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PMT17-00017 City of Menifee Permit No.: PMT17-00017 29714 HAUN RD. Type: Residential Addition �I-►CCEL/-> MENIFEE, CA 92586 MENIFEE Date Issued: 01/0 412 01 7 PERMIT Site Address: 25040 SHERMAN RD, MENIFEE, CA Parcel Number: 329-270-013 92585 Construction Cost: $3,000.00 Existing Use: 1 &2 Family Residence Proposed Use: Description of CONSTRUCT 5'X 120 L FT CITY STANDARD WALL 3' BLOCK W/2'WROUGHT IRON&5 PILASTERS Work: W/ELECTRICAL,4 LIGHTS, ROLLING GATE 5'GATE X 10 L FT Owner Contractor JOSE SEVILLA 25040 SHERMAN RD MENIFEE, CA 92585 Applicant License Number: JOSE SEVILLA 25040 SHERMAN RD MENIFEE, CA 92585 Phone:7144867638 Fee Description ,gyt Amount(S) Receptacle, Switch,Outlet&Fixture 4 131.00 Building Permit Issuance 1 27.00 Wall/Fence,standard 1 83.00 GREEN FEE 1 1.00 SMIP RESIDENTIAL 1 1.00 General Plan Maintenance Fee-Building 1 4.15 General Plan Maintenance Fee-Electrical 1 6.55 $253.70 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_Perm@_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 contractor(s)pursuant to the Contractors State License Law). Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contractors State License Law for Professions Code and my license is in full force and effect. the fallowing 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 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 ❑I hereby affirm under penalty of perjury one of the following declarations:) 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 www.leginfo.ca.gov/calaw.html. this permit is issued. Policy tJ Date ❑I have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT section 3700 of the Labor Code,for the performance of the work for which ❑By my signature below I certify to each of the following:I am the property this permit is issued.My workers compensation insurance carder and policy owner or authorized to act on the property owners 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 Jt Expires enter the above identified prope for inspection purposes. (This section need not to be completed is the permit is for one-hundred Date dollars($100)or less PROPEIRTY OWNER OR AUTHORIZED AGENT ❑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 subjectto the CITY BUSINESS LICENSE Jf workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the workers compensation provisions of Section 3700 of the Labor Code,1 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 that the �t amounts spe Mad on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS a'�es No UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Willtheintended use of the building by the applicant or future building AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permitfor the construction or modification from South ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines CONSTRUCTION LENDING AGENCY ❑Yes A'ho 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) ❑Yes .e ho 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 Contractors 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 permitto ,- as >* :T5 Date construct,alter,improve,demolish or repair any structure,prior to its PROPERTY TIER OR AUTHORIZED AGENT issuance,also requires the applicant far the permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING(FIRM 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 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 ❑I,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( )portion of the work,and the structure is www.eva.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 Contractors State License Law does not apply to an owner of a ❑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. ❑No EPA Lead-Safe Certified Firm is required for this project because: o I,as owner of the property am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractors 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. BUILDINGUP APPLICATION 4"Men fee DATE 01/04/2016 PERMIT/PLAN CHECK NUMBER 1 TYPE: ❑COMMERCIAL ❑✓ RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME EIPOOLISPA ❑SIGN SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION ,❑ELECTRICAL ❑MECHANICAL ❑NEW [—]PLUMBING ❑RE-ROOF-NUMBEROFSOUARES DESCRIPTION OF WORK Install 3' masonary block front yard wall with 5' pillards PROJECTADDRESS 25040 Sherman Road ASSESSOR'SPARCELNUMBER 329-2704'b LOT 2 TRACT 916042 PROPERTY OWNER'S NAME Jose Sevilla ADDRESS 25040 Sherman Road PHONE (714)486-7638 EMAIL sevillal@me.com APPLICANT NAME Jose Sevilla ADDRESS @5040 Sherman Road PHONE (714)486-7638 EMAIL sevillal@me.com CONTRACTOR'S NAME Gabriel Hernandez OWNER BUILDER? ❑YESQNO BUSINESS NAME California Construction&Reglaze Inc.. ADDRESS PHONE (714)486-7638 EMAIL sevillal@me.com CONTRACTOR'S STATE LIC NUMBER 917827 LICENSE CLASSIFICATION B C54 C61/D12 VALUATION$ $3,000.00 SO FT 400 L SO FT APPLICANT'SSJGNATUME DATE 01104/2016 CITY STAFF USE ONLY DEPARTMENT MSTRV9UMN CVTY OP MEW"susmvss LICENSE NLIMRER BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP INVOICE O PAID AMOUNT AMOUNT 3i 0 CASH O CHECK k O CREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT pcav+ G ,,,CKa OcevATCARD VVSA(Mc OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO City of Menif e Building&Safety Deportment 29714 Houn Pd. Nfenlfec, CA 92586951-672-6777 www.citvofinenifee.us Inspection Request Line 951-246-6213