PMT16-03048 City of Menifee Permit No.: PMT16-03048
29714 HAUN RD. Type: Commercial Alteration
MENIFEE, CA 92586
MENIFEE Date Issued: 0811712017
P E R M I T
Site Address: 26660 ENCANTO DR, MENIFEE, CA Parcel Number: 331-120-065
92585 Construction Cost: $14,000.00
Existing Use: Proposed Use;
Description of RENOVATION OF EXISTING TOILET ROOMS(TWO)TO CONFORM TO CURRENT HANDICAP
Work, CODE REQUIREMENTS, INTERIOR RENOVATION 137 SQ FT
Owner Contractor
POLLY'S INC EBS CONSTRUCTION SERVICES INC
173 E FREEDOM AVE P 0 BOX 822
ANAHEIM, CA 92801 TUSTIN, CA 92781
Applicant Phone:7148367700
, CA License Number: 973962
Phone: 9495424450
Fee Description QtV Amount
Building Permit Issuance 1 27.00
Inspections not specified 516 516.28
Additional Plan Review Building 193 193.42
GREEN FEE 1 1.00
SMIP COMMERCIAL 1 4.00
$741.70
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_Permlt Ternplate.rpt 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 o I am exemptfrom licensure underthe Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class 13 License No 9*7 3rl(jqc� By my signature below I acknowledge that,except for my personal residence
Expires (1)60 - signature��42' Vfi:7�L 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
o 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.leginfo.ca.goy/calaw.htmi.
Policy# Date
'Mk I have and will maintain worker's compensaton insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which in 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 owner's beha If.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 Onpo"fil— building construction.I authorize representatives of this city or county to
Policy It Q\A J� Ab-2�i4j R Expires 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 cerft 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 work
1ws compensation provisions of Section 3700 of the Labor
Code,I shal f rt I 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
Ap. —Date S J-7-1-7 amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes \JNo
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the Intended use of the building by the applicant or future building
AND 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 in Yes 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) c Yes O\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
Contractor's License Law for the reason(s)indicated below by the hazardous mated porting.
checkmarlds)I have placed next to the applicable itemjs)(Section 7031.5 �Wes (!5)(C t,(
Business and Professions Code).Any city orcounty that requires a permitto Z Date 17-11
construct,alter,improve,demolish or repairany structure,priorto 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,REPAIR AND PAINTING(FIRM
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 licensure 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 dothe paint-disturbing work themselves orthrough their
o 1,as ownerofthe property,or my employee with wages as theirsole employees.For more information about EPA!s Renovation Program visit:
compensation,will do I )all of or I )portion of the work,and the structure is "wega.govLlead 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 0 An EPA Lead-Safe Certified Renovator will be responsible forthis 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:
n 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and ProfeWons
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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
-A'Menifee
DATE 09/14/2016 Ito
PERIVIIT/PLAN CHECK NUMBER W1 b ()?)0
TYPE: [ZICOMMERCIAL E]RESIDENTIAL []MULTI-FAMILY EIMOBILEHOME [-]POOL/SPA F]SIGN
SUBTYPE: [—]ADDrnON [Z]ALTERATION [-]DEMOUTION F]ELECTRICAL EIMECHANICAL
[-]NEW F]PLUMBING [:IRE-ROOF-NUMBEROFSCIUARES_
DESCRIPTION OF WORK renovation of existing toilet rooms(two)to conform to current handicap code requirements-
interior renovation-137 sq.ft.
PROJECT ADDRESS 26660 Encanto Drive, Sun City
ASSESSOR'S PARCEL NUMBER 3311-11204f�C21915 LOT TRACT
PROPERTY OWNER'S NAME Polly'sinc.
ADDRESS 173 E.Freedom Avenue Anaheim Calffomia92801
PHONE (714)459-0041 EMAIL
APPLICANT NAME Charles Flamm,Architect
ADDRESS 1001 Avenida Pico #C-440 San Clemente California 92673
PHONE (949)542-4450 EMAIL chariesrammOcox.net
CONTRACTOWS NAME OWNERBUILDER? [-]YESZNO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ $14.000.00'Zon SQ4 137A LSQFT
APPLICANIT'S SIGNATURE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION to CITY OF MENWEE BUSINESS LICENSE NUM13EK
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP
= 1 150cla, PAID AMOUNT 0 CASH 0 CHECK# OCREDITCARD VIWIVIC
PLAN CHECX FEES PAID AMOUNT 0 CASH 0 CHECK# OOREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 No DILNUMBER NOTARIZEDLETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Haun Rd.Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
002921h
Emphre.
.C-ONSTRUCTION
August 11, 2017
Suzanne DeRossett
City of Menifee EBS Construction Services, Inc.
29714 Haun Road PO Box 533
Menifee, CA 92586 Tustin, CA 92781
Please recognize this letter as a ccrtified confirmation that Larry Martinez is endorsed to act on
behalf of E-4ire Construction. He is authorized to obtain permits, business licenses, and other
applicable documents under our General Contractor's License#973962.
If youhayeJany ques6ofis regarding the authenticity of this letter, please do not hesitate to contact
my office at (114� 936-7�7.00.
,Sincerely
r ident
Siiianfi6 DeRoss6tt P es
FBS,Constructi6n Scrviccs�Jnc.
P (714) 06-7700
SuzanneD@g6em-pire.com.
General Contracting Construction Management
TOLL FREE 888.296.2078
P.O. Box 822, Tustin, California 92781
Tel. 714.836.7755 Fax 714.836.9538
www.qcempire.com
GC License#973962
ACKNOWLEDGMENT
A notary public or other officer completing this
certificate verifies only the identity of the individual
who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or
validity of that document.
State of California
County of Orange
On August 11,2017 before me, Shaina Carmen Martin/ Notary Public
(insert name and title of the officer)
personally appeared Suzanne DeRcissett
who proved to me on the basis of satisfactory evidence to be the person�4 whose name�srishffe--
subscribed to the within instrument and acknowledged to me that4e/sh6ftey executed the same in
—his/her/Rireir authorized capacity(0<and that by 44s�her/their-signatu rev on the instrument the
persox, or the entity upon beh,alf of which the persoi�c, Lfted the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.
SHAINA CARMEN MARTIN
W NE 9S my hand Commission#2109674
'T
ITNESS my hand ia
Notary Public -California z
Z
Orange County >
Siqna re (Seal)