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PMT16-03272 City of Menifee Permit No.: PMT1 6-03272 29714 HAUN RD. Type Residential New <A--CCELX.' MENIFEE, CA 92586 MENIFEE Date Issued: 11/23/2016 P E R M I T Site Address: 32348 MADDY CT, MENIFEE, CA 92584 Parcel Number: 362-450-027 Construction Cost: $159,512.40 Existing Use: Proposed Use: 1 &2 Family Residence Description of NSFR-SUP FACTORY BUILT HOME, 1416 SF. NO GARAGE Work: Owner Contractor DANIEL&JAIME TREMBLY LAND HOME CONSTRUCTION INC 32350 MADDY COURT 35325 HIGHWAY 74 MENIFEE, CA 92594 HEMET, CA 92545 Applicant Phone: 9519261581 CRAIG DAVIS License Number:892706 LAND HOME CONSTRUCTION INC 35325 HIGHWAY 74 HEMET, CA 92545 Fee Description Qtv Amount I$) Factory Built Home 1 196.00 Residential Factory Built Site Prep 1 196.00 Plan Check Fee 103 102.50 Building Permit Issuance 1 27.00 Additional Plan Review Building 135 135.00 GREEN FEE 1 7.00 SMIP RESIDENTIAL 1 21.00 New Construction Permit Fee 1 733.76 General Plan Maintenance Fee-New 1 36.69 Construction $1,454.95 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%dolation 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_B1dg Permit—Template.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 ci I am exempt from licensu re under the Contractor's State License Law for Professions Code and my license is in full force and effect. the following reason: License Clan i c 7 � License No. 9NF 0.'1 By mysignature below I acknowledge that,exceptfor mypersonal residence Expires 3 -?2 Signature .4 Qa/,� 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 WORKEWS COMPENSATION DECLARATION have built as an owner-builder if It has not been constructed in its entirety by ci 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 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.Ieginfo.ca.gov/caIaw.htmI. this permit is Issued. Policy$1 Date PROPERTY OWNER OR AUTHORIZED AGENT a I have and will maintain workees compensation insurance,as required by 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 ca rder a nd policy owner or authorized to act on the property ownees behalf.I have read this number are; gj WZ5�66 application and the information I have provided is correct.I agree to comply Carrier I/V (A/ C with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy# �N INC? ', ( 4 1 gq I 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 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# 6795 workees 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 COMPI With visions. Will the applicant or future building occupant handle hazardous material ora mixture cotaining a hazardous material equal to or greater thatthe c Applicant Date 53ecifiedonthe Hazardous Materials Information Guide? 0 WARNING:FAILURET"ECUREWORKER'S COMPENSATION COVERAGE N 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 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 SECrION 3706 OF THE LABOR CODE,INTEREST�AND ATTORNEYS FEES for guidel CONSTRUCTION LENDING AGENCY o Yes �t I hereby affirm that under the penalty of perjury there is a construction Will the proposed building orincidifled facility be within 1000 feet of the lending agency for the performance of the work which this permit is issued outer bo#(dary of a school? (Section 3097 Civil Code) oYes plNo 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 C fif mi H Ith&Safety Code,Section 25505 and 25534 concerning Contractor's License Law for the reason(s)Indicated below by the h:.'.Ordu�ysaterial reporting. checkma rk(s)I have placed next to the applicable item(s)(Section 7031.5 25 0 Business and Professions Code).Any city or county that requires a permit to A`t'C' A -A Date construct,alter,improve,demolish or repair any structure,priorto its PROPERTYOWNER OR AUTHORIZED AGENT issuance,also requiresthe applimntforthe permitto file a signed statement that he orshe is licensed pursuantto the provisions of the ContmctoesState EPA RENOVATION,REPAIR AND PAINTING(RRP) License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors Business a nd 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 exem ption.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 renta I property owners and property than($500). managers who do the paint-disturbing work themselves or through their o 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( )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 70",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 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 yea r of Firm Certification No.: completion,the Owner-Builder will have the burden of proving that it was not built or im proved for the purpose of sa le. ci No EPA Lead-Safe Certified Firm is required for this project because: ci 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. & SAFETY PERMIT/PLAN CHECK APPLICATION '"""Menifee DATE PERMIT/PLAN CHECK NUMBER TYPE: OCOMMERCIAL VRESIDENTIAL 0MULTI-FAMILY OMOBILEHOME 0 POOL/SPA 0 M Me lifee SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRICAL OMECHANI&ifdlng & sawy Dept. /NEW OPLUMBING ORE-ROOF-NUMBEROFSQUARES- 2016 DESCRIPTION OF WORK Se-COIJ61 (/A)I 4 PX-�I� I� 13 lof � - 00�? )�Io Receii ed PROJECTADDRESS � zziso CQA5�,L( -6(;L-4 �O LOT j ASSESSOR'S PARCEL NUMBER TRACT C4 OWNER NAME DANJ� :rjembfy ADDRESS '� �o mpi), C4 PHONE (3 91� 18�`? Rf EMAIL APPLICANT NAME Z— A�Jolknm(, C-f,65�-JC41L� 1�1 (' I ADDRESS ;53L� Hu,:� 491-le"j, CA PHONE EMAIL CONTRACTOR'SNAME OWNER BUILDER? 0 YES C/NO BUSINESS NAME //� c ADDRESS '14?lr e-4 PHONE EMAIL CONTRACTOR'SSTATE LIC NUMBER SqZ706 LICENSE CLASSIFICATION If 161) cz-7 VALUATION SO,FT LSQFT APPLICANT'S SIGNATURE A La,� DATE a - 0, DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP I INVOICE AMUUN I PAIDAMOUNT IS . _ffl 1 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT I 1 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC OWNER BUILDER VERIFIED OYES 0 NO DLNUMBER NOTARIZEDLETTER 0 YES 0 NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityofmenifee.us Inspection Request Line 951-246-6213