PMT16-04018 City of Menifee Permit No.: PMT16-04018
29714 HALIN RD. Type: Residential Alteration
<A—CCELA> MENIFEE,CA 92586
MENIFEE Date Issued: 02116/2017
P E R M I T
Site Address: 27200 HOLLAND RD, MENIFEE, CA Parcel Number: 360-120-012
92584 Construction Cost; $16,559.40
Existing Use: I &2 Family Residence Proposed Use:
Description of CONVERT EXISTING GARAGE&PATIO COVER TO CONDITIONED SPACE 780 SCI FT
Work:
Owner Contractor
RAY&YVONEE MONTENEGRO
27200 HOLLAND RD
MENIFEE, CA 92584
Applicant License Number.
RAY&YVONEE MONTENEGRO
27200 HOLLAND RD
MENIFEE, CA 92584
Phone: 9512190857
Fee Description Qtv Amount
Receptacle,Switch,Outlet&Fixture 5 136.00
Air Handling/Condensing Units SFR 1 133.00
Building Permit Issuance 1 27.00
Inspections not specified 258 258.14
Additional Plan Review Building 148 148.37
Additional Plan Review Building 74 74.18
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 300
New Construction Permit Fee 1 76.17
General Plan Maintenance Fee-Building 1 12.91
General Plan Maintenance Fee-Mechanical 1 6-65
General Plan Maintenance Fee-Electrical 1 6.80
General Plan Maintenance Fee-New 1 3.81
Construction
$887.03
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 Bldg_Pemit-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).
ChapterEl(commencing with section 7000)of Division 3 of the Business and 41 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. 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 priorto completion of
improvements covered by this permit.I cannot legallysell 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,loued 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,fo r the performance of work for which
this permit is issued. www.leginfo.ca.gov/calaw.html.
Policy If 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 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 ownees behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
Carrier with all applk:abi C dcountyoprdi nces and state laws relating to
c
building constr u ti. I th rize representatives of this city or county to
Policy# Expires enterth"bov Ide ifi dp erty for inspection purposes.
(This section need not to be completed is the permit is for one-hundred 1/4,411, -2--iLlb
I Date
dollars($100)or less PROPCIRTY OMaROR�—ALIT�O�IZEO TAGENT
ci I certifythat in the performance of the worliforwhich this permit is issued,
Ishallnotemplo any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's compensation of California,and agree that if I should become HAZARDOUS MATERIAL DE RATION
nw �f
subject to the worker's om atio r visions of Section 3700 of the Labor
Code,I shall om I Isions Will the applicant or future u Iding occupant handle hazardous material cra
mixture containing I s material equal to or greater that the
Applicant �0 //*Date 1.
_'k—I amounts specified c 3 rdous Materials Information Guide?
WARNING:FAILUR OTOSQU� KERSCOMPENSATION COVERAGE IS a Yes Vo
K'
UNLAWFUL, LL % MPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
P
AND CIVIL Fil I_JRTHOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
-.N
ADDITION TC N TION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidel' es
CONSTRUCTION LENDING AGENCY o Yes Z G
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 b diary of a school?
(Section 3097 Civil Code) ci Yes ZrN'.
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&Sa ty ode,Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the hazardou! P I
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 dyes
Business and Professions Code).Any city or county that requires a permit:to 5P
1� Datec--216
Z9, A
construct,alter,improve,demolish or repair any structure,prior to its OPER 0 Ti III ZfEhT
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 Contractor's State EPARENOVATIO REPAIR 10 PAINTING RAP
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repaii nd Painting(RRP)Rule requires contractors
Busine,ss and Professions Code)or that he or she Is exempt from licensure receiving ost work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence to be RRP-certlfied firms and comply with
an Applicant for a penmit 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
ci 1,as owner of the property,or my employee with wages as their sole employee,s.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.epa.noy/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 c;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. ad-SafeceMFirm required for this project because:
ci 1,as owner of the property am exclusively contracting with licensed I
contractors to construct the project(Section 7044,Business and Professions N fyvm 10
Code:The Contractoes State License Law does not apply to an owner of a If your project dc��snot comply wVh TIP rule please fill out the RRP
Acknowledgement.
BOTLI)IMIG & SAFETY PERMIT/PLAN CHECK APPLICATION
"Menife 'ce Copy
Offl
DATE PERMIT/PLAN CHECK NUMBER 1�mb_ 0"I'MIS
TYPE: 0 COMMERCIAL 0 RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA 0 SIGN
SUBTYPE: OADDITION VALTERATION C)DEMOUTION OELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK _00d\qw-� Q�Ovqcke_
j v
PROJECTADDRESS e�-Izx VW�ltanet
ASSESSOR'S PARCEL NUMBER '360 '— [";,�0 —0�� LOT LA TRACT
OWNER NAME Af mar)�L) Pmr,
ADDRESS
PHONE EMAIL
APPLICANT NAME �J-VoAvve-
ADDRESS _�_�J �Op 4APII&R(A V_ Ila,
PHONE EMAIL kA6J—Wt�L 0
4aU FOLM',11 C�\)� ND),
CONTRACTOR'S NAME OWNER BUILDER? [JYES ONCI
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ 300to, 00 SO FT :2�e 6065 L SQ FT
I APPLICANT'S SIGNATURE &A md—lan DATE III ('GJ0
i
I OTYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION SM CITY UF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN IP
INVOICE PAIDAMOUNT
AMOUNT I I OCASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT I I OCASH OCHECK# OCREDITCARD VISA/MC_
OWNER BUILDER VERIFIED 0 YES 0 NO DLNUMBER NOTARIZED LEITER 0 YES 0 NO
City of Menifee Building& Safety Department 29714 HGUn Rd. Menifee, CA 92586 951-672-6777
www.citVofmenifee.us Inspection Request Line 951-245-6213
To whom it may concern. ission to Ray Montenegro and Ivonne Montenegro to alter,
1, Armando Elenes authorize/ grant perm ence located at 27200 Holland Rd in Menifee,
modify, repair, construct, and make additions to the resid
California, Montenegro to apply or
1,Armando Elenes authorize/ grant permission to Ray Montenegro and Ivonne and
request permits with the City, County or State for the above. I also authorize them to apply for
operate a large child care center at 27200 Holland Rd in Menifee, california.
Ray Montenegro and Ivonne Montenegro are purchasing the above mentioned property from me,
Armando Elenes.
city of menifee
Building & Safety Dept.
OEC 0 9 201�
ee aftached CA AcknOwledgment
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
of that do
document to which this certificate is attached,and not the truthfulness,accuracy,or validity*cument.
State of California
County Of Melissa Rodriguez,NotarY Public
On f-j2b_�_ before me,
Date Here Insert Name and Title of the Officer
personally appeared < VhV;eAe5 -
Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are
subscribed to the within Instrument and acknowledged to me that he/she/they executed the same in
his/her/their authorized capacity(les), and that by his/her/their signature(s)on the instrument the person(s),
or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph
is true and correct.
WITNESS my hand and official seal.
Signature
IEUSSA RODRIGUEZ
Comm #2000128 Signature of Notary Pabllc(�
TARYPUEuc;-cAuFoRIl0A
IMPERALCOUNN
My Comm.FNdrm JanuaiY3.EDIT
Place Notary Seat Above
OPTiONAL.
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document:42n�-:�b .. Docurnent Date:
Number of Pages: Signer(s) Other Than Named Above:
Capacityries) Claimed by Signer(s)
Signer's Name: Signer's Name:
•Corporate Officer — Title(s): El Corporate Officer — Title(s):
• Partner — 0 Limited 0 General 0 Partner — 0 Limited 0 General
• Individual 0 Attorney in Fact 0 Individual 0 Attorney in Fact
•Trustee 0 Guardian or Conservator 0 Trustee 0 Guardian or Conservator
El Other: 0 Other:
Signer Is Representing: Signer Is Representing:
@2014 National Notary Association - www.Nationa]Notary.org - 1-800-US NOTARY(1-800-876-6827) Item#5907