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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