PMT16-03176 City of Menifee Permit No.: PMT1 6-03176
29714 HAUN RD. Type: Residential Addition
<AcciELA—> MENIFEE, CA 92586
MENIFEE Date Issued: 02102/2017
P E R M I T
Site Address: 29055 AVENIDA GAVIOTA, MENIFEE,CA Parcel Number: 341-133-017
92584 Construction Cost: $32,938.98
Existing Use: 1 &2 Family Residence Proposed Use:
Description of RESIDENTIAL ADDITION OF 239 SO FT
Work:
Owner Contractor
GILDARDO PAMATZ
29055 AVENIDA GAVIOTA
MENIFEE,CA 92587
Applicant License Number:
CA
Fee Description Oty. Amount($1
Receptacle,Switch,Outlet&Fbiture 5 136.00
Building Permit Issuance 1 27.00
Inspections not specified 516 516.28
Additional Plan Review Building 126 125.70
Additional Plan Review Building 45 45.00
GREEN FEE 1 2.00
SMIP RESIDENTIAL 1 5.00
New Construction Permit Fee 1 151.52
General Plan Maintenance Fee-Building 1 25.81
General Plan Maintenance Fee-Electrical 1 6.80
General Plan Maintenance Fee-New 1 7.58
Construction
$1,048.69
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 camed on thereunder when in Violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherMse 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.
AkBldg_Pemnit-Tempate.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 &I am exempt from licensure under the ontra Law for
Professions Code and my license is in full force and effect. the following reason: Ts
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
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.legiiifo.ca.gov/calaw.html.
Policy Date
o I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,forthe performance of the work for which o 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 buildling construction.I authorize representatives of this city or county to
Policy# Expires enter the above identified property for Inspection purposes.
(This section need not to be completed is the permit is for one-hundred
j�, Ir/O RO 04 Q 4-7 Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
o 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
Applicant Date mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKEWS COMPENSATION COVERAGE IS oYes oNo
UNLAWFUL,AND SHALL SUBJECr AN EMPLOYER TO CRIMINAL PENALTIES Will the Intended use of the building by the applicant or future building
AND CIVIL FINES UP TOONE 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 oYes allo
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) o Yes j 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 perjurythat[am exemptfrom the California Health&Safety Code,Section 25505 and 25534 conceming
Contractor's License Law for the reason(s)Indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oYes o No
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any 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 JRRP)
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($500). managerswho clothe paint-disturbing workthemselves orthrough their
o I,as ownerof the property,or my employee with wages astheirsole employees.For more information about EPA's Renovation Program visit:
compensation,wit!do( )all of or( )portion of the work,and the structure is www.epa.gov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a o An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. o No EPA Lead-Safe Certified Firm is required for this project because:
o 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
& SAFETY PERMIT/PLAN CHECK APPLICATION
E2
11-Wenifee
DATE PERMIT/PLAN CHECK NUMEIERPMI(Pb�bmll
TYPE: OCOMMERCIAL XRESIDENTIAL 0MULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: (>,ADDITION OALTERATION ODEMOLITION OELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK 0!:f�—eq qp?q "—at(-74�
PROJECTADDRESS tk
ASSESSOR'S PARCEL NUMBER LOT TRACT *,V-7, 5�Z
OWNER NAME ��wc;�e�ellle
ADDRESS �2 JVI57�
PHONE EMAIL
APPLICANT NAME 'A':07
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME U OWNER BUILDER? XYESO NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ 2��, L SQ Fr
, q*O SO FT
APPLICANT'S SIGNATURE DATE
ff
DEPARTMENT DISTRIBUTION SMI�� I CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN
INVOICE PAIDAMOUNT
AMOUNT 11615-10 1 1 1 OCASH OCHECK# 0 CREDIT CARD VISA/MC
PLAN CHECK FEES I PAIDAMOUNT I 1 0 CASH 0 CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DILNUMBER NOTARIZED LETTER 4 0 YES 0 NO
Ciry of Menifee Building&Safety Deperrmlent 29714 Houn Rd. 110enifee, CA 92586 951-0572-67 7
,7
wtvw.cityofmenifee.us Inspection Request Line 95)-245-6213