PMT16-03495 City of Menifee Permit No.: PMT16-03495
29714 HAUN RD. Type: Residential Addition
<A—CCELA—> MENIFEE, CA 92586
MENIFEE Date Issued: 11/2112016
P E R M I T
Site Address: 28818 DAKOTA HILLS CIR, MENIFEE, CA Parcel Number: 372-440-012
92584 Construction Cost: $15,000.00
Existing Use: I &2 Family Residence Proposed Use:
Description of CONSTRUCTION OF PATIO/DECK 196 SQ FT W/ELECTRICAL,ADDING DOOR AT MASTER
Work: BEDROOM FOR ACCESS TO DECK
Owner Contractor
ALVIN JENKINS E J WALLACE ENTERPRISES INC
28818 DAKOTA HILLS CIR 20620 S LEAPWOOD AVENUE STE G
MENIFEE, CA 92584 CARSON, CA 90746
Applicant Phone: 3102255510
ED WALLACE License Number:876396
E J WALLACE ENTERPRISES INC
20620 S LEAPWOOD AVENUE STE G
CARSON, CA 90746
Fee Description Wit Amount($1
Receptacle,Switch, Outlet&Fixture 10 161.00
Building Permit Issuance 1 27.00
Deck/Patio, non-standard 1 133.00
Inspections not specified 129 129.07
Additional Plan Review Building 210 210.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 2.00
General Plan Maintenance Fee-Building 1 6.65
General Plan Maintenance Fee-Electrical 1 8.05
$677.77
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 builicling 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 BidgPermit—Ternplate.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARA'nON 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 o I am exempt from licensure underthe 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
Expires Signature inwhich I musthave resided for at least one year prior to completion of
improvements covered bythis permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-buildeT 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 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.leginfo-ca.gov/calaw.litm 1.
Policy# Date
"ve 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 workees 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
Carrier 9-e,,cz.JX Mini,, with all applicable cityand county ordinances and state laws relatingto
building construction.I authorize representatives of this city or county to
Policy# 5-1 0 FD*Z'5& Expires Co (X enter the above identified property for inspection purposes.
(This section need not to be completed is the Perm it 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 am Ploy any persons in any ma nner so as to become subject to the IdTY BUSINESS LICENSE#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's coTe;gsatlon provisions of Section 3700 of the Labor
Code,I shall forthwith q�ftly with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date mixture containing a hazardous material equal to or greater that the
amounts s ecified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS 0 Yes 7r o
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($200,000),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 forguidel as
CONSTRUCTION LENDING AGENCY o Yes X.10
I herebyaffirm that underthe pena[tVof perjurythere isa construction W1111 the pr osed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer bo clary of a school?
urw;
(Section 3097 Civil Code) a Yes o No
OWNER BUILDER DECLARATIONS I haw 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 perjury that I am exempt from the California Health&Safety Code,Section 25505 and 25534 concerning
Contractor's Jcense Law for the reason(s)indicated below by the hazardou ing.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 ciYes ci;��
Businessand Professions Code).Any city or county that requires a permitto Date
construct,alter,improve,demolish or repair any structure,prior to its PRUPERTY 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 Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRP)
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
and the basis for the alleged exemption.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 rental property owners and property
than($500). managers who do the paint-disturbing workthemselves 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( )all of or I )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 o An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through 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. o 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 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
'wenifee
DATE rt!j IZZ+ PERMIT/PLAN CHECK NUMBER 16M
t G
TYPE: OCOMMERCIAL IIESIDENTIAL 0MULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION Q41LTERATION C)DEMOLITION OELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES_
—]?-1
DESCRIPTION OF WORK
Q�C"
PROJECTADDRESS *Z!2> E�' kCb --D01AJ� C.11 V--
ASSESSOR'S PARCEL NUMBER LOT Ll TRACT
OWNER NAME
ADDRESS
PHONE
EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILDER? 0 YES ONO
BUSINESSNAME
ADDRESS
PHONE3t(:) ZZ-'� q7'3-1 Q EMAIL L C'q�?-
CONTRACTOR'S STATE LIC NUMBER t-Q(.0-3c>( CO LICENSE CLASSIFICATION B
VALUATION$ t 57 OC)Q-�> SO FT LSQFT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DtSTRIBUTION Ito SM,P cr-YOF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN
INVOICE
jjkAfiP& PAIDAMOUNT
AMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# 0 CREDIT CARD VISA/MC
LOWNERB=UILDER VERIFIED 0 YES 0 NO DLNUMBER NOTARIZED LETTER 0- YES 0 NO=
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www,cityofmenifee.us Inspection RequestLine 951-246-6213
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