PMT16-02991 City of Menifee Permit No.: PMT16-02991
29714 HAUN RD. Type: Residential Alteration
<A—CCELA—> MENIFEE,CA 92586
MENIFEE Date Issued 09/0812016
P E R M I T
Site Address: 26945 PINEHURST RD,MENIFEE, CA Parcel Number: 338-061-006
92586 Construction Cost: $30,000.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of HOURLY INSPECTION FOR FIRE DAMAGE
Work:
Owner Contractor
LURA CLOUGH NEWREAL INC
26945 PINEHURST ROAD 1120 W 9TH ST
MENIFEE,CA 92586 UPLAND,CA 91786
Applicant Phone:9099315280
RICK FORD License Number:633590
NEWREAL INC
1120 W 9TH ST
UPLAND, CA 91786
Fee Description Qtv Amount
Building Permit Issuance 1 27.00
Inspections not specified 129 129.07
$156.07
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 buillding 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 ronstructlion 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_Permit 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 a I am exempt from licensure under the Contractoes State License Law for
Professions Cod d my license I.s in full force and effect. the following reason:
7. C,335eO
License Class V Lice N By my signature below I acknowledge that,except for my personal residence
Expires JZ/3f/17 Signature in which I must have resided for at least one year prior to completion of
I 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
n 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-Insu re 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.leginfo.m.gov/calaw.htmi.
Policy# Date
o I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3�00 of the Labor Code,for the performance of the work for which cr By my signature below I certify to each ofthe 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 provided is correct.I agree to comply
with all applicable city and county ordinances and state laws relating to
Carrier Z_ ru�) — building construction.I authorize representatives of this city or county to
Policy# 9 1,e2_Pq3 Expir ta/
es enter the above identified property for Inspection purposes.
(This section need not to be completed is the permit is for one-hundred
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT Date
ci I certify that in the performance of the work for which this permit is issued,
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensatin%provIsions of Section 3700 of the Labo,
Code,I shall fo th comply w ose provisions. Will the applicant or future building occupant handle hazardous material or a
Date$&f F/2o 11, mixture containing a hazardous material equal to or greater that the
7— amounts specified an the Hazardous Materials Information Guide?
All I IREYO!�!CRIE WORKER'S COMPENSATION COVERAGE 15 o Yes a No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the Intended use of the build Ing by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN
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 LA13OR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQY1D)?See permitting checklist
forguidelines
CONSTRUCTION LENDING AGENCY a Yes a 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) ciYes nNo
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 2SS34 concerning
Contractor's License Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable iterms)(Section 7031.5
Business and Professions Code).Any city or county that requires a permit to ciYes ci No
construct,alter,improve,demolish or repair any structure,prior to its Date
issuance,also requires the applicant for the permit to file a signed statement PROPERTY OWNER OR AUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractoes State EPA RENOVATION,REPAIR AND PAINTING IRRPI
License Law(Chapter 9(commencing With Section 7000)of Division 3 ofthe 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 a pre-1978
and the basis for the alleged exam ption.Any violation of Section 7031.S 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
than($500). required practices.This includes rental propertyownersand property
managers who do the paint-disturbing work themselves or through their
o 1,as owner ofthe property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )allofor( )portion ofthe work,and the structure is www.epa.fitoy/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 70",Business and Professions I-SOD-424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a n 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 yea r 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 sa le. a No EPA Lead-Safe Certified Firm is required for this project because:
a 1,as owner of the property a in 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 Ifyour project does not comply with EPA RRP rule please fill out the RRP
Acknowledgment.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Wenifee
DATE 2—c 16 PERMIT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL KRESIDENTIAL CMULTI-FAMILY OM0131LEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION OALTERA11ON CDEMOUTION e—ELECTRICAL JeMECHANICAL
ONEW 61PLUMBING P RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK ke 0� Rec,",�,Z4 I
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER LOT TRACT City of Menifee
OWNER NAME LtIRA Building & Safety Dept.
SEP v 8 2016
ADDRESS 2 (,' c7 V-5 PfA-le-A'P-� F R
PHONE C?,57/- YnQ V-� -3 86 EMAIL Removed
APPLICANT NAME k /- 0 W—j
ADDRESS J( q7-4 5' /'— L,"p (AJ (71 7eC
PHONE '7j9 '? EMAIL
CONTRAcrows NAME L OWNERMILDER? CYES,00
BUSINESS NAME e'
ADDRESS X,12 (n T4 Ll-e (A J C4
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ ��()QCX:F,��2 SO L SQ FT
APPLICANT'SSIGNATUR r
DATE
CITYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP CITY OF MENIFEE BUSINESS LICENSE NUMBER
INVOICE PAIDAMOUNT
AMOUNT I ump- OA I 1 0 CASH 0 CHECK# OCREDITCARD VISAINIC
PLAN CHECK FEES I PAID AMOUNT I 1 0 CASH C CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 No DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menfee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213