PMT16-03622 City of Menifee Permit No.: PMT16-03622
29714 HAUN RD. Type: Residential Alteration
<A-CCELA> MEN]FEE, CA 92586
MENIFEE Date Issued: 09105/2017
P E R M I T
Site Address: 29181 HIDDEN MEADOW DR, MENIFEE, Parcel Number: 364-290-039
CA 92584 Construction Cost: $5,499.90
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL SHOWER ADDITON TO CURRENT POWDER ROOM 30SQFT
Work:
Owner Contractor
KINGSLEYVARGAS YELTSIN GONZALEZ
29181 HIDDEN MEADOW DRIVE 19321 PYRAMID CIRCLE
MENIFEE, CA 92584 LAKE ELSINORE,CA 92530
Applicant Phone: 9512947042
KINGSLEYVARGAS License Number: 1018302
29181 HIDDEN MEADOW DRIVE
MENIFEE, CA
Phone:6268185464
Fee Description Qtv Amount($1
Building Permit Issuance 1 27.00
Reinspections/Additional Inspections 516 516.28
Additional Plan Review Building 129 129.07
Additional Plan Review Building 148 148.37
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 1.00
New Construction Permit Fee 1 25.30
General Plan Maintenance Fee-New 1 1.27
Construction
$849.29
The issuance of this pemit 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_Perrnit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts forthe projects
I hereby affirm under penalty of perjury that I am under provisions of Ith licensed contractor(s)pursuant to the Contractors State License Law).
m
Chapter9(commencing with section 7000)of Division 3 of the Business and �a exempt from licensure under the Contractoes 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 in which I m ust have resided for at least one yea r 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-insure forworker's 7044 of the Business and Professions Code,is av�illable 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.c0ov/caIaw.html.
—�7
Policy# X*4W� Date
o I have and Will maintain worker's compensziUon insurance,as required by PR&FhY OAER�R AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which ci 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 an the property owner's behalf.I have read this
number am: appllution 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)"kauthorize representatives of this city or county to
Policy# Expires enter the e I ed property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less 4n&- -
o I certify that in the performance of the work for which this permit is Issued, PROPEk.rY NWNERMAU ORIZEDAGENT
Ishalinotemolo 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
Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
Applicant Date amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 oYes cNo
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($100,000),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 for guidelines
CONSTRUCTION LENDING AGENCY a 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) o Yes n No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQIVID
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 oYes ci 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 Contractor's State EPA RENOVATION,REPAIR AND PAINTING IRRPI
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-certifiad firms and comply with
an Applica nt for a permit subjects the applica nt 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 or through their
o 1,as owner of the property,or my em playee 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.govIlead 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 a An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or persona I 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. ci No EPA Lead-Safe Certified Firm is required for this project because:
0 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contmctorjs 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.
City of Menitee
Building & Safety Dept.
2016
ILIJING &SAFETY PERMIT/PLAN CHECK APPLICATION
Received
Menifee
DATE 10/2412D16 PERMIT/PLAN CHECK NUMBER m-T t 14 - 0-lip 2
TYPE: EICOMMERCIAL ERESIDEN-nAL FIMULTI-FAMILY F]MOSILEHOME []POOL/SPA [-]SIGN
SUBTYPE: []ADDITION E]ALTERATION E]DEMOLITION []ELECTRICAL F]MECHANICAL
FINEW EPLUMBING El RE-ROOF-NUMBEROF SQUARES-
DESCRIPTION OF WORK Shower addition to current powder room
PROJECTAIDDRESS 29181 Hidden Meadow Drive,Menifee,CA,92584
ASSESSOR'S PARCEL NUMBER 364-290-039 --L LOT 261 TRACT 30422-2
PROPERTY OWNER'S NAME Kingsley Vargas
ADDRESS 29181 Hidden Meadow Drive,Menifee,CA,925B4
PHONE (626)818-5464 EMAIL pyrtaniz@prytani7-com
APPLICANT NAME Kingsley Vargas
ADDRESS 29181 Hidden Meado Ddve,Menifee,CA,92584
PHONE (626)818-5464 EMAIL prytaniz@prytaniz.com
cowmcrolil!S NAME YeltsinGonzalez OWNER BUILDER? RfYES MIND
BUSINESSNAME General Construction Contractor Dependable Construction Services
ADDRESS
PHONE (951)294-7042 EMAIL gonzalez_yeltsin@yahoo.com
CONTRACTOR'S STATE LIC NUMBER 1018302 LICENSE CLASSIFICATION B
dVALUATION$ 5?6�00 SO FT 5.6 x 5.3 L SO FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION SMIP CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN
INVOICE PAIDAMOUNT
AMOUNT 1 5S. I I OC4SH OCHECK# OCREDITCARD VISAINIC
PLAN CHECK FEE PAIDAMOUNT I 1 0 CASH 0 CHECK# OCREDITCARD VISAtmc
OWNER BUILDER VERIFIED OYES 0 NO DILNUMBER NOTARIZEDLETTER 0 YES 0 NO
Menifee Buildina&Safet.v DeIoortment 29714 Houn Rd. Menifee, CA 92586 951-672-6777
,immcavormenifee.us Inspection Request Line 951-246-6213