PMT16-03242 City of Menifee Permit No. PMT16-03242
29714 HAUN RD. Type: Residential Alteration
<A—CCEL;P . MENIFEE,CA 92586
MENIFEE Date Issued: 10103/2016
P E R M I T
Site Address: 33421 DAILY RD, MENIFEE, CA 92584 Parcel Number: 384-010-031
Construction Cost: $0.00
Existing Use: 1 &2 Family Residence Proposed Use:
Descriptilon of HOURLY INSPECTION FOR FIRE DAMAGE IN KITCHEN
Work:
Owner Contractor
LYNNAH MCGERVEY
33421 DAILY ROAD
MENIFEE, CA 92584
Applicant License Number:
LYN NAH MCGERVEY
33421 DAILY ROAD
MENIFEE, CA 92584
Phone:7609942040
Fee Description ON Amount
Building Permit Issuance 1 27.00
Inspections not specified 129 129.07
$156.07
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 carried 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 BIdg_Permit—Ternplate.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 a I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the folloviiing reason:
License Class License No. By my signature below I acknowledge that,except for my personal residence
Expires_Signature in which I in ust 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 entirely by
a I hereby affirm under pena ItV 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.IegInfo.ca.gov/caIaw.htmI.
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,for the 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 building construction.I authorize representatives of this city or county to
Policy# Expires ent e a ove,ldeffied property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less ix�
7,6!iTY OWN ER OR ALVFHORIZEeGENT
u I certify that In the performance of the work for which this permit is issued V
Ishallnotemplo any persons in any manner so as to become subject to the C BI ISINESS 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 orgreater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKEWS COMPENSATION COVERAGE IS uYes oNo
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or futu re building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or madification 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 o Yes a 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 0 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 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 aYes cs 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 Contractoes State EPA RENOVATION,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 ham 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-certffiecl firms and comply With
a n Applicant for a permit subjects the applicant to a civil pena Ity of not more req uired practices.This includes rental property owners a nd property
than($500). managers who do the paint-disturbing work themselves or through their
ci 1,as ownerof the property,or my employee with wages as their sole employees.For mom information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.eva.goy/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 project
property who,th rough 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 and Professions
Code:The Contractor's State License LaQv 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
i-zmeni ee
DATE Ji PERMIT/PLAN CHECK NUMBERM"U 02aQ
TYPE: 0 COMMERCIAL �?ftStDENTIAL 0 MULTI-FAMILY t4KMOBIUE HOME 0 POOLISPA 0 SIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES_
DESCRIPTION OF WORK 5/-Z�-
6
PROJECTADDRESS 3'3ydl City of MenIfE e
Liul(cling & Safety Dept.
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME z(111 q --/ OCT 0 3 2016
ADDRESS
fL L 0,nGeiVE. d
PHONE -)60 9� �P ,�>Oyb EMAIL /,�,4 "a
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME 5 OWNER BUILDER? (XYES-W
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ L SQ FT
APPLICANT'S SIGNATURE
DATE
DEPARTMENT DISTRIBUTION SMIP CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING EN61NEERING FIRE GREEN
INVOICE PAIDAMOUNT
AMOUNT 1�5Lt - �4 ko'le-4CASH 0CHECK# 0 CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT I OCASH OCHECKII 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DLNUMBER NOTARIZED LETTER 0 YES 0 NO-1
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213