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PMT16-02957 City of Menifee Permit No.: PMT16-02957 < _6Ceu 29714 HAUN RD. Type: Residential Alteration —A A—> MENIFEE, CA 92586 MENIFEE Date Issued: 10/1112016 P E R M I T Site Address: 27672 APPLE BLOSSOM CIR, MENIFEE, Parcel Number: 336-451-023 CA 92585 Construction Cost: $20,000.00 Existing Use: 1 &2 Family Residence Proposed Use: Description of FOUNDATION UNDERPINNING REINFORCEMENT Work: 15 TOTAL SID UNDERPINS Owner Contractor JOHN ROBINSON EAGLELIFT INC 27672 APPLE BLOSSOM CIRCLE 10410 TRADEMARK STREET MENIFEE, CA 92585 RANCHO CUCAMONGA, CA 91730 Applicant Phone:9099806222 DAVID VASQUEZ License Number.778157 EAGLELIFT INC 10410 TRADEMARK STREET RANCHO CUCAMONGA,CA 91730 Fee Description Qtv Amount Building Permit Issuance 1 27.00 Inspections not specified 387 387.21 Additional Plan Review Building 148 148.37 GREEN FEE 1 1.00 SMIP RESIDENTIAL 1 3.00 General Plan Maintenance Fee-Building 1 19.36 $585.94 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_Pemit-Template.rpt Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects with a licensed contractor(s)pursuant to the Contractors State License Law). I hereby affirm under penalty of perjury that I am under provisions of 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 A License No. -) -7- By my signature below I acknowledge that except for my personal residence in which I must have resided for at least one year prior to completion of Expires 0 5/91 signature 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 a I hereby affirm under pena Ity 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 seil-insure for workees 7044 of the Business and Professions Code,is available upon req uest 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 www.leginfo.ca.goy/calaw.litml. this permit is issued. Policy# PROPERTY OWNER OR AUTHORIZED AGENT Date ofhave and will maintain workerrs compensation insurance,as required by 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 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 Gwnees behalf.I have read this number are: application and the information I have provided Is correct.I agree to comply .e2 With all appiicablecityand county ordinances and state laws relatingto Carrier- 71=r-is :S 6-,,I,-e c(DIVI-1p building construction.I authorize representatives of this city or county to Policy#-�o 2? 6 r. 3 9 -Expire 1/1 1 ZI -7 enter the above identified property 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 a I certify that in the performance of the work for which this permit is issued, 07 I sha 11 not employ any persons in any ma imer so as to become subject to the CITY BUSINESS LICENSE# workees 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 those provisions. Will the applimnst or future building occupant handle hazardous material or a :2� mixture containing a hazardous material equal to or greater that the Applicant----� amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVAAGE IS oYes ANo UNI.AWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building AN D 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 a Yies 9(No I hereby affirm that u rider 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) uYes P(No OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD permitting checklist.I understand my requirements under the State of I hereby affirm under penalty of perjury that I am exempt from the California Health&Safety Code,Section 25505 and 25534 concerning Contractoes 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 Business and Professions Code).Any city or county that requires a permitto 'Ayes 0 N '4"L F'a"-E Date construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWN ER OR AUfHORIZED A 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 PAINT NG(RRP1 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 Rcensure 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 a 1,as owner of the property,or my employee with wages as their sale employees.For more information about EPA's Renovation Program visit: compensation,will do I I all of or I I portion of the work,and the structure is www.epa.gov/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 Contractor's State License Law does not apply to an owner of a a 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 am 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. a No EPA Lead-Safe Certified Firm is required for this project because: o 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 & SAFETY PERMIT/PLAN CHECK APPLICATION "Menifee DATE PERMIT/PLAN CHECK NUMBER TYPE: OCOMMERCIAL kRESIDENTIAL 0MULTI-FAMILY 0MOBILEHOME 0 POOL/SPA 0 SIGN SUBTYPE: OADDITION 0ALTERATION ODEMOLITION OELECTRICAL O- MECHANICAL ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES- DESCRIPTION OF WORK PROJECTADDRESS ele rr-^e,�X, C-4 z�g ASSESSOR'S PARCEL NUMBER 3& j2 LOT TRACT OWNER NAME 11� Of Menifen JuIlAg, & Salety Del t. ADDRESS SEP 0 6 2016 PHONE EMAIL APPLICANT NAME ADDRESS PHONE EMAIL CONTRAcrows NAME OWNERBUILDER? OYESWO BUSINESS NAME ADDRESS lj)ello -rl-r-ole�--I� -S4- 24�" PHONE C?,O 'F- EMAIL AQ:L%C� eO /C ±�j 6 CONTRACTOR'S STATE LIC NUMBER �7"7 !?/5'17 LICENSE CLASSIFICATION VALUATION$ -2 4 SQ FT L SO FT APPLICANT'S SIGNATURE DATE DEPARTMENT DISTRIBUTION CITY OF ENSE NUMBER BUILDING PLANNING ENGINEERING FIRE � GREEN I SMIP INVOICE 11 PAIDAMOUNT AMOUNT 15 1 1 OCASH OCHECK# 0 CREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT I 1 0 CASH 0 CHECK# 0 CREDIT CARD VISVMC OWNER BUILDER VERIFIED 0 YES 0- NO DLNUMBER 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