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PMT16-03694 City of Menifee Permit No.: PMTI 6-03694 29714 HAUN RD. Type: Residential Demolition <A-CCEU� MENIFEE, CA 92586 MENIFEE Date Issued: 11116/2016 P E R M I T Site Address: 30231 CALLE BELCANTO, MENIFEE,CA Parcel Number: 364-101-019 92584 Construction Cost: $1,000.00 Existing Use: Proposed Use: Description of DEMOLITION OF EXISTING DRY ROTTED BALCONY/DECK 340 SO FT Work: Owner Contractor CAROL ANN VANDERFEER 30231 CALLE BELCANTO MENIFEE,CA 92584 Applicant License Number: CAROL ANN VANDERFEER 30231 CALLE BELCANTO M ENIFEE, CA 92584 Phone:9516791487 Fee Description Qtv Amount Building Permit Issuance 1 27.00 Demolition Permit 1 140.00 $167.00 The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and spedfications 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_Parrnit Template.rpt Page 1 of 1 CITY OF IVIENIF E P� LICENSED DECLARATION :�Yho builds or improves thereon,and who contracts for the projects If, I hereby affirm under penalty of perjury that I am under provisions of ....d lontractor(s)pursuant to the Contractors State License Law). Chapter9(commencing with section 7000)of Division 3 of the Business and a 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,exceptfor my personal residence Expires_Signature In which I in ust have resided for at least one year prior to completion of improvements covered by this perm it.I cannot legally sell a structu re that I WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by a I hereby affirm under penalty of perjury one of the followilng declarations:I licensed contractors.I understand that a copy of the applicable law,Section have and will maintain a certificate of consent of gelf-Insure for worker's 7044 of the Business and Professions Code,is available upon request when h 1 7 n I I 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. ngw.leginfo.ca.govCcalaw.html. Policy# 'A� - Date o I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZE$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 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 If Expires tertheabovei ntiftecipppe r inspection purposes. (This section need not to be completed is the permit Is for one-hundred dollars($100)or less M�I= Date PROPERTY OWNER OR AUTHORIZED EGENT n I certify that In the performance of the work for which this permit is issued, Ishallnotemplo 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? MAANING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 oYes ciNo 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 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 CONSTRUCrION LENDING AGENCY oYes ciNo 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 ri No WNER 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 Ca lifornia Health&Safety Code,Section 25SD5 and 25534 concerning Contractor's License Law for the reason(s)indicated below by the hazardous material reporting. checkma rk(s)I have placed next to the applicable item(s)(Section 7031.5 nYes ci No Business and Professions Code).Any city or county that requires a permit to Date construct,after,improve,demolish or repair anystructure,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 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 orthrough 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.eva.goy/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-800424-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 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 improvementis 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 forthe purpose of sale. u No EPA Lead-Safe Certified Firm is required for this project because: n 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 Men if ee DATE %k k6 "lit (o PERMIT/PLAN CHECK NUMBER TYPE: OCOMMERCIAL ORESIDENTIAL 0MULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN SUBTYPE: OADDITION OALTERATION 7, DEMOLITION OELECTRICAL OMECHANICAL ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES— DESCRIPTION OF WORK _-be-mu TeNIZOT-ieD 8 g PROJECTADDRESS 2,)07,Sl O—kLI-E _1;�ElLdA�J_M �Aw I t:��c_ CIA ASSESSOR'S PARCEL NUMBER t,4JO( (:)J!3 LOT TRACT OWNERNAME CAFbL A," \J PvP o e?_iPeere- ADDRESS BC-ewTo 09W(FIME PHONE EMAIL APPLICANT NAME kiQ0 ADDRESS 3p-?,Sl �,Aue PHONE L-lq 14 EMAIL CONTRACTOR'S NAME OWNER BUILDER? " YES 3'NO BUSINESS NAME ADDRESS PHONE EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION$ f -RLM S I LSQFT APPLI "(1QeA--�DATE DEPARTMENT DISTRIBUTION 4ff CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDiNG PLANNING ENGINEERING FIRE GREEN 7 SMIP �10 INVOICE PAIDAMOUNT CHECK# 0 CREDIT CARD VISA/MC AMOUNT I I QCASH 0 PLAN CHECK FEES PAIDAMOUNT I 1 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC OWNER BUILDER VERIFIED 0 YES 0 No DLNUMBER NOTARIZED LE17ER 0 YES 0 NO City of Menifee Building& Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777 www.cityof,menifee.us Inspection Request Line 951-246-6213 tY of Menifee 9 & Safety Dept 16 2016 tow Alk