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PMT16-02799 City of Menifee Permit No.: PMT16-02799 29714 HAUN RD. Type: Residential Alteration <A-CCIEL:A-�' MENIFEE,CA 92586 MENIFEE Date Issued: 09/0712016 P E R M I T Site Address: 29747 NORTHSHORE ST, MENIFEE,CA Parcel Number: 340-510-011 92584 Construction Cost: $45,000.00 Existing Use: 1 &2 Family Residence Proposed Use: Description of RESIDENTIAL BATHROOM ALTERATION,208 SF, REPLACE EXISTING TUBISHOWER WITH Work: ROLL-IN SHOWER, NEW ELECTRICAL, RELOCATE TOILET, REPLACE SLIDING GLASS DOOR WITH FRENCH DOORS, REPLACE WINDOW IN MASTER BEDROOM WITH DOOR Owner Contractor PAUL KOCINA YOUNGREN CONSTRUCTION INC 29747 NORTHSHORE STREET 443 EAST ALVARADO STREET MENIFEE, CA 92584 FALLBROOK, CA 92028 Applicant Phone:7607289874 DAVE HENRIKSON License Number. 784656 YOUNGREN CONSTRUCTION INC 443 EAST ALVARADO STREET FALLBROOK, CA 92028 Fee Description Qtv Amount Building Permit Issuance 1 27.00 Inspections not specified 258 258.14 GREEN FEE 1 2.00 SMIP RESIDENTIAL 1 6.00 New Construction Permit Fee 1 207.00 $500.14 The issuance of this permit shall not prevent the building official from thereafter requiring the correction of en-ors 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 BidgPermil-Template.ript 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 a 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: —IS — License Class, License No. Le 6G f1v By my signature below I acknowledge that except for my persona I residence Expires CQ t-7 Signature In which I in ust 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 eZ have built as an owner-builder if it has not been constructed in its entirety by ci I hereby affimn 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 workees 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 La bor Code,for the performance of work for which this permit is issued. www.Ieg!nfic.ca.gov/caIaw.htmL Policy# Date X 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 for which o By my signature below I certify to each of the finflowhig: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 provided is correct.I agree to comply Carrier AF-% e7 with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy#'(Q_2!?K 2-42LLA—Zo%apires T>C7_ ZaD enter the above identified property for inspection Purposes. (This section need not to be completed is the permit is for one-hundred dollars($100)or less Date PROPERTY OWNER OR AUTHORIZED AGENT 0 1 certify that in the performance of the work for which this permit is issued, Ishallnotemplo any persons 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 subject to the wpjkejs compensation provisions of Section 3700 of the Labor HAZARDOUS MATERIAL N Code,I shall rt ith clo v! ions. Will theapplicant or future building occupant handle hazardous materialora Applicant P-�� mixture containing a hazardous material equal to or greater that the Date 'I'l amounts specified on the Hazardous Materials Information Guide? WARNING, AILURETOSECU ORKER'S COMPENSATION COVERAGE 15 o Yes UNLAWFUL,AND SHALL S CT AN EMPLOYER TO CRIMINAL PENALTIES X10— AND CIVIL FINES UPTO 0 E HUNDRED THOUSAND DOLLARS($100,000),IN Will the intended use of the building by the applicant or future building ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)?See permitting checklist forguidelines CONSTRUCTION LENDING AGENCY a Yes >fr- 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 'o OWNER BUILDER DECLARATIONS I have ?ad the Hazardous Material Information Guide and the SCAQMD I hereby affirm u rider pena Ity of perjury that I am exempt from the permitting checklist I understand my requirements under the State of Contractor's License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 onc ni.ng checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous mat ' I rt, Business and Professions Code).Any city or county that requires a permit to ciy:IoF:;��. construct,alter,improve,demolish or repair any structure,prior to its Date issuance,also requires the applicant for the Penn it to file a signed statement PROPERTY ,QW14ER OR AUTHORIZED AGENT that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RgP) License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt from licensure The EPA Renovation,Repair and Painting(RRP)Rule requires contractors and the basis for th e alleged exemption.Any violation of Section 7031.5 by receiving compensation for most work that disturbs paint in a pre-1978 an Applicant for a permit subjects the applicant to a civil penalty of not more residence or childcare facility to be RRP,certffied firms and comply with than($500). required practices.This includes rental property owners and property managers who do the Paint-disturbing work themselves or through their ci 1,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( I portion of the work,and the structure is mmepa.Royllead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LFAD(5323). Code,The Contractor's State License Law does not apply to an owner of a property who,through employees!or personal effort,builds or Improves the ci An EPA Lead-Safe Certified Renovatorwill be responsible forthis project property provided that the improvemehts are not intended or offered for Certified Firm Name: sale.If,however,the building or improvement is sold within one Yearof completion,the Owner-Builder will have the burden of proving that it was Firm Certification No.: not built or improved for the purpose of sale. No EPA Lead-Safe Certified Firm is required forthis project bemuse: ci 1,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 RRP rule please fill out the RRP Acknowledgement