PMT16-03971 City of Menifee Permit No. PMT16-03971
29714 HAUN RD.
<A-CCIEILA--�." MENIFEE, CA 92586 Type: Residential Addition
MENIFEE Date Issued: 06120/2017
P E R M I T
Site Address: 30179 PUERTO VALLARTA WAY, Parcel Number: 360-020-004
MENIFEE. CA 92584 Construction Cost: $34,317.36
Existing Use: 1 &2 Family Residence Proposed Use:
Description of CONSTRUCTION OF NEW GARAGE 792 SO FT"DEFERRED TRUSS CALCS**
Work:
Owner Contractor
JOHN&ERIN JOHNSON A M P MANUFACTURED HOME SPECIALIST
30179 PUERTO VALLARTA WAY 27630 CONNIE WAY
MENIFEE, CA 92584 SUN CITY, CA 92586
Applicant Phone: 9513138484
DENISE SKINNER License Number:997499
A M P MANUFACTURED HOME SPECIALIST
27630 CONNIE WAY
SUN CITY, CA 92586
Fee Description Qtv Amount 1$)
Receptacle,Switch, Outlet&Fixture 13 176.00
Building Permit Issuance 1 27.00
Additional Plan Review Building 129 129.07
Additional Plan Review Electrical 210 210.00
GREEN FEE 1 2.00
SMIP RESIDENTIAL 1 5.00
New Construction Permit Fee 1 157.86
General Plan Maintenance Fee-New 1 7.89
Construction
$714.82
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications or from preventing bulliding 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.
AkB[dg_Pemit Template.ript Page 1 of I
CITY OF MENIFEE
LICENSED DECLARATION propertywho 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 Ilcensure 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,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,for the performance of work for which www.le Vo..ca.gov calaw.h
this permit is issued. F Vo v/calaw. tmL
Policy If >;�_/11_�4 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 u 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 enter theabove identified property for Inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date :;z
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 empt 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?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 in 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 occupant require a permitfar 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 f6rguidelines
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 forthe performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) a Yes o 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 75505 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 applicant for the permitto file a signed statement
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAJR 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 work themselves or through their
o 1,as owner of the property,or my employee with wages as their sale 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.epa.gov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7D44,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 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. u No EPA Lead-Safe Certified Firm is required forthis project because:
'�(I'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
if ee
DATE PERMIT/PLAN CHECK NUMBER 12t!r1lo , 0 ,M11
TYPE: F-ICOMMERCIAL ORESIDENTIAL []MULTI-FAMILY []MOBILEHOME []POOL/SPA []SIGN
SUBTYPE: [:]ADDITION E]ALTERATION []DEMOLITION Ej ELECTRICAL El MECHANICAL
E]NEW EIPLUMBING El RE-ROCIF-NUMBER OF SQUARES
DESCRIPTION OF WORK
PROJECTADDRESS jZJ((7jj'6Cf46 VQ, �64-il
ASSESSOR'S PARCEL NUMBER 3&6-(UQ-- doq LOT TRACT
PROPERTY OWNER'S NAME ao k A q, Ev, I' n \To h n ,�p f I
ADDRESS &Cr-eq0 VcL( I arja 00-(-( ,
PHONE b j-o5 g-�7"S3-7 EMAIL
APPLICANTNAME
ADDRESS �22.-�o Conn;P- 10mj , lHeI11:46V-11
PHONE !q 314-c-Q Y I EMAIL Y)I>-f(I rtla VH 5r) CC V4
CONTRACTOR'S NAMEAdrl- ......i RBUILDER? [:]YES&fNO
io fkAlla ,
BUSINESS NAME
ADDRESS (oZ 6 Con vi i e Ct Y,
�1,3 aoqai I I q I q4�gj� hoin, ; I, e
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALLIATION$ 3(�OC) 0 SO FT LSQFT
APPLICANT'S SIGNATURE DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOI:E 11.15 PAIDAMOUNT
C Ty I
AMOU�N & _ I OCASH OCHECK# OCREDITCARD VISAIMC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISAIMC
OWNER BUILDER VERIFIED DYES 0 No DLNUMBER NOTARIZED LE17ER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-C777
www.cityofmenifee.us Inspection Request Line 951-246-6213