PMT16-04008 City of Menifee Permit No.: PMT16-04008
29714 HAUN RD. Type: Residential Alteration
4;i�CCECA—> MENIFEE. CA 92586
MENIFEE Date Issued: 12107/2016
PERMIT
Site Address: 25640 WHITE ASPEN CIR, MENIFEE, CA Parcel Number: 339-450-018
92584 Construction Cost: $150,000.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of SPECIAL INSPECTION TO ASSESS DAMAGE CAUSED BY FIRE
Work:
Omer Contractor
ELVIA RUANO PULIDO CLEANING&RESTORATION INC
25640 WHITE ASPEN CIR PMB 427
MENIFEE, CA 92584 27475 YNEZ ROAD
Applicant Phone: 9512969090
KENJOHNSON License Number:710901
,CA
Fee Description QtV Amount(S)
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
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 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 BidgPermit-Template.rpt Page I 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 a I am exempt from licensure under the Contractor's State License Law for
Profmions Code and my license is in full force and effect. the following reason:
License Class '? 1 0 41 D I
res Cj��License No, By my signature below I acknowledge that,except for my personal residence
i Signature
Expi Signature_ I!S�� in which I must have resided for at least one year prior to completion of
'0' L__ 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
kI 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.leginfo.m.goy/calaw.htmi.
Policy# FQLVC70,297 �p Date
)4 have and wfll 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 workees compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
number am: application and the Information I have provided is correct.I agree to comply
carrier with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# P V W C—'749.k S776 Expires 9 1-7 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
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 C BUSINESS LICENSE# .3C�yo
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
IZC)de,I shall fort it in with those provisions. Will the applicant or future building occupant handle hazardous material or a
--,A :�� Date mixture containing a hazardous material equal to or greater that the
pplIcant —IL amounts specified on the Hazardous Materials Information Guide?
WARNING:FAI URETO S UBE WORKER'S COMPENSATION COVERAGE IS a Yes 0
JUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
UNLAWFUL,A SH
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
CONSTRUCrION LENDING AGENCY 0 Yes XNO
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Y
Y
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I hereby affirm that under the pena Ity 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) ci Yes KNo
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 a in exam pt from the lifornia Hea Ith&Safety Code,Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the ha ardous mat ' reporting.
checkmark(s)I have placed next to the applicable itemis)(Section 7031.5 es
Business and Professions Code).Any city or county that requires a permit to 4 Date
construct,alter,improve,demolish or repair any structure,prior to its OW R ORA THORIZED 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 Contractoes State EP ATION,REPAIR AND PAINTING JRRP)
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 ficensure receiving compensation for most work that disturbs paint in a pre-1978
a nd the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certffied firms and comply with
an Applica nt for a permit subjects the applicant to a civil pena Ity of not more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing workthemselves orthrough their
u 1,as owner of the property,or my employee with wages as their sole employees.For mom information about EPA's Renovation Program visit:
compensation,will do I )all of or( )portion of the work,and the structure is www.epe.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 for this project
property who,through employees'or persona I 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 EPA Lead-Safe Certified Firm Is required for this pmject became:
kgQ,r.4
il��U,/
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 your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
r
Aj� e nITe e
DATE PERMIT/PLAN CHECK NUMBER C)4ws
TYPE: 0 COMMERCIAL )KRESIDENTIAL _0 MULTI-FAMILY 0 MOBILE HOME 0_ POOL/SPA SIGN
SUBTYPE: OADDITION OALTERATION ADEMOLITION XELECTRICAL JjrMECHANICAL
ONEW XPLUMBING KRE-ROOF-NUMBEROFSCLUARES
DESCRIPTION OF WORK Al-Ife e6�0A,0_ 7A ao5-j es - hvrve T',
7. /21�411*49
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER do LOT TRACT :Z 0'96'
OWNER NAME JR V A.,V
ADDRESS P164YV CV1417� ��&IV c-j.-z IkI421vi(pyel 0+ elz5gil
PHONE q�5'1- iZ�4 909? EMAIL
APPLICANTNAME A�eV �70AV�f4OV
ADDRESS 17//5715 <f�'tf 6,57— cl>i� 01 1?2-5-9y
PHONE qP- 29-3-47Y61? E MAIL O�da/a el"l ZOA/ j eV le-1-4
CONTRACTOR'S NAME I OWNERBUILDER? OYES)410
13USINESS NAME
ADDRESS11_)q7'5' YWeZ XO q25
PHONE 57/ 2 474- e_70 90 EMAIL
CONTRACTOR'S STATE LIC NUMBER 'T(0 '10 LICENSE CLASSIFICATION
VALUATION L SQ FT
APPLICANT'S SIGNATURE DATE
1 a A—
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE � GREEN SMIP
INVOICE PAIDAMOUNT
AMOUNT I 1 0 CASH 0 CHECK# OCREDITCARD ViSA/MC
PLAN C,ECK H." PAIDAMOUNT I I OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LE17ER 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
MLLA