PMT16-03746 City of Menifee Permit No.: PMT16-03746
29714 HAUN RD. Type: Residential Addition
<A-CCEL:A-> MENIFEE, CA 92586
MENIFEE Date I ssued: 01131/2017
P E R M I T
Site Address: 25647 FARMINGTON RD, MENIFEE,CA Parcel Number: 358-100-051
92584 Construction Cost: $17,332.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of 400 SO FT OFFICE/ACCESSORY BUILDING WIELECTRICAL
Work:
Owner Contractor
JONATHON MITCHELL
25647 FARMINGTON RD
MENIFEE,CA 92584
Applicant License Number:
JONATHAN MITCHELL
25647 FARMINGTON RD
MENIFEE. CA 92584
Phone:95122662011
Fee Description P!X Amount
Services,Switchboards, Control Centers&Panels 1 116.00
Receptacle, Switch, Outlet&Fixture 22 221.00
Plan Check Fee 103 102.50
Susperided/Recessed Wall/Floor Mounted Heater 1 133.00
Air Handling/Condensing Units SFR 1 133.00
Building Permit Issuance 1 27.00
Inspections not specified 129 129.07
Additional Plan Review Building 129 129.17
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 3.00
New Construction Permit Fee 1 79.73
General Plan Maintenance Fee-Mechanical 1 1320
General Plan Maintenance Fee-Electrical 1 16.85
General Plan Maintenance Fee-New 1 3.99
Construction
$1,108.61
The issuance of this permit shall not prevent the building official from thereafter requiring the correcrion 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_Pernilt-Ternplatexpl: 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 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 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 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
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,forthe performance of work for which www.Ieginfo.ca.govJcaIaw.htrnl.
this permit is Issued.
Policy# 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 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
Carrier with all appip'cable city and county ordinances and state laws relating to
building C94struApn.I authorize representatives of this city or county to
Policy# Expires nt h roperty,for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less P
/#11PEf6Y OW�kR OR AUTHORIZED AGENT
o 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 it
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
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 IS a Yes o No
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
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FO occupant require a permit for the construction or modification from South
R Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguldelines
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) o Yes o No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements underthe State of
Contractor's License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmarlds)I have placed next to the applicable item(s)(Section 7031.5 hazardous material reporting.
Business and Professions Code).Any city or county that requires a permit to ciYes o No Date
construct,alter,improve,demolish or repair anystructure,priorto its PROPERTY OWNER OR AUTHORIZED AGENT
issuance,also requires the applicantforthe permittofile a signed statement
that he or she is licensed pursuant to the provisions of the Contractor's 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 ficensure r . . ompensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by receiving c
an Applicant for a permit subjects the applicant to a civil penalty of not more esidence or childcare facility to be RRP-certified firms and comply with
tha 1500). required practices.This includes rental property owners and property
managers who do the paint-disturbing work themselves or through their
r1as owner of the pro?",or my employee with wages as their sole employees.For more Information about EPA!s Renovation Program visit:
compensation,will do(14all of or I 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 a An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,th rough 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:
o 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
Menifee
DATE 0-,�J-J(X PERMIT/PLAN CHECK NUMBER 1P M((o e V�ILKP
TYPE: 0 COMMERCIAL ARESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA 00 SIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRICAL OMECHANICAL
YNEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK IA(Ces�ar� by jjjin:f,
PROJECTADDRESS d5-(,q7 F�jry)jjulc)4V�J, rjt
ASSESSOR'S PARCEL NUMBER 0 J55 05( LOT TRACT
OWNER NAME )Cw 01,j IV)14rkz I
ADDRESS c4S(A7 FertwL!�4/J rd. 1V-eAjXee_ 64 , qjM'
PHONE EMAIL �76 oAj (-olvi,
APPLICANTNAME
ADDRESS �5_bLO FAr-mfLL�:Illj A
PHONE EMAIL Tj �,k),,4-61JOM MI4C9e11CV,e-,j,4,1,
CONTRACTOR'S NAME OWNER BUILDER? AVES ONO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S ISTIATE LIC NUMBER LICENSE CLASSIFICATION
It L
VALUATION$ SO FT LSQFT
C;
APPLICANT'SSIGNATURIE DATE
CrrY STAFF USE ONL
DEPARTMENT DISTRIBUTION SMIP WIT UIMtNIFEE BU51NE55 LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN
INVOICE
AMOU T PAID AMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0 CASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 No DLNUMBER NOTARIZEDLE-FrER 0 YESO NO
City of Menifee Building& Safety Deportment 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line-951-245-6213