PMT16-02931 City of Menifee Permit No.: PMT16-02931
29714 HAUN RD. Type: Residential Electrical
<A--CCELA—> MENIFEE,CA92586
NY,- MENIFEE Date Issued: 09102/2016
P E R M I T
Site Address: 30298 SAN RAFAEL ST, MENIFEE, CA Parcel Number: 360-413-002
92584 Construction Cost; $200.00
Existing Use: proposed Use:
Description of CONNECT EXISTING 50A DISCONNECT BOX TO NEW ABOVE-GROUND SPA
Work:
Owner Contractor
MATTHEWGILMORE
30298 SAN RAFAEL STREET
MENIFEE,CA 92584
Applicant License Number:
MATTHEWGILMORE
30298 SAN RAFAEL STREET
MENIFEE, CA 92584
Phone:9519732851
Fee Description Q—ty Amount($
Building Permit Issuance 1 27.00
Inspections not specified 116 116M
Inspections not specified 116 116.00
GREEN FEE 1 1.00
$260.00
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_Permit Templatespit Page i of 1
CITY OF M
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LICENSED DECLARATION P' 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 a2icensed contractor(s)pursuant to the Contriictors;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 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
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
ci 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. www.Iegi9fo.ca.goy/caIaw.htmL
Policy# I nyoti�-�41- a%-O— Date ?1-2-1141-
o 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 folloVing:I am the property
this permit Is issued.My workees compensation insurance carrier and policy owner or authorized to act on the property ownees behalf.I have read this
number am: 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 authodze representatives of this city or county to
Policy# Expires enter the above Identified progrtV 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
o I certify that In the performance of the work for which this permit Is issued,
I shall not empi 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 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 or a
mixture containing a hazardous material equal to or greater that the
Applicant Date amounts speciffled on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS a Yes ci No
UNLAWFUL,AND SHALLSUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVI L 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(SCAQUID)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORN EYS FEES for guidelines
CONSTRUCTION LENDING AGENCY u Yes ci No
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or in oclifted facility be within 1000 feet of the
lending agency for th e performance of the work which this permit is issued outer boundary of a school?
I e 3 97 c Yes a No
S Clio" 0 Chn'r
"NER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
h reby, r, e,Pe 'I of per that I am exempt from the California Health&Safety Code,Section 25505 and 25534 concerning
he m.Ju�(s)indicated below by the hazardous material reporting.
t s
I t ct.f R Ud
C n' r's License Law f.
,heck'a,k(,)I have placed next to the applicable item(s)(Section 7031.5 uYes ci No
Business and Professions Code).Any city or county that requires a permitto 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 Contractor's State EPA RENOVATION,REPAIRAND PAINTING IRRPJ
License Law(Chapter 9(commencing with Section 70DO)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 ficensure receiving compensation for most work that disturbs paint in a pre-1978
a nd 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
a n Applicant for a permit subjects the applicant to a civil pena Ity 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
Alas owner of the property,or my employee with wages as their sole employees.Far more information about EPA's Renovation Program visit:
l pensation,will do( )all of or( I portion of the work,and the structure is www.eva.govIlead 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 Contractor's State License Law does not apply to an owner of a u 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:
u 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 role please fill out the RAT
Acknowledgement
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
��O'Menifee
DATE 8- 15� 16 PERMIT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL *RESIDENTIAL CMULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION C)ALTERATION ODEMOLITION #ELECTRICAL OMECHANICAL
*NEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES—
DESCRIPTION OF WORK 04 4ed �a 50 4W
4D A)&.,, W—A
PROJECTADDRESS 17 513q
ASSESSOR'S PARCEL NUMBER 36V e02��LOT TRACT
OWNER NAME M heu,� dAj Tz4lve <� 11nepf e-
ADDRESS 302.61b 5-In 944e-( !�! ; lmet--f&- i 64. I-L56y
PHONE EMAIL VJ2- DAM Y-44"" COV0
IM01
APPLICANT NAME /0441ha4_1 (�j 2—
ADDRESS 5A7yi ilz' im5 Aeol-C
PHONrjt_q 57 q15- -2-K EMAIL
CONTRACTOR'S NAME OWNERBUILDER? 0YESCN0
BUSINESS NAME
ADDRESS
PHONE EMAIL
I CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION $ '.')00, 00 SO FT L SO FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION SMIP JK I CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN
INVOICE I &Lon_ PAID AMOUNT OCASH OCHECK# 0 CREDIT CARD VISAINIC
AMOUNT
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# 0 CREDIT CARD VISA/MC
[OWNER BUILDER VERIFIED 0 YES 0 No DLNUMBER W5C6q660 NOTARIZED LETTER 0- YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
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