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PMT16-03072 City of Menifee Permit No-, PMT1 6-03072 29714 HAUN RD. 'qX_CCEL:^__'J' MENIFEE, CA 92586 Type: Residential Addition MENIFEE Date Issued: 10107/2016 P E R M I T Site Address: 31260 GEARY ST,MENIFEE, CA 92584 Parcel Number: 358-200-001 Construction Cost: $24.999.00 Existing Use: 1 &2 Family Residence Proposed Use: Description of AS BUILT 304 SO FT DETACHED ACCESSORY STRUCTURE Work: Owner Contractor LEON R PANGBURN III 31260 GEARY ST MENIFEE, CA 92584 Applicant License Number. LEON R PANGBURN III 31260 GEARY ST MENIFEE,CA 92584 Phone: 9096370905 Fee Description ON Amount Receptacle, Switch, Outlet&Fixture 34 281.00 Building Permit Issuance 1 27.00 Additional Plan Review Building 148 148.37 GREEN FEE 1 1.00 SMIP RESIDENTIAL 1 4.00 New Construction Permit Fee 1 115.00 General Plan Maintenance Fee-Electrical 1 14.05 General Plan Maintenance Fee-New 1 5.75 Construction $696.17 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-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)pu rsuant to the Contractors State License Law). I hereby affirm u nder penalty of perjury that I a m u rider provisions of Chapter9(commencing with section 7000)of Division 3 of the Business and in 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 c 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 Busimess 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 www.leEinficA ov/calaw.htmi. this permit is issued. Date Policy# PRO W �4 AUT��AGENT ci I have and will maintain worker's compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which n By my signature below I certify to each of the following:I am the property this permit is issued.My workees 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 buildling construct n.I authorize representatives of this city or county to Policy# Expires enter heabovei ritified property for inspection purposes. _? i's — (Thissection need not to be completed is the permit is for one-hundred Date— dollars($100)or less t OR AUTHORIZED AGENT a I certify that in the performance of the work for which this permit is issued, Ishallnotempi 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 specified on the Haze rcous Materials I nformation Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS oYes nNo 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),1 N occupant require a permit for the construction or modification from South ADDITION TO TH E 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 ATTORN EYS FEES forguldelines CONSTRUCTION LENDING AGENCY oYes ciNo 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) ct Yes a 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 lem(s)(Section 7031.S mYes ci No Business and Professions Code).Any city or county that requires a permit to 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 G IRRPI that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIRAND PAINT[ 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 do the paint-disturbing work themselves or through their ci 1,as owner of the property,or my employee with wages astheir sole employees.For more information about EPA!s Renovation Program visit; compensation,will do If I all Of Or( )portion of the work,and the structure is www.epa.govIlead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 14OD-424-LEAD(5323). Code,The Contractor's State License Law does not apply to an owner of a ci 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: a 1,as owner of the property a m 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.