9.;ZS PHONE 95I — 5DO— 5'7Z 6 EMAIL CONTRACTOR'S NAME OWNER BUILDER? ES O NO BUSINESS NAME ADDRESS PHONE EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION$ _ Q FT L SO FT APPLICANT'S SIGNATURE DATE l DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP 1< INVOICE PAID AMOUNT �, AMOUNT OCASH OCHECK# CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT I 0CASH 0CHECK# O CREDIT CARD VISA/MC OWNER BUILDER VERIFIED O YES 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 e4 f4tv City q Menifee Building S AP IMa"Dept. JUL 21 2016 -------- Received A'CMoW:LE"DGMENT 'notary:Ru.bIIc'or:other•be pasting this cerilflcate verifies only .the identify:of'the IndfvlduaJ who signed fha•document to which this certificate Is attached, and not the truthfulness,.accuracy, or valldlt of: document Slate'of California County of C-Z e On—(� lL-0/& before me, •Y4e4 ' 'e n ' o / / �O ✓'arc (j`G(Insert name and title of the off cer)Personally appeared �G` �O� who proved to me on the basis of satisfactory evidence to be the perscn(s) whose name(s)Is/are psubscribed to the within Instrument and acknowledged to me that he/she/they executed the same in erso (s), oatheeriz-edntIty °apse (aes),et�d•Ehat y#4sfher/t#lelrslgnefure(s}or�•t+le•�nstr menldhe person(s), or t'he,ehtlly upon behalf of which the Person(s) acted, executed the Instrument. I certify under PENALTY OF PERJURY under the laws of the Paragraph Is true and correct, State of California that the foregoing WITNESS my hand acid offfclalseal, .....ARE'............ ......_ Comm 1�37560� Sig �f` �,G` "z .°NoTaN Aube C aiiforNo 'z nature 2 Riversltl' oun d :......�zc... "No Oemmission E\pj �— �u.n.u.uq, mber21 2019 r: ,r • city of Menifee Building & Safety Dept. i JUL 21 20% Received G t'(,pL to V t b CITY OF MENIFEE �. BUILDING AND SAFETY DEPAW ENT PLAN APPROVAL REVIEWED BY O DATE *Approval of these plans shall not be construed to be a rmit for,or an approval of,any•iolation of any provisions of the federal state or city regulations and ordinances, This set of approved plans ust be kept on the jobsite until completion. V t G� 00 �o r--,)