PMT16-03199 C4 of Menifee Permit No.: PMT16-03199
29714 HAUN RD. Type: Residential Electrical
't�kCCF-LA> MENIFEE,CA 92586
MENIFEE Date Issued: 09/2812016
P E R M I T
SiteAddress: 30914 YOUNG DOVE ST,MENIFEE, CA Parcel Number: 360-451-007
92584 Construction Cost: $723.00
Existing Use: Proposed Use:
Description of 48 L FT ELECTRICAL LINE&45 L FT GAS LINE FOR FUTURE BBQ&FIREPLACE
Work:
Owner Contractor
ROMISHABAN MC CABES 14URSERY/GALLERY OF 6VINS�INC
30914 YOUNG DOVE ST 27349 JEFFERSON AVE STE 110
MENIFEE, CA 92584 TEMECULA,CA 92590
Applicant Phone:9516945384
INGRID MIJANGOS License Number:864648
MC CABES NURSERY/GALLERY OF GRAINS INC
27349 JEFFERSON AVE STE 110
TEMECULA, CA 92590
Fee Description Qtv Amount($
Plumbing Fixtures and Vents,fixtures 1 116.00
Building Permit Issuance 1 27.00
Inspections not specified 116 116.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Building 1 5.80
General Plan Maintenance Fee-Plumbing 1 5.80
$271.60
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 carded on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwrise stated,a permit for construction under which no work is commenced within six
mohfhs lifter issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
M_13idgPermit Templale.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 contractar(s)pursuant to the Conimchm;State License Law),
Chapter9(commencing with section 7000)of Division 3 of the Business and u I a in 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 �A License No. fe 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 corn pletkin of
improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATION D _ 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 workees 7044 of the Business and Professions Code,is available upon request when
compensation,issued by the Director of Inclustriia I 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.Ieginfo.ca.gov/caIaw.htmI.
Policy# Date
PROPERTY OWNER OR AUTHORIZED AGENT
14 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 a By my signature below I certify to each of the follomiling:I am the property
this permit Is issued.My workees com pensation insurance ca rrier and policy owner or authorized to act on the property owner's behalf.I have read this
num ber are: application and the information I have provided is correct.I agree to comply
Carrier with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy#WLIS 4-93 T1 S2—S 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
o I certify 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 If
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 fooluelth comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applican Date zq mixture containing a hazardous material equal to or greater that the
4:= amounts specified on the Fiazardous Materials Information Guide?
WARNING:FAILURE To NS ��6 ER'S COMPENSATION COVERAGE IS 0 Yes _Po
UNLAWFUL,ANDS SU JECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
SU
AND CIVIL FINE! 17MWE 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 SECrION 3706 OF THE LABOR CODE,INTEREST�AND ATTORNEYS FEES for guidelines
CONSTRUCrION LENDING AGENCY 0 Yes V: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) 0 Yes "Po
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 a m exempt from the Calil�rnla Health&Safety Code,Section 25505 and 25534 concerning
Contractoes License Law for the reason(s)indicated below by the ha5ardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Ves
Business and Professions Code).Any city or county that requires a permit to Date -01('L-1 I t Le
construct,a Iter,improve,demolish or repair any structure,prior to its _��RIZED AG
issuance,also requires the applicant for the permit to file a signed statement PROPERTY V ER 05 ENT
that he or she is licensed pursuant to the provisions of the Contractor's S1 REPAIR AND PAINTING(RRPI
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 ficensure receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemprion.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certifled firms and comply with
an Applica nt for a permit subjects the applicant to a civil penalty of not more required practices.This includes renta I property owners and property
then($SOO). managerswho clothe paint-disturbing work themselves or through their
a 1,as owner of the property,or my employee with wages as their.sale 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.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 n An EPA Lead-Safe Certified Renovator will be responsible for this pmject
property who,through employees'or personal effort,builds or Improves the
property provided that the improvements am 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. a 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 contractoes 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
6",
Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL * RESIDENTIAL OMULTI-FAMILY 0MOBILEHOME 'C POOL/SPA SIGN
I I
SUBTYPE: CADDITION CALTERATION ODEMOLITION " ELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK CAee*v:C
5P_,-.A,,n4
PROJECTADDR9SS qQjjq e-40, 01 ;X56L(
ASSESSOR'S PARCEL NUMBER co-7 LOT LH TRACT
OWNERNAME
ADDRESS ':-�Avvp 0�, V0o/3o,,,t_
PHONE ajD96 EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL:W%Ail
CONTRACTOR'S NAME OWNERBUILDER? OYES ONO
BUSINESS NAME
ADDRESS Q-I Mq 4p� Ste= I j0 �vee-y .I,, 64/_� c:,j1Sf1ro
PHONE 'I-;I. (�'j EMAIL Ce,,
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION (L,;t_j
VALUATION $ —12-3 SO FT L SO FT j L:lr
APPLICANT'SSIGNATUPkt.- -DATE 9[;1J'1A0
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVO:ICE
J N:
T:E�
al 1,10D PAID AMOUNT
JNT CASH C CHECK# CREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT OCASH OCHECK# C CREDIT CARD VISVMC
OWNER BUILDER VERIFIED -YES NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmentfee.us Inspection Request Line 951-246-6213
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