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PMT16-03073 City of Menifee Permit No.: PMT16-03073 29714 HAUN RD. Type: Residential Alteration <A-CCIELX—> MENIFEE, CA 92586 MENIFEE Date Issued: 09116/2016, P E R M I T SiteAddress: 29316 CASTLEWOOD DR, MENIFEE,CA Parcel Number: 340-553-002 92584 Construction Cost: $1,525.00 Existing Use: 1 &2 Family Residence Proposed Use: Description of NEW SHOWER VALVE AND NEW TRAP FOR DRAIN Work: Owner Contractor MIRIAM BRIJANDEZ A A A RESTORATION INC 29316 CASTLEWOOD DR 29850 2ND STREET MENIFEE,CA 92584 LAKE ELSINORE,CA 92532-2420 Applicant Phone: 9514715828 LANCE REMINGTON License Number:834839 A A A RESTORATION INC 29850 2ND STREET LAKE ELSINORE,CA Fee Description city Amount($1 Plumbing Fixtures and Vents, fixtures 2 116.00 Building Permit Issuance 1 27.00 GREEN FEE 1 1�00 General Plan Maintenance Fee-Plumbing 1 5.80 $149.80 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 camed 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_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 perjurythat I am under provisions of with a licensed contactor(s)pursuant to the Contractors State License Law). Chapter9(commencing with section 7000)of Division 3 of the Business and o I a m exempt from licensure under the Contractoes State License Law for Professions Code and my license is in full force and effect. the following reason: License Class_Z4C�-5,C-3� UcenswNo. By my signature below I acknowledge that,except for my personal residence Expires 9-5) -4�;)12i Signature in which I must have resided for at least one year prior to completion of 4�� improvements covered by this permit.I cannot legally sell astructurethati 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 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 web5ite: bySection 3700 of the Labor Code,forthe performance of work for which this permit is issued. WWW.Ieginfo.�.gov/calaw.html. Policy# Date Xi 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 u 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 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 building construction.I authorize representatives ofthiscity orcounlyto Pollcv#0��F40n_117&�7 Expires !1-1 -Z6 L-2 enter the above identified property for Inspection purposes, (This section need not to be completed is the perm it is for one-hundred Date dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT "bd.certify that in the performance of the work for which this permit is issued, Ishallnotemplo any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# 00;5-TWO:51 worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the workees compensation provisions of Section 3700 of the Labor Code,I shall forth ' c I 'h hose provisions. Will the applicant or future building occupant handle hazardous material of a those prov mixture containing a hazardous material equal to or greater that the Date amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes ANO 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(SCAQM D)?See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines CONSTRUCTION LENDING AGENCY a Yes XNo 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) a Yes XNo OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of Contractor's License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning hazardous materV reporting. checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 "r, N Business and Professions Code).Any city or county that requires a pemit to Date construct,alter,Improve,demolish or repair any structure,priorto its PERTY OWNEIf OR AUTkORIZED 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 MAP) 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 licen5ure 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 applica nt to a civil penalty of not more required practices.This includes rental property owners a nd property than($500). managers who do the paint-disturbing work themselves or through their o 1,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit: compensation,will do( )all of or( )portion of the work,and the structure is www.epa.sroy/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 70",Business and Professions 1-800-424-LEAD(5323). Code,The Contractor's State License Law does not apply to an owner of a cr An EPA Lead-Safe Certified Renovator will be responsible for this project property who,through employees'or personal effoM 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. ci No EPA Lead-Safe Certified Firm is required for this project because: cr 1,as owner of the property am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Co.ntractor'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. ,'ll.-ik.- Menifee DATE PERMIT/PLAN CHECK NUMBER TYPE: OCOMMERCIAL )I(RESIDENTIAL 0MULTI-FAMILY OMOBILEHOME 0 POOL/SPA 0 SIGN SUBTYPE: OADDITION OALTERATION 0DEMOUTION OELECTRICAL CMECHANICAL ONEW 19PLUMBING 0 RE-ROOF-NUMBER OF SQUARES_ DESCRIPTION OF WORK t4r_�,o 1�%�Dc23r V�kIIVe A-A,4 -,j:F PROJECTADDRESS QC137ep ASSESSOR'S PARCEL NUMBER M-3-WD-tOT 5b TRACT X-3 01,5:3 OWNER NAME -Z� ADDRESS :,� PHONE EMAIL APPLICANT NAME 16A ADDRESS CA PHONE EMAIL CONTRACrOR'S NAME OWNERgUILDER? OYESXNO BUSINESSNAME -AAlk ADDRESS 9�(V56 eAr PHONE '751-41'7t- 5aa5 EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION -9 1�1-19 I C-a-3 VALUATION$ jg�9-_%-j - SQ FT L SQ FT APPLICANT'S SIGNATURE DATE Z,-_Q10 I<- DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE � GREEN SMIP INVOICE PAIDAMOUNT AMOUNT LMD I I 1 0 CASH 0 CHECK# OCREDITCARD VISA/MC PLAN CHECK FEES I PAIDAMOUNT I I OCASH OCHECK# 0CREDITCARD VISA/MC OWNER BUILDER VERIFIED 0 YES 0 No DLNUMBER NOTARIZED LETTER () YES ON 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 r 0 04 rn CY .2s. 2t 0 > rn rrl )W9 , @ - m El - m E! z Cn 2:c) m lb CD I 1 -0 CD — co w < CD r2=0, 0 CL 0 r. Tj CIO pwn(o OW15 0 rry