PMT16-04360 City of Menifee Permit No.: PMT1 6-04360
29714 HAUN RD. Type: Residential Plumbing
'(7�CCIELA—> MENIFEE, CA 92586
MENIFEE Date Issued: 12127/2016
P E R M I T
Site Address: 23582 LA BERTHA LN, MENIFEE,CA parcel Number: 350-233-042
92587 Construction Cost: $5,000.00
Existing Use: Proposed Use:
Description of REPLACE LEACH LINES, EHS APPROVED
Work:
Owner Contractor
ROBERTO AYALA LE PEW INDUSTRIAL INC
23582 LA BERTHA LANE 41735 ELM STREET#303
MENIFEE, CA 92587 MURRIETA, CA 92562
Applicant Phone:8889615971
DAN BROWN License Number:988020
LE PEW INDUSTRIAL INC
41735 ELM STREET#303
MURRIETA, CA 92562
Fee Description City Amount 1$1
Sewer 1 150.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 7.50
$185.60
The issuance of this permit shall not prevent the building official from thereafter requidng the correction of emors 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 Menifea.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.Bidg_Permit—Template.rpt Page 1 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 contractoqs)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and o 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 e_-q,;I License No. il�t&;-c> By my signature below I acknowledge that,except for my personal residence
Expires ((211:7 SignatureA In which I must have resided for at least one year prior to completion of
improvements covered bythispermit.I cannot legally sell astructurethati
WORKERS COMPENSATIO 4 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 70"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.Ieg!nfo.ca.gov/caIaw.htmI.
Policy# 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 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($200)or less PROPERTY OWNER OR AUTHORIZED AGENT
O'l�certlfy that In the performance of the work for which this pennit is issued,
Ishallnotemplo any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
workrees compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to tfid_v�qrker'sAompensation provisions of Section 3700 of the Labor
C forl Wh those provisions. Will the applicant or future building occupant handle hazardous material or a
A Date mixture containing a hazardous material equal to or greaterthat the
� le — (-2-—X2— amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS a Yes ci No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant orfulture building
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 Coast Air Quality Management District(SCAQMD)?See permitting checklist
for guidelines
CONSTRUCTION LENDING AGENCY ciYes ciNo
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) ci Yes ci 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 ci No Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED AGENT
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 EPA RENOVATION,REPAIR AND PAINTING(RRP1
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 com ply 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 sole employees.For more information about EPA!s Renovation Program visit:
compensation,vvill do( )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 7044,Business and Professions 1-800-424-LEAD(5323).
Cocle;The Contractor's State License Law does not apply to an owner of a ci An EPA Lead-Safe Certified Renovator will be responsible forthis project
property who,through employees'or personal effortj 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 for this project because:
u 1,as owner of the property am exclusively contracting with licensed
contractors to constma the project(Section 7044,Business and Professions
Co cle: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.
7:
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
A
�'�`Menifee
DATE 1'2 _2.�_7- PERMIT/PLAN CHECK NUMBER
TYPE: 0 COMMERCIAL e-ITESIDENTIAL 0 MULTI-FAMILY -0 MOBILE HOME 0_ POOL/SPA 0 SIGN
SUBTYPE: OADDITION CIALTERATION ODEMOLITION 0ELECTRICAL OMECHANICAL
ONEW Go-PTUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Lezz,,& Lv,�
PROJECTADDRESS (-C, T2
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(;Ity Ot Mel Ifee
ASSESSOR'S PARCEL NUMBER -2- LOT TRACT BuildIng & Sak ty Dept.
OWNERNAME DEC 2 Z !016
ADDRESS 9 cl
PHONE EMAIL
APPLICANTNAME I v�/ 4�III
ADDRESS <J_ 4�1
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PHONE EMAIL e—A&,vi Q__ 1_,) � t1d LJ< 'r r h�
CONTRACTOR'S NAME OWNER BUILDER? 0 YES-JgpNO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION c
VALUATION$ SOL FT L SQ FT
LAO DATE
CITY STAFF USE ONLY _w
DEPARTMENT DISTRIBUTION � LIIYU�PAENIFEEBUSINLbSLILLNSLNUMLiEK
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE � \.55.050 PAID AMOUNT
AMOUNT � \Z5.1!56 0 CASH ()CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT Or-ASH OCHECK# OCREDITCARD VISA/MC
I OWNER BUILDER VERIFIED OYES __' NO DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Sofety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-6777
WWW.City0fMenifee.LIS Inspection Request Line 951-246-6213
r A /
AM
Roberto & Crystal Ayala City of Menifee
APN #350-223-042 Building & SaI9ty Dept.
Lic.#C42-9 88020 23582 La Bertha Lane, Menifee, CA 92587-8969 DEC 2 7 2016
Received
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BUILDING, AND SAFETY
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REVIEWEDBY —JJ-OL--Aa)PnVD��AtE
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regulations and or 1&81105-This set of approved pWdffPA be &4CA-\ tL,\
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888.961.5971 1 41735 Elm Street, Suite 303 Murrieta, CA92562 I www.lepewindustrial.com
OitY of manifee
ISUilding & Safety Dept.
DEC 2 7 2016 CL
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