PMT16-04259 OFF
City of Menifee Permit No.: PMT16-04259
29714 HAUN RD. Type: Mobile Home
'5ACCIECA-> MENIFEE,CA92586
MENIFEE Date Issued: 0310312017
P E R M I T
Site Addiess: 32525 BRADLEY RD,MENIFEE,CA Parcel Number: 360-340-002
92584 Construction Cost: $10,000.00
Existing Use: Proposed Use:
Description of INSTALL MOBILE HOME AS SECOND UNIT
Work:
Owner Contractor
JEREMIAH RAXTER GREAT OAKS ENTERPRISES INC
32525 BRADLEY ROAD P 0 BOX 391300
MENIFEE, CA 92584 ANIZA, CA 92539
Applicant Phone:9517634009
JAMES SHERIDAN License Number:885346
GREAT OAKS ENTERPRISES INC
P 0 BOX 391306
ANZA, CA 92539
Phone:9518342035
Fee Description QtV Amount
Manufactured Install 1 240.72
Permit Fee 1 27.00
$267.72
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.
CONDITIONS
Condition Comment
1 OUTSTANDING PLNG FEES
AA�_Bldg_Perrnit-Templatexpt Page I of 1
CITY Cl� MENIFEE
LICENSED DECLARATION propertywho builds or improves thereon,and who contracts for the projects
I herebyaffirm under penalty of perjurythat I am underpicivisions of with a licensed contmctor(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 Clam—/�-I License No et_s.5 ell. By my signature below I acknowledge that,except for my personal residence
Expires JOAZI in which I must have resided for at least one year prior to completion of
- T-7 1,V— Signatur All improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATIOI tgr� have built as an owner-builder if it has not been constructed in its entirely by
o 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 workees 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.legmfo.ca.gov/calaw.htmI.
Policy# Date
ci I have and will maintain workees 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 workees compensation insurance carrier and policy owner or authorized to act on 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 relating to
building construction.I authorize representatives of this city or county to
Policy# Expires 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
",e fy that In the performance of the work for which this permit is Issued, 17 n
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# 0
worker's compensation laws of California,and agree that if I should become
subject to the worker's compensation provisions of Section 3700 of the Labor HAZARDOUS MATERIAL DECLARATION
Code,I shall forthwit:h 7coVpb those provisions. Will the applicant or future building occupant handle hazardous material or a
API)Ilcant Date 3-S-)-7 mixture containing a hazardous material equal to or greater that the
amounts spec':ed on the Hazardous Materials Information Guide?
WARNING:&I I R SECURE-WORKER'S COMPENSATION COVERAGE IS 0 Yes ;;fic'
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future build Ing
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South
IN SECTION 3706 OF THE LABOR CODE,INTEREST�AND ATTORNEYS FEES CoastAi.r Quality Management District(SCAQMD)?See permitting checklist
for guidelines
CONSTRUCTION LENDING AGENCY o Yes 2_16�
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) n Yes a-M-6
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 permitring checklist.I understand my requirements under the State of
Contractor's License Law for the reason(s)indicated below by the California Health&SafeAy Code,Section 5505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 azar usmatelal p ing.
a No
Businessand Professions Code).Any city or county that requires a permitto s jt'�t
construct,alter,improve,demolish or repair any structure,prior to its MOPE TY OWNER OR AUTHORIZED AGENT Date
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 F=-�--11-110N.REPAIR AND PAINTING IRRP
License Law JChapter 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 residence or childcare facility to be RRP-certified firms and comply with
an Applicant for a permit 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 propeft or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do I )all of or( )portion of the work,and the structure is www.epa.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 a An EPA Lead-Safe Certified Renovator will be responsible forthis 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, o No EPA Lead-Safe Certified Firm is required forthis project because:
ci 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contmactor'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 I
Wen'fee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL ORESIDENTIAL OMULTI-FAMILY elgO-BILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRiCAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK :1�-SrACC� CWAt—VFACrVzsz)
PROJECTADDRESS —5zsz,-�, i5 R014D
ASSESSOR'S PARCEL NUMBER LOT TRACT
"'y
OWNER NAME BuIldi,I'1"=,0,
, -e
ADDRESS 2D nn.�
PHONE (9,ef V-2-0 3 s— EMAIL RD, 4 U LUJU
APPLICANITNAME 5;Hirelnq^�, Received—
ADDRESS ?Q, 'j�o-,c 3�1(3o L *z(,\-, r-,4 -
PHONE (7SI) S-*3y- ?,D3 5- EMAIL
CONTRACTOWS NAME ECM:r AJ& OWNER BUILDER? 0 YES O�
BUSINESS NAME
ADDRESS vio Sri (3 0 6 /&oj M, C4-
PHONE 9-7
2,() EMAIL
CONTRACTOR'S STATE LIC NUMBER &9S3LfG LICENSE CLASSIFICATION
VALUATION$ 10,0W n Aii SO.FT /,!5"1 Z- L SO FT
APPLICANT'S SIGNATURE DATE I-Z -2-0
1 � I , .1
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP
INVOICE I PAID AMOUNT
AMOUNT I I OCASH OCHECK# 0 CREDIT CARD VISAIMC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECKN 0 CREDIT CARD VISAIMC
A/ML
[OWNER BUILDER VERIFIED 0 YES 0 No DLNUMBER NOTARIZED LEITER 0 YES 0 N�O�_
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
County of Riverside
DEPARTMENT OF ENVIRONMENTAL HEALTH
www.rivcoeh.org
ff LAND USE APPLICATION
OFFICE USE ONLY
PE CORC FEE:
3880 Lemon Street-Suite 200-Riverside-CA-92501-(951)955-8980 ISO, 62-2 ZI 0
El 47-950 Arabia Street-Suite A-Indio CA 92201-(760)863-7570 V&P, � —
-EFHS ON# 1 ! LMS I �, C1 APN:
E,
TIRF
LOT 4
LOT# 2, _Cj
TRIPM ' 'j-'E OF�'Ee
%,fly UT F
SECTION A
Name
OWNER: Address lcz� 52ADI'- city -gk3
Phone
CompanyName L�'z A nt/Contractor
AGENT/ Ci zip 2539
CONTRACTOR: Mailing Address �3cll300
Phone 3
Email --Tz-i
Site Address 2. 62,S' 12'Z�41
PROPERTY INFO: . 1/1
Water A encYfWell V,2- 'A �— ;-
DATE:
APPLICANTS SIGNATURE:
SECTION 6 Below-For Office Use Only
CHECK BOX IF REQUIRED
if any boxis checked,this a ication shall be considered denied unfit the i imation is rovlded�
Floor Plan andfor Plumbing Layout Required
El Holding Tank Agreements Kequimu 0 Special Feasibility Boring Report Required
[]Certificate of Existing OWTS Required(C-42) 0 Detailed Contour Plot Plan Required(11 to 5 foot intervals)
0 WQCB Clearance Required 7,
mtolls Percolation Re It uired
SITE ECT REMARKS:
EVALUATION INS
E,IS 1411TALS/DATE: VO,
SE 10 C W BDIRMS#
-�T Tr ITS
t3-NEW 0 REPAIR I REP 'STING 171 PUMP
S'ils Percolation/Boring Report By:,
Date: Ucense# 7
C-42 Certifica"On By: Tested Depth: Max. trench depth:
Septic tank cap.:: Soil Rate*.,
I Line(s)'.
!t'Ft o rea:: Total Linear Ft:
-F
�W; �gl,plssflc Chambers
Sq.ft.Running foct Rock below drmain line: in. or
Sidewall Allowance; Ft.Rock/
Leach Linesibed special design for slope: 11 MIA 0 Overburden Factor. Pit Total D th::: Max ilowable depth:
Pit Diameter No.pits: Depth below inlet(bi):
CONSTRUCTIO NSTALLATION RtMAKNO:
SECTION D OWTS as indicated on the accompanied plot plan using the requirements set forth in
This Application is IS Approved Li Denied regarding the design of the�
Section C above.6 construction is permitted in the required rese.-,ld 100%Expansion area. Date:
-ERSSIgnature:
�,YELLOW-Mdg.MPL P1W-APP11=t
EPO42(REV 7116)
V,)?-[( I�VAJJ)ot�kot-L MUSk bp raA,41' U'u. PAOV- 4D zc�vvn_�
County of Riverside
DEPARTMENT OF ENVIRONMENTAL HEALTH
www.rivcoeh.org
OWTS INSPECTION CARD
APN: 360 340 - 002- ON No.: so,[(
0 EHS No.: I 6c) 86L4
SiteAddress: 3oq5AS 'BT�adtw , rzoma( , M,01A 1-pp-e—
To Schedule anqnspection Please Call (951) 955-8980
CWTS Components Date Re-inspection Inspector
�pticT n� of Inspection Date Initials—
SeptiGT-aRk_�nrnent
_Swmer-�I
Final lnspdT�
TO BEPOSTED A TJOBSITEINPLAIN VIEW
EPO-54(REV 9/Z)
Government Code 27361.7
1 Certify Under Penalty of Pedury That The Notary Seal
On The Document To Which This Statement is Attached
Reads As Follows:
Name of Notary: -RE� Zz- e A )
Commission No:
Date Commission Expires:
County:
By
Date:
1111111111111111111 IN 2 of 2
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