PMT16-03236 City of Menifee Permit No.: PMT1 6-03236
29714 HAUN RD. Type: Residential Demolition
'C;kCCELX—> MENIFEE, CA 92586
MENIFEE Date Issued 10103/2016
P E R M I T
Site Address: 23477 CASA BONITA AVE, MENIFEE,CA Parcel Number: 351-102-020
92587 Construction Cost: $5,000.00
Existing Use: Proposed Use:
Description of DEMO EXISTING GARAGE 20'X 20'SQ FT
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($1
Building Permit Issuance 1 27.00
Demolition Permit 1 140.00
$167.00
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of emors 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 othervvise 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 BldgPermit Template.rpt Page I of 1
CITY OF MENIFEE
UCENSED 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).
Cbapter9(commencing with section 7000)of Division 3 of the Business and a I a m exempt from Hoensure 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
Expbres_Signature in which I must have resided for at least one year prior to completion of
improvements covered by this permit.I ca nnot legally sell a structure that I
WORKEWS 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 website:
by Section 3700 of the Labor Code,for the performance of work for which www.leAinfo.ca.Rov/calaw.htmI.
this permit is issued.
Policy If PROPERTY OWNER OR AUTHORIZED AGENT Date
o 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 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 I ent'led property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred
— e Date 10A
dollars($100)or less PROPERTY 6wNER OR AUTHORIZED AGENT
u I certify that in the performance of the work for which this permit is issued,
I shall not employ any persons in any ma nner so as to become subject to the CITY BUSINESS LICENSE It
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARAT113N
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?
WARININGi FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 0yes pNo
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 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 forguidelines
CONSTRUCTION LENDING AGENCY a Yes pNo
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) 0yes PNO
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQIYD
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
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 0yes pNo
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 OWN ER OR AUTHORIZED AGENT
issuance,also requires the applicant for the permit to file a signed statement
that he or she is licensed pursua nt to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING IRIRPI
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
a nd the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certifled 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 as their sole employees.For more information about EPA's Renovation Program visit;
compensation,will do I )all of or I I 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 1-800-424-LEAD(5323).
Code;The Contiactor'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,th rough em ployees'or persona I effort,builds or irn Proves 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 yea r 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. PkNo 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
Menifee
'g-ilk,
DATE ( 0/3/1L PERMIT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL IVRESIDENTIAL CIMULTI-FAMILY OMOBILEHOME 0 POOLISPA 0 SIGN
SUBTYPE: OADDITION 0ALTERATION YDEMOLITION OELECTRICAL QMECHANICAL
CNEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OFIARKZ4,,� ai�:Efaz:�-_o
U v U
PROJECTADDRESS '�2,2 ('ar A v4 I:Ee C
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME
ADDRESS _(e Ck, LeZE,,a, MA' G4 522 C 5_3
PHONE 3lo -099- q,2,�iq E M A I L r,,
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILDER? �0 YES ONO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION $ 500 SO FT L SO FT
APPLICANT'S SIGNATURE DATE �t7,��
DEPARTMENT DISTRIBUTION SMIP CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN
INVOICE PAIDAMOUNT
AMOUNT iwlc�p I OCASH OCHECK# 0 CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC
Q
OWNER BUILDER VERIFIED 0 YES 0 NO DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Meoifipe Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.ciryof,menifee.us Inspection Request Line 951-246-6213