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PMT16-03672 City of Menifee Permit No.: PMT16-03672 29714 HAUN RD. Type: Residential Electrical <A—CCELA?' MENIFEE, CA 92586 MENIFEE Date Issued: 11/14/2016 P E R M I T Site Address: 28313 SUNRISE SKIES WAY, MENIFEE, Parcel Number: 333-560-071 CA 92585 Construction Cost: $1,200.00 Existing Use: Proposed Use: Description of INSTALL GAS AND ELECTRICAL LINES FOR FUTURE BBQ ISLAND AND FUTURE POOL Work: Owner Contractor RUSSELL BREEDING 28313 SUNRISE SKIES WAY MENIFEE, CA 92585 Applicant License Number RUSSELL BREEDING 28313 SUNRISE SKIES WAY MENIFEE,CA 92585 Phone: 9517561243 Fee Description Amount Plumbing Fixtures and Vents,fixtures 116.00 Building Permit Issuance 1 27.00 Inspections not specified 116 116.00 GREEN FEE 1 1.00 General Plan Maintenance Fee-Building 1 5.80 General Plan Maintenance Fee-Plumbing 1 5.80 $271.60 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 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 licensure under the 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 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 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 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.leainfo.ca.gov/calaw.htmi. Policy# 4z�— �� Date 11-1e;X-1611' ci I have and will maintain worker's compensation insurance,as required by XOPERTY OWNER OR 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 on the property owners 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# 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 ci 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# 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 comply 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 specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 ciYes ciNo UNLAWFUL,AND SHALL SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building AND CIVIL FINES UP TOONE 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 ci Yes ci 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) ci Yes ci No 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 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 uYes a 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 Contractors State 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 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 permitsubjects the applicant to a civil penalty of not more than($500). required practices.This includes rental property owners and property managers who do the paint-disturbing work themselves or through their ci 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 I all of or( I portion of the work,and the structure Is www.epa.govAead 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 Contnictoes 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 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 forthis project bemuse: 14 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. Knifee FBU I�LDING & SAFETY PERMIT/PLAN CHECK APPLICATION Mi v D ve ...'Menifee DATE PERMIT/PLAN CHECK NUMBER TYPE: OCOMMERCIAL ORIESIDENTIAL 0MULTI-FAMILY OMOBILEHOME 0 POOL/SPA 0 SIGN SUBTYPE: OADDITION OALTERATION ODEMOLITION CELECTRICAL OMECHANICAL ONEW *PLUMBING 0 RE-ROOF-NUMBER OF SQUARES— DESCRIPTION OF WORK oi� 7Z�;) (�4744- ft,�— q3bQ ILI/) AA-(:) FZ (zIz7- fibo,�-. PROJEc-rADDRESs 200w3 :5uw2-5F- L-,4 12 st,5 -Z)v —2 ASSESSOR'S PARCEL NUMBER 535 —45Y Q LOT I' TRACT �)q IT) OVINERNAME 13)Lc�- �D,/Ale, Z'� ADDRESS 1'5 6d $?21SO5 PHONE EMAIL (v�5,7'-L- l3itc r. 2 6 APPLICANTINAME )�,�>517LL ADDRESS -Zep'2 1'3 PHONE EMAIL O)s5i7a Fb C� CONTRACTOR'S NAME OWNER BUILDER? @YES ONO BUSINESS NAME ADDRESS PHONE EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION$ C:>0 SO FT L SO FT APPLICANT'S SIGNATURE DATE -P-1110"r,1114% DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GRIEN SMIP INVOICE � 211.11() 1 PAID AMOUNT AMOUNT I I C)CASH 0 CHECK# 0 CREDIT CARD PLAN CHECK FEES PAIDAMOUNT I I OCASH OCHECK# OCREDITCARD 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 5- 75 4 1 , NAME PHONE 7 Lt-3 JOB ADDRESS �54,Ale;j:r 51e�p,.V 4f!�� 44er0-Fee TRACT/PARCEL MAP LOT ASSESSOR'S PARCEL NO. REAR PROPERTY LINE -X- Alye-jvl z W4 Qh W4 FRONT PROPERTY LINE STREET