PMT16-03897 City of Menifee Permit No.: PMT16-03897
29714 HAUN RD. Type: Residential Addition
<A—CCEL:A—> MENIFEE,CA 92586
MENIFEE Date Issued: 12/0712016
P E R M I T
Site Address: 29717 NORTHSHORE ST, MENIFEE,CA Parcel Number: 340-490-041
92584 Construction Cost: $3,200.00
Existing Use: I &2 Family Residence Proposed Use:
Description of CONSTRUCT CONCRETE STAIRS DOWN TO SLOPE 100 SQ FT
Work:
Owner Contractor
LINDAVANKIRK R I P CONCRETE
29717 NORTHSHORE ST 26100 NEWPORT RD STE 12#69
MENIFEE, CA 925134 MENIFEE,CA 92584
Applicant Phone:9515229692
LINDAVANKIRK License Number:916573
29717 NORTHSHORE ST
MENIFEE,CA 92584
Phone: 9517237398
Fee Description Div Amount
Building Permit Issuance 1 27.00
Inspections not specified 258 258.14
Plan Review Building 74 167.79
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 1.00
General Plan Maintenance Fee-Building 1 12.91
$467.84
The issuance of this permit shall not prevent the building official from thereafter requiring the carrection of enurs in the plans and
specifications or from preventing building 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.
AkBk1g_Perrnit—TempIate.rpt Page I of 1
CITY OF MENIFEE
AICENSED 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.0 By my signature below I acknowledge that,except for my personal residence
Expiresi� -30- �Ysignature in which I must have resided for at least one year prior to completion of
46 747(�_
IWORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I
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-Insum 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.leginfo.ca.aoy/caIaw.htmL
Policy# Date
ci 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 ci By my signature below I certify to each of the following:I am the property
this permit is issued.My workees compensation Insurance carrier and policy owner or authorized to act on the property ownees 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.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
(>41certify 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 1�
subject to the worker's compensation provisions of Section 3700 of the Labor HAZARDOUS MATERIAL DECLARATION
Code,I shall forthwith complywith those provisions' Will the applicant or future building occupant handle hazardous material or a
Applicant 11 Date 2- 7-9 mixture containing a hazardous material equal to orgrearter that the
_&�Lw </I-) -, amounts specified an the Hazardous Materials Information Guide?
WARNING:FAILURETO SECUREWORIKER'S COMPENSATION COVERAGE IS ayes E(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 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
CONSTRUCHON LENDING AGENCY ayes ro
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) oYes J�No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements underthe 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 ayes
Business and Professions Code).Any city or county that requires a permit to . , - 2-1",
construct,alter,improve,demolish or repair any structure,prior to its &� Date
issuance,also requires the applicant for the permit to file a signed statement PROPERT)MWINJER OR AUTHORIZED AGENT
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
and the basis for the alleged exemption.Any violation of Section 7031.5 by recervi ng compensation for most work that disturbs paint in a pre-1978
an Applicant for a permit subjects the applicant to a civil penalty of not more residence or childcare facility to be RRP-certified firms and comply with
than($500). required practices.This includes rental property owners and property
managers who dothe paint-disturbing workthemselves orthrough their
a 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 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 o 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 yearof 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. a No EPA Lead-Safe Certified Firm is required for this project because:
a 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 el I*
Menifee
DAT! PERMIT/PLAN CHECK NUMBER
TYPE: 0 COMMERCIAL AESIDENTIAL OMULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION CIALTERATION ODEMOLITION CELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK IA6tn)(2� '.:�kOPLO- A-n
PROJECTADDRESS 0 IL� U1 Avvep
ASSESSOR'S PARCEL NUMBER 340"PqID-044 LOT TRACT
OWNER NAME
ADDRESS q'7 1
PHONE EMAIL q MCA
APPLICANT NAME [—A V'�
ADDRESS
PHONE —731? EMAIL C-%'v,
C—vll JI,.N OWNr.MM1111M'P OYESX'NO
CONTRACTOR'S NAME
BUSINESSNAME
ADDRESS
I . kkk-
PHONE (q5-11 EMAIL L�OU3, rrX—�—ScavE!�l V
CONTRACTOR'S STATE LIC NUMBER 9 [ (,�f—
LICENSE CLASSIFICATION
VALUATION $1 SO FT LSQFT
LA-P-P-L DATE
CITY STAFF USE ONLY
DEPARIMENT UISIKIBU I IUN CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PL4NNING ENGINEERING FIRE GREEN SMIP
INVOICE 1 (9,110 PAIDAMOUNT
AMOUNT I I OCASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDANIOUNT I I OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER 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
office Copy
CITY OF ci y of Monifee
Buildi g &, Safety Dept.
AND SAFE
C 0 6 2016
PLAN AP ROVAL
?I R ceived
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*Approval of th plans Tt%q4qued to be a permit for,or an
approval of,any olationtany Orovisio'ns of the federal,state or city
regulations and o clinances. This set of approved plans must be kept on the
jobsite until comp etion.
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