PMT16-03887 City of Menifee Permit No.: PMT16-03887
29714 HAUN RD. Type: Residential Alteration
-17�CCECA—> MENIFEE,CA 92586
61�11 MENIFEE Date Issued: 12/01/2016
P E R M I T
Site Address: 28804 PEBBLE BEACH DR, MENIFEE, Parcel Number: 337-215-003
CA 92586 Construction Cost: $0.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of HOURLY INSPECTION TO ASSESS DAMAGE TO GARAGE
Work:
Owner Contractor
ROGERTIBBETTS ASSOCIATED PROPERTY RESTORATION&
28804 PEBBLE BEACH DRIVE INSURANCE SERVICES
MENIFEE, CA 92586 1560 COMMERCE STREET UNIT H
Applicant Phone: 8444627747
KURT SZALONEK License Number: 1002435
ASSOCIATED PROPERTY RESTORATION&INSURANCES
1560 COMMERCE STREET UNIT H
CORONA,CA 92880
Fee Description Qtv Amount
Building Permit Issuance 1 27.00
Inspections not specified 129 129.07
$156.07
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specificstions 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�Sldg_Pemit Template.rpt Page 1 of I
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).
Chapterg(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 an my license is in full force and effeft the following reason:
License Class Licensplt.. By my signature below I acknowledge that,except for my personal residence
Expires3L3)b 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
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
ve 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.leginfo.ca.gov/calaw.htmi.
this permit is issued.
Policy If (A) CCJIZ�7� PROPERTY OWNER OR AUTHORIZED AGENT Date
o I have and will maintain worker's compensation insurance,as required by
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 6a'a"4 building construction.I authorize representatives of this city orcountvto
Policy# WC01 fo/ -I'M Expires CV-2-47 enter the above identified property for inspection purposes.
(Thissection need not to be completed is the permit is for one-hundred Date
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,
I shall not employ 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 workees compeyation provisions of Section 3700 of the Labor
Code,I shall forth h comp ith those provisions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to orgreaterthat the
Applicant Date L6�-/ /&/ amounts specified on the Hazardous Materials Information Guide?
WARNING:FAlLU1 rETAt—URE WORKER'S COMPENSATION COVERAGE IS 0 Yes 0 No
UNLAWFUL,AND SHALLSUBJECr 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 o Yes o 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 BUIL13ER 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 oYes 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 appliciintfor 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-certlfied 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 work themselves or through their
o 1,as owner of the property,or my employee with wages as their sole employees.For more information about EPNs Renovation Program visit:
compensation,will do I )all of or I )portion of the work,and the structure is www.epa.goy/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 o An EPA Lead-Safe Certified Renovator will be responsible forthis 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 because:
ci 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project fSection 7044,Business and Professions
Code:The Contractor's State Uicense 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
A2
DATE 6 PERMIT/PLAN CHECK NUMBER 0!�w Lo - n3a�m
TYPE: OCOMMERCIAL 4RESIDENTIAL -- MULTi-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION kALTERATiON 0DEMOUTION OELECTRICAL OMECHANICAL
CNEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Pf_12ALA, C`PA-�
PROJECTADDRESS aVjN)c4 OA2e &Ac�g �uxi Cir4 9J-S_k4
y of Menifee
ASSESSOR'S PARCEL NUMBER LOT EII g P. safety Dept.
OWNER NAME eWIfe BE6 0 1 N16
_j
ADDRESS
PHONE EMAIL Received
APPLICANT NAME Ie4-44
ADDRESS corq� (0-10 1,,A C"A 9.�00)
PHONE 63-b'?,96- '4q6t-1 — EMAIL 1�?Ukd'e Aj%jS�rne
CONTRACTOR'SNAME _MA4;6 OWNERBUILDER? OYESJqNO
BUSINESS NAME lqg Co I,_I na IP1,70 fj Lrj 3 t/"-N C q S r
ADDRESS IV�40 L'-OMoae,, u Vy_ud� j Oyvitd &XorvA C/In
PHONE Gg- w6- qqbq EMAIL )eunt6v Aft i. o',-(
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ SQ FT L SO FT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP F X7
INVOICE
AMOUNT PAID AMOUNT 6 OCASH OCHECK# 0 CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0 CASH 0 CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED 0_YES 0 NO DL NUMBER NOTARIZED LETTER 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