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PMT16-02405 City of Menifee Permit No.: PMT16-02405 29714 HAUN RD. 4ACCELA4? MENIFEE,CA 92586 Type: Residential Alteration "' """''"""" MENIFEE Date Issued: 08/09/2016 PERMIT Site Address: 23745 NEWPORT RD,MENIFEE,CA Parcel Number: 350-281-030 92587 Construction Cost: $1,950.00 Existing Use: 1 &2 Family Residence Proposed Use: Description of SPECIAL INSPECTION FOR REHABILITATION OF EXISTING HOME TO INCLUDE ELECTRICAL, Work: SEPTIC TANK COVER,A/C, ROOF, FLOORS,STAIRS, EXTERIOR DOORS,SMOKE DETECTORS Owner Contractor ANDREW NGUYEN , 9611 PORT CLYDE DR HUNTINGTON BEACH,CA 92646 Applicant License Number: ANDREW NGUYEN 9611 PORT CLYDE DR HUNTINGTON BEACH,CA 92646 Phone:3106780609 Fee Description Opt r Amount(S) Services,Switchboards,Control Centers&Panels 1 116.00 Sewer 1 150.00 Air Handling/Condensing Units SFR 1 133.00 Building Permit Issuance 1 27.00 Inspections not specked 148 148.37 $574.37 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_Permil_Template.rpt Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATIL-^ property who builds or improves thereon,and who contracts for the proje s 1 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 z 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 tha-,except for my personal residen e Expires Signature in which I must have resided for at least a ie year prior to completion of improvements covered by this permit.I c;nnot legally sell a structure that I WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has nor been constructed in its entirety y J I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a t opy of the applicable law,Sectio have and will maintain a certificate of consent of self-insure for worker's 7044 of the Business and Professions Cart!,is available upon request when compensation,issued by the Director of Industrial Relations as provided for this application is submitted or at the folly wing website: by Section 3700 of the Labor Code,for the performance of work for which this permit is issued. Ww,tae�infoca.gov[c�law_himl. Policy# �U � �^a -Date 9 �� r_I have and will maintain workers compensation Insurance,as required by PROPERTY OWNER OR A•UTAOROED AGEf T section 3700 of the Labor Code,for the performance of the work for which ei-ey my signature below I certify to each,if the following:I 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 prc vided is correct.I agree to comp with all applicable city and county ordinar ces and state laws relating to Carrier building construction.I authorize representatives of this city or county to Policy IFExpires enter the above identified property for inspection purposes. (This section need not to be completed is the permit is for one-hundred Date O — q Z dollars($100)or less � PROPERTY OWNER OR AUTHO RE G fT 1 certify that in the per' :Hance of the work for which this permit is issued, I shall not emoloV any pers,ns in any manner so as to become subject to the CITY BUSINESS LICENSE# worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the worker's 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 o a mixture containing a hazardous material equal to or greater that the Applicant Date amounts specked on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑yes Wflo UNLAWFUL,AND SHALLSUBIECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by th a applicant or future building AND CIVIL FINES UP TOONE 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(SC AQMD)?See permitting checklis IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguide;fp s CONSTRUCTION LENDING AGENCY ❑Yes .KN, I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified fat ility,be with in 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) . c Yes �o QWNER BUILDER DECLARATIONS 1 have read the Hazardous Material Information Guide and the SCAQMD permitting checklist-1 understand my regt irements under the State of I hereby affirm under penalty perjury that I am exempt from the California Health&Safety Cade,Section 25505 and 25534 concerning Contractor's License Law for thhee reason(s)indicated below by the hazardous material reporting. checkmark(s)I have placed next to the applicable items)(Section 7031.5 ,4 c Ne Business and Professions Code).Any city or county that requires a permit to lit Date 4 Z� construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTH RIZ A EIIT 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 PAINTIN3 fiRRP 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 rde)or that he or she is exempt from licensure receiving compensation for most work IN t disturbs paint In a pre-1978 and the basis for the allea. 'exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-oortified firms and comply with an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental Fir tperty owners and property than($500). managers who do the paint-disturbing we rk themselves or through their c 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 O portion of the work,and the structure is mime oa.eov lead or contact the Nation;I 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%ill 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. ❑No EPA Lead-Safe Certified Firm is requ red for this project because: -11,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 iRP rule please fill out the RRP Acknowledgement.