PMT16-04238 City of Menifee Permit No.: PMT16-04238
29714 HAUN RD. Type: Residential Alteration
<A-CCELA—> MENIFEE, CA92586
MENIFEE Date Issued: 1211912016
P E R M I T
Site Address: 25025 RUFFIAN RD, MENIFEE,CA 92585 Parcel Number: 330-180-037
Construction Cost: $0.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of CODE CASE CE13-0921 SPECIAL INSPECTION TO VERIFY UNPERMITTED STRUCTURE&SHED
Work: HAVE BEEN REMOVED
Owner Contractor
ALEJANDRO&MARIA L MENDOZA
25025 RUFFIAN RD
MENIFEE, CA 92585
Applicant License Number
ALEJANDRO&MARIA L MENDOZA
25025 RUFFIAN RD
MENIFEE, CA 92585
Phone:7602729045
Fee Description 2-q Amount($I
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 canted 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.Gidg--Permit Ternplate.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION propertVwho builds or improves thereon,and who contracts forthe 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 ci I am exempt from licensure under the Contractoes 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 p rior to completion of
WORKER'S COMPENSATION DECLARATION im P rovements covered by this permit.I ca nnot legally sell a structu re that I
have built as an owner-builder if it has not been constructed in Its entirety by
c 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 forworker'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.html.
Policy It 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 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 an the property owner's behalf.I have read this
number are: application and the Information I have provided is correct.I agree to comply
Carrier with all applicable city and county ordinances and state laws rel2ting to
building construction.I authorize representatives of this city or county to
Policy# Expires enter;he above identi ed property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred
dollars($100)or less I_M\� �Ul'��A�,— Date
o I certify that in the performance of the workforwhich this permit is issued, 7ROPERTY OWNER OFI`AUTHORIZE�AGENT
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 worker's compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date mixture containing a hazardous material equal to or greater thatthe
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 o Yes o No
UNLAWFUL,AND SHALL SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupa
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR nt require a permitfor the construction or modification from South
IN SECrION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)?See permitting checklist
for guidelines
CONSTRUCrION LENDING AGENCY o 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
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 Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material reporting.
Business and Professions Code).Any city or county that requires a permit to oYes o No
construct,alter,improve,demolish or repair any structure,prior to Its —Date
issuance,also requires the applicantforthe permitto file a signed statement PROPERTY OWNEROR AUTHORIZEDAGENT
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRP)
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 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
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 orthrough their
o 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( )all of or( I 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 7044,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 u 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.It 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. n 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
Menifee
DATE )1 01 PERMIT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL ORESIDENTIAL 0MULTI-FAMILY OMOBILEHOME 10POOL/SPA OSIGN
SUBTYPE: OADDITION 0ALTERATION 0DEMOUTION OELECTRICAL OMECHANICAL
CNEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNERNAME a� co L - H,0 Ind=
ADDRESS '25()'ZS �-C
PHONE EMAILM I-merl, jq y i?,-(:ff) , ne
APPLICANT Q(MOEO) 2n OL—cl 0
ADDRESS
PHONE EMAIL
CONTRACrOR'S NAME OWNERBUILDER? OYESONO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
I VALUATION$ SO FT L SQ FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
1NVOICE—J—
I 1�.0 PAID AMOUNT 0 CASH 0 CHECK# OCREDITCARD VISA/MC
AMOU T CASH
PAIDAMOUNT CASH 0 CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES DAmOuNT 0 CAS
7 PAA1,F H
OWNER BUILDER VERIFIED 0 YES 0 NO DL NUMBER NOTARIZED LETTER 0 YES
City of Menifee Building& Safety DepOrtn7ent 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-245-6213