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PMT16-03507 City of Menifee Permit No.: PMT16-03507 29714 HAUN RD. Type: Residential Addition <A—CCI---LA—> MENIFEE, CA 92586 MENIFEE Date Issued: 12/0712016 P E R M I T Site Address: 30522 BYERS RD, MENIFEE, CA 92584 Parcel Number: 358-100-045 Construction Cost: $20,001.80 Existing Use: 1 &2 Family Residence Proposed Use: Description of ROOM ADDITION,314 SF WITH ELECTRICAL AND HVAC Work: Owner Contractor MIKE FALCO MITCHELL CONSTRUCTION 30522 BYERS ROAD 25647 FARMINGTON RD M ENIFEE, CA 92584 MENIFEE, CA 92584 Applicant Phone:9512266201 JONATHON MITCHELL License Number.928421 MITCHELL CONSTRUCTION 25647 FARMINGTON RD MENIFEE, CA 92584 Fee Description Oty Amount Receptacle, Switch, Outlet&Fixture 47 346.00 Plumbing Fixtures and Vents, fixtures 2 116.00 Gas System 1 116.00 Water Heater 1 83.00 Building Permit Issuance 1 27.00 Additional Plan Review Building 213 212.94 Additional Plan Review Building 45 45.00 GREEN FEE 1 1.00 SMIP RESIDENTIAL 1 3.00 New Construction Permit Fee 1 92.01 General Plan Maintenance Fee-New 1 4.60 Construction $1,046.55 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 Bldg_Pemit—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 contraictor(s)pursuant to the Contractors State License Law). Chapter9i(commencing with section 7000)of Division 3 of the Business and o I am exemptfrorn licensure under the Contraictor's State License Law for Professions Code and my license is in full force and effect. the following reason: License Class P) —Licen 0. By my signature below I acknowledge that,Except for my personal residence Expires--1 7 bk Sianature 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 DECLARATIOf have built as an owner-builder if it has not been constructed in its entirety by o I hereby affirm under penalty of perju ne of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section have and will mail gpif-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/calaw.htmI. Policy It 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 far 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 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 Pertify that in the performance of the work for which this permit is issued, sch",K not employ any persons in any manner so as to become subject to the CITY BUSINESS UCENSE# 05(a04 worker's compensati laws a:fonnira,�a�nild agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the wo m lofntt'cm P. ons of Section 3700 of the Labor Code,I shall forth visions. Will the applicant or future building occupant handle hazardous material or a Applicant Date /�,- 7-A, mixture containing a hazardous material equal to or greater that the amounts specified on the Hazardous Materials Information Guide? WARNING:FAfILE TOVE CURE WORKER'S COMPENSATION COVERAGE IS o Yes \No S LIN SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building UI AN UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South TORNEYS FEES for gulifellnes IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND AT CoastAir Quality Management District(SCAQMD)?See permitting checklist CONSTRUCTION LENDING AGENCY o Yes 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) a Yes No OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD permitting checklist.I under,4and my requirements under the State of I hereby affirm under penalty of perjury that I am exempt from the California Health& Fetv e,Section 25505 and 25534 concerning Contractor's License Law for the reason(s)indicated below by the hazardous mater I po 1 checkmark(s)I have placed next to the applicable ltem(s)(Section 7031.5 oYes No Business and Professions Code).Any city or county that requires a permit to k W77 _Dateu_ z � construct,alter,improve,demolish or repair any structure,prior to its PROPERTY;OrEFCWAUTHORIZED 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 Contractor's State EPA BEN ON,REPAIR AND PAINTING IRRPJ License Law(Chapter 9(commencing with Section 7000)of Division 3 of the tl The EPA Renovation,Repair and Painting(RRP)Rule requires contractors Business and Professions Code)or that he or she is exempt from ficensure 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 work themselves orthrough their ri 1,as owner of the property,Or my employee with wages as their sole employees.For more information about EPAs Renovation Program visit: compensation,will do I )all of or( )portion of the work,and the structure is www.epa.gay/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 rtifica n No.: completion,the Owner-Builder will have the burden of proving that it was not built or Improved for the purpose of sale. ANo EPA Le feC led 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 E. u r Code:The Contractor's State License Law does not apply to an owner of a / If you roject does not comply with EPA RRP rule please fill out the RRP Ackn ledgement.