PMT16-03170 City of Menifee Permit No. PMT1 6-03170
29714 HAUN RD. Type: Residential Addition
<ACCELA-> MENIFEE, CA 92586
MENIFEE Date Issued: 09/26/2016
P E R M I T
Site Address: 23477 CASA BONITA AVE, MENIFEE,CA Parcel Number: 351-102-020
92587 Construction Cost: $20,000.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of SPECIAL INSPECTION FOR FIRE DAMAGE TO GARAGE,
Work:
Owner Contractor
FAHIMIAN FAMILY TRUST
26181 RED CORRAL RD
LAGUNA HILLS, CA 92653
Applicant License Number:
FAHIMIAN FAMILY TRUST
26181 RED CORRAL RD
LAGUNA HILLS, CA 92653
Phone:3109774760
Fee Description Qtv Amount
Building Permit Issuance 1 27.00
Inspections not specified 129 129.07
$156X7
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications orfrom preventing builiding operations being carried on thereunderwhen 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 cornmenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA BIdgPennit—Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION propertywho builds orimproves thereon,and whocontracts forthe projects
I herebyaffirin underpenaltyof perjurythat 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 Contractor's State Ucense 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
Expines_Signature in which I must have Tesid ed for at least one year prior to completion of
inn provements covered by this permit.I cannot legally sell a stnictu re that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
u 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 www.IeeinI5o.ca,g2VcaIaw.htmL
this permit is issued.
Policy# ::%��_Date
PROPERTY'OWNIER OR AUTHORIZED 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 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 of this city or county to
Policy# Expires enter the above identified property for inspection purposies.
(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,
Ishallnotemplo 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 Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes a No
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 crYes oNo
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) uYes oNo
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
Conimactor's License Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable itemis)(Section 7031.5 uYes a 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
that he or she Is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRPl
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 re�rdence or childcare facility to be RRP-certified firms and comply with
a n 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 sole employees.For more information about EPA's Renovation Program visit;
compensation,will do( )all of or( 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 ci An EPA Lead-Safe Certified Renovator willi 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. u No EPA Lead-Safe Certified Firm is required for this project because;
a 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business a nd 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 RRIP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION wo
d wikA ..- Menifee
hl�-�--,
DATE 9/;Z PERMIT/PLAN CHECK NUMBER TM110-0�Dlj 0
TYPE: OCOMMERCIAL ARESIDENTIAL CIMULTI-FAMILY OMOBILEHOME 0 POOL/SPA 0 SIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION 0ELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-N UMBER OF SQUARES—
DESCRIPTION OF WORK ge bLl d A,% eer e,,e,,'s 6-n
PROJEcTADDRESS 2 3 q--7 CaSa ike-e CA qA 5-9
ASSESSOR'S PARCEL NUMBER LOT All TRACT
OWNER NAME Fsl /I FA InI
ADDRESS 2ajFj Rj i�,qcrjkaz Z �,gaylg W, 1(5, Cq q24- 5-3
PHONE EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME OWNERBUIUDERZ AYESONO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACT`OR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ c2d)(000 SO ET L SO FT
DATE
I APPLICANTS SIGNATURE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP I
INVOICE � 1 0-1 -CASH C)CHECK# 0 CREDIT CARD VISA/MC
AMOUNT PAIDAMOUNT
I
PLAN CHECK FEES AIDAMOUNT
P, I OCASH OCHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 No CILNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-5777
Li)ww.cityofmenifEe.us Inspection Request Line 951-246-6213