PMT16-03883 City of Menifee Permit No. PMT16-03883
29714 HAILIN RD. Type: Residential Demolition
<ACCIELJ-S�' MENIFEE, CA 92586
MENIFEE Date Issued: 12/01/2016
P E R M I T
Site Address: 29632 PATELLI WAY, MENIFEE, CA Parcel Number: 327-370-014
92585 Construction Cost: $500.00
Existing Use: Proposed Use:
Description of DEMO EXISTING MOBILE HOME, 1440 SF
Work:
Owner Contractor
STEVE BRADFLITE
29632 PATELLI WAY
MENIFEE, CA 92585
Applicant License Number:
STEVE BRADFLITE
29632 PATELLI WAY
MENIFEE, CA 92585
Phone:9512378877
Fee Description Qtv Amount($I
Building Permit Issuance 1 27.00
Demolition Permit 1 140.00
GREEN FEE 1 1.00
$168.00
The issuance ofthis permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications orfrom preventing builiding operations being carried on thereunderwhen in violation ofthe Building Code orof any other
ordinance of City of Menifee.Except as otherwise stated,a permit for construction underwhich 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_Pennit-Ternplate.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 o I am exempt from 11censure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Ciao 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
a 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 www.legmfo.ca.eov/ca1aw.html.
this permit Is Issued.
Policy# Date
o I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER ORAUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work forwhich cr 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.
.�_:W(This section need not to be completed is the permit is for one-hundred , .- "P o�7�-e� Date 1'2- A�
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
o 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 Ora
mixture containing a hazardous material equal to or greater that the
Applicant Date amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE M SECURE WORKEWS COMPENSATION COVERAGE IS 0 Yes o No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER M 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 fo�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 o Yes o No
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility he 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) 0 Yes a 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 Dyes o 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
a nd the basis for th e alleged exemption.Any violation of Section 7031.5 by residence or ch Ildca re facility to be RRP-certified firms and comply with
a n Applica nt fo r a perm it subjects the applicant to a civil pena Ity of nut more
required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing workthemselves or through 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( )all 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 1-80D-424-LEAD(5323).
Code;The Contractoes State License Law does not apply to an owner of a 0 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 for this project bemuse:
0 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 RAT rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
r
meniTee
DATE /& PERMIT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL KRESIDENTIAL CMULTI-FAMILY 0MOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION )�'DEIVIOLITION 0ELEcTRICAL OMECHANO City ot Meni ee
6ng & Safet I Dept.
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK -1? eawve- DEC 0 016
i3Qcwvad
PROJECTADDRESS 3 2 1,4-7'�-4 6
ASSESSOR'S PARCEL NUMBER 970 LOT TRACT
OWNER NAME -57-e- V
ADDRESS Z 96� 'Y 2 /�4
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PHONE -2 3 7 - 7 EMAIL 7-,!5F 19 Xl&'rJ C-- -'07
APPLICANT NAME -re ve
ADDRESS 2 �7&' 4�� 7-SZ -?.2
PHONE 3 7 7,�7 EMAIL
CONTRACrOR'S NAME OWNER BUILDER? ;VYES ONO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION $ OVO- SQ FT L SO FT
APPLICANT'S SIGNATURE DATE
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IT-A— y
DEPARTM,- UIN-1-11-1, CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICIE
AMOU T ��Qt. (QZ Co 0 CASH 0 CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 1 0 CASH 0 CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
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Building &Se,ety Dept' 0
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CITI Y OF MENIFEE
BUILDING AND SAFETY DEPARTMENT
PI.AN APPROVAL
REVIEWED By (-UA
DATE
*Approval of these plans shall not be construed to be a permit for,or an
approval of,any violation of any provisions of the federal,state or city
regulations and ordinances. This set of approved plans must be kept on the
jobsite until completion.
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