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PMT16-03980 City of Menifee Permit No.: PMT16-03980 29714 HAUN RD. Type: Residential Alteration <AACCIECA? MENIFEE, CA 92586 MENIFEE Date Issued: 12/0612016 PERMIT Site Address: 28740 WEE BURN WAY,MENIFEE,CA Parcel Number: 339-125-013 92586 Construction Cost: $3,500.00 Existing Use: 1 &2 Family Residence Proposed Use: Description of REMOVE EXISTING SIDING AND INSTALL NEW FIBER CEMENT SIDING WITH INSULATED Work: PLYWOOD BACKING TO EXTERIOR OF FRONT OF HOUSE Omer Contractor RONJOHNSON A L S SIDING 28740 WEE BURN WAY 29353 FALL CLASSIC ST MENIFEE, CA 92586 LAKE ELSINORE, CA 92530 Applicant Phone:9515525632 ADAM STRUTZMAN License Number. 1014665 A L S SIDING 29353 FALL CLASSIC ST LAKE ELSINORE, CA 92530 Fee Description 21 Amount Building Permit Issuance 1 27.00 Inspections not specified 258 258.14 GREEN FEE 1 1.00 $286.14 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 builiding operations being carried on thereunder when in violation of the Building Code or of any other ordinance of City of Menifee.Except as otherviise 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. CONDITIONS Condition Comment 1 SPECS AA BIdgPermit Ternplate.rpt Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION propertywho builds or improves thereon,and who contracts forthe projects I hereby affirm under penalty of perjurythat I am underprovislons of with a licensed contiaictor(s)pursuant to the Contractors State License Law). Chapterg(commencing with section 7000)of Division 3 of the Business and o 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 UOV�)V( LICAns. .1 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 ci 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 this permit is issued. WWW.Ieginfo.ca.gov/calaw.litmi. 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 a 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 lam 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 X1 certify that in the performance of the work for which this permit Is Issued, 11'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'vorker'S Compensation provisions of Section 3700 of the Labor Will the applicant or future building occupant handle hazardous material or a . F Wit ly Code,I sh h I lic. with those provisions. mixture containing a hazardous material equal to or greater that the Applicantm& Date amounts specified onthe Hazardous Materials Information Guide? WARNING:FAILURETO SECURE WORKEWS COMPENSATION COVERAGE IS o Yes ci No UNLAWFUL,AND SHALL SUBJECT AN EMPLOYERTO CRIMINAL PENALTIES Will the intended use of the building bythe applicant or future building ANDCIVIL FINES UPTO ONE HUNDREDTHOUSAND DOLLARS($100,000),IN occupant require a permitfor 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 forguidelines 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 permitting checklist.I understand my requirements underthe State of I hereby affirm under penalty of pedury 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 c No Business and Professions Code).Any city or countythat requires a permitto Date construct,alter,improve,demolish or repair anystructure,priorto its PROPERTYOWNER OR AUTHORIZED AGENT issuance,also requires the applicant forthe permitto filea signed statement that he orshe is licensed pursuarittothe 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(RRPj 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 than($500). required practices.This includes rental property owners and property managers who do the paint-disturbing work themselves orthrough their ci 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 )all of or I 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 ci 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 Omer-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 k4 Menlfe��l DATE PERMIT/PLAN CHECK NUMBER and-n-a-mlo TYPE: C". COMMERCIAL 0 RESIDENTIAL 0 MULTI-FAMILY Q MOBILE HOME POOL/SPA -SIGN SUBTYPE: 0 ADDITION ALTERATION '_' DEMOLITION ELECTRICAL MECHANICAL , NEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES_ DESCRIPTION OF WORK `�V\(,I�C44A�jOVI O � �\. Ut/f C/a/mtvik 0 io foa 140 US0, PROJECTADDRESS 'VS_j\-(0 \AJ'g al �&j A-q cra-3a-P -Y UT M I) fee ASSESSOR'S PARCEL NUMBER S_%5q-105-ols LOT TRACT 9 a Saoft,I Dept. OWNERNAME �.Ohj jo�Vj��O/') DEC o g 9 ADDRESS 6 I-A)&b 6 tJ U W�� PHONE I - bO � EMAIL Recelve APPLICANTNAME ADDRESS cAagi,c/ 1/4a v jsWt6 PHONE EMAIL CONTRACTOR'S NAME OWNER WILDER? YES 3NO BUSINESS NAME A -\, -C,-) co I 'VA A - ADDRESS PHONE q EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION$ i 4AFT LSQFT APPLICANT'S SIGNATURE DATE DEPARTMENT DISTRIBUTION CITY OF MENIFEE BU_INFqS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE ILA PAID AMOUNT AMOUNT Q&.1LA 1 0 CASH 0 CHECK It OCREDITCARD VISA/MC PLAN CHECK FEES PAID AMOUNT CASH "')CHECK# J CREDIT CARD VISA/MC I Q LOWNER BUILDER VERIFIED 0 YES C NO DL NUMBER NOTARIZED LETTER 0 YES 'Q NO City of Menifee Building& Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityof,menifee.us Inspection Request Line 951-246-6213