PMT16-04116 City of Menifee Permit No.: PMT16-04116
29714 HAUN RD. Type: Residential Alteration
<A-CCECA-> MENIFEE,CA 92586
MENIFEE Date Issued: 02/23/2017
PERMIT
Site Address: 26945 PINEHURST RD, MENIFEE, CA Parcel Number: 338-061-006
92585 Construction Cost: $15,642.13
Existing Use: 1 &2 Family Residence Proposed Use:
Description of CONVERT EXISTING CARPORT TO GARAGE 361 SO FT
Work:
Owner Contractor
LAURA CLOUGH MNT CONSTRUCTION
26945 PINE HURST RD 1120 WEST 9TH STREET
MENIFEE,CA 92586 UPLAND,CA 91786
Applicant Phone:9099315280
KEN JOHNSON License Number: 1018529
MNT CONSTRUCTION
1120 WEST 9TH STREET
UPLAND, CA 91786
Fee Description QtY Amount($
Receptacle, Switch, Outlet&Fixture 4 131.00
Building Permit Issuance 1 27.00
Inspections not specified 387 387.21
Additional Plan Review Building 570 569.95
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 3.00
New Construction Permit Fee 1 71.95
General Plan Maintenance Fee-New 1 3.60
Construction
$1,194.71
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of en-ors in the plans and
specifications or from preventing builiding operations being carded 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 construclion 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 Ternplaterpt Page I of 1
CITY OF IVIENIFEE
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
Professions Code and my license is in full force and effect. the following reason:
License Class 13 License No. -5 7- By my signature below I acknowledge that,except for my personal residence
Expires 67- 3 0 2 49 4 Signature—A"/ in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I
have built as an owner-builder if it has not been constructed in its entirety by
ri 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.leginfo.ca.gov/calaw.litmi.
Policy# Date
ave and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHOR17ED 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 5`�1_4 r-e F-(,,J with all applicable city and county ordinances and state laws relatingto
building construction.I authorize representatives of this city or county to
enter the above identified property for inspection purposes.
Policy# 3 Expires /0//, 12L
(This section need not to he completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
Q I certify that in the performance of the work for which this permit is issued,
I 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 watter's compens rovisions of Section 3700 of the Labo,
Code,I shall, wit omplywit"I
ose provisions. Will the applicant or future building occupant handle hazardous material or a
/1 mixture containing a hazardous material equal to or grearterthat the
Applicam�A/ Date 2 o-1 7 amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO�ElffURE WDRKER'S COMPENSATION COVERAGE IS o Yes No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000 Will the intended use of the building by the applicant or future building
I,IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR fity Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Qua
for guidelines
CONSTRUCTION LENDING AGENCY ci Yes A�o
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 IIIRO
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractor's License Law for the reason(s)indicated below by the California H fetV Section 25505 and 25534 concerning
H
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 h !,darda',it"S". ic,
Business and Professions Code).Any city or county that requires a permit to e
construct,alter,improve,demolish or repair any structure,prior to its 5K Data- 23— 7
issuance,also requires the applicant for the permitto file a signed statement PROPERTY OWNWOR AUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING IRRPI
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
and the basis for the alleged exemption.Any violation of Section 7031.5 by receiving compensation for most work that disturbs paint in a pre-1978
an Applicant for a permit subjects the applicant to a civil penalty of not more residence or childcare facility to be RRP-certified firms and comply with
than($500). required practices.This includes rental property owners and property
managers who do the paint-disturbing work themselves or through their
a 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 I all of or( )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 70",Business and Professions 1-800-424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a
property who,through employees'or personal effort,builds or improves the ci An EPA Lead-Safe Certified Renovator will be responsible for this project
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 itwas
not built or improved for the purpose of sale. o No EPA Lead-Safe Certified Firm Is required for this project because:
ci 1,as owner of the property am exclusively contracting with licensed
contractors to constnuct 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 It
Li
Menifee
DATE 7- - 7-3 - 2-o 17 PERMIT/PLAN CHECK NUMBER -PH-11to- 04II(o
TYPE: OCOMMERCIAL JLRESIDENTIAL OMULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION kALTERATION ODEMOLITION OELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK -e-A., c 10 5- A w- I�Aa e�+Kao
PROJECTADDRESS V-5 T'A/ e�'op_s-r Ak It,
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNERNAME Ltlll,4 c
ADDRESS 2,
. q 9 -5 1,v eAl 0-12-F
PHONE Clfl- 30 ? - IF 2 ,9 EMAIL
APPLICANT NAME REck 69/�_0
ADDRESS (/ 20 w , c174 T C)f(,f 61 cf( 7&,�
PHONE (Yoq - '� 3/- .52-eO EMAIL -To �A,�
CONTRACTOR'S NAME /1��- 4(-1044 c OWNERBUILD 0YESjKNO
BUSINESS NAME .72kc- :,DO(1- /l/e kJ A QAr (_
ADDRESS /I ZO IV, q7_4 �;_r Cle 4�
PHONE EMAIL
CONTRACTOR S STATE LIC NUMBER 0 5 2- Cl LICENSE CLASSIFICATION
VALUATION $ 6? ,:�2 L SO FT
SO FT
APPLICANT'S SIGNATURE DATEZ , 23- 2 ol �7
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS UOLNSL NUMBhK
BUILDING PLANNING ENGINEERING FIRE � GREEN SMIP I
INVOICE PAID AMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
AMOUNT I I
PLAN CHECK FEES PAID AMOUNT I I OCASH OCHECK# 0OREDITCARD VISA/MC
I OWNER BUILDER VERIFIED OYES C' No DLNUMBER NOTARIZED LE17ER 0 YES 0 NO
City Of Mellifee BUilding& Safety Department 2.9714 HOLin Rd. Menifee. CA 92586 951-672-6777
vvwuv.dtyoj'menrfee.us Inspection Request Line 951-246-5213