PMT16-03275 City of Menifee Permit No.: PMT16-03275
29714 HAUN RD. Type: Residential Alteration
<A—CCELX—> MENIFEE,CA 92586
MENIFEE Date Issued: 10105/2016
P E R M I T
Site Address: 31051 DESERT VIEW CT, MENIFEE, CA Parcel Number; 372-360-004
92584 Construction Cost: $7,000.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of REPLACE TUB,VALVE,TRIM IN GUEST HALL BATHROOM
Work:
Owner Contractor
RODERICK WILLIAMS U S REMODELERS INC
31051 DESERT VIEW CT 2455 PACES FERRY ROAD
MENIFEE,CA 92584 ATLANTA,GA 30339
Applicant Phone:7707791423
KEVIN CONKLIN License Number:768707
U S REMODELERS INC
2455 PACES FERRY ROAD
ATLANTA, CA 30339
Fee Description 9!Y Amount
Plumbing Fixtures and Vents,fixtures 2 116.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 5.80
$149.80
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of effors 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.BidgPe"it-Template.rpt Page 1 of I
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
with a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in ful force and effect. the following reason:
License Class M la C& By my signature below I acknowledge that,except for my personal residence
Utz No.
Exphes(& Signature W 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-insurne for workees 71344 of the Business and Professions Code,Is available upon request when
com pensat':on,issued by the Director of Industrial Relations as provided for this application Is submitted or at the following website:
by Section 3700 of the La bor Code,for the performance of work for which wwvv.Ieginfci.ca.gov1caIaw.html.
this permit Is Issued.
Date
Policy# PROPERTY OWNER OR AUTHORIZED AGENT
Ahave 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 carrier and policy owner or authorized to act on the property ownees behalf.I have read this
number 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#�X Clf';�?-2 1 Lt �� 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#
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 lora
Code,[ h; f hwith comply with those provisions. Will the applicant or future building occupant handle hazardous materia
—/1 mixture containing a hazardous material equal to or greater that the
Applicas.14 Date t 4>1 0', amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes &*
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 TO ONE HUNDRED THOUSAND DOLLARS($100,00),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 a Yes ':PiNo
I hereby affirm that under the pena Ity 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) ci Yes aoN6
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMID
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perju ry 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 �e N�o Date
Business and Professions Code).Any city or county that requires a permit to X
construct,alter,improve,demolish or repair any structure,priortoits PR PERTY WNERORAUTHORIZEDAG'ENT
issuance,also requires the applicant for the permit to file a signed statement G IRRPI
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINITI
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 a fleged 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 pena Ity of not more required practices.This includes renta I property owners a nd 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 I )portion of the work,and the structure is www.epa.goyllead 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 contractoes State License Law does not apply to an owner of a u An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,th rough employeee 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 o No EPA Lea d-Safe Certified Firm is required for this project because:
not built or improved for the purpose of sale.
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
& SAFETY PERMIT/PLAN CHECK APPLICATION
ree
R New
Adklh�-
DATE 10 PERM IT/PLAN CHECK NUMBER
TYPE: CCOMMERCIAL 64ESIDENTIAL OMULTI-FAMILY OMOBILEHOME CPOOL/SPA CSIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRICAL OMECHANICAL
ONEW rLkLUMBING 0 RE-ROOF-NUMBER OF SQUARES—
DESCRIPTION OF WORK C-C-,- V (,,k Vt- f rn 14c, 1)
PROJECT ADDRESS D e-s.-.+ v,," eDLI�4, Alleor(e.- CA 9 AS"
ASSESSOR'S PARCEL NUMBER - %-oO - ODL-VOT TRACT
OWNER NAME �� 0 C�Qr(�CAe-
ADDRESS -3 ) OSI 00- �,Or4 VhA�) C4- - rX.t 41,
PHONE q 5 1 EMAIL
APPLICANT NAME tkoj)/' CD�Ujl
ADDRESS CA :�L
PHONE EMAIL 16 Q-c- Pe-rinn r 4-s o- !(6 Pn ct Ii. c-o
CONTRACTOR'S NAME M J,,- OWNERBUILDER? 0YESA<NO
BUSINESSNAME
t,,& I
Ll
ADDRESS >
PHONE (P ---' (I - >DID ) EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION e- 1-:7, C
VALUATION $ 1! 92 00 SO FT C) - LSQFT
APPIL DATE—LV-Z--VE
CITY STAFF USE ONL Y
DhPARIMENFUINTHIBUTIUN CITY OF MENIFEE BUSINESS LICENSENUMBER
BUILDING P"NNING ENGINEERiNG FIRE I GREEN SMIP7
INVOICE I lZlQ,%V I
AMOUNT rl PAID AMOUNT 0 CASH 0 CHECK# 0 CREDIT CARD VISA/NIC
PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 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.cityofmenifee.Lis Inspection Request Line 951-246-6213
V
City of Menifee
"-�%�Y 0 F MENIFEE Building & Safety Dept.
BUILD NG AND S FETY DEPARTMENT OCT 0 5 2016
PLAN PPROVAL
Received
REVIEWED BY. I M w --I
LIATt
*Approval C� pw*for,-or an
approval ofj awf violation of any provisions of the bderA 9W a city
regulations and ordinances. This set of approved plans AN k kept on the
jobsite until compleltim.
7�-
KM
TTI
-Rkf� A)Ab
\A\—qe
IA�