PMT17-00034 City of Menifee Permit No.: PMT17-00034
29714 HAUN RD. Type: Residential Alteration
�ACCELX. MENIFEE, CA 92586
MENIFEE Date Issued:
01/05/2017
PERMIT
Site Address: 29900 CAMINO CRISTAL,MENIFEE, CA Parcel Number: 340-082-010
92584 construction Cost: $1,500.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of RELOCATE EXISTING SHOWER DRAIN, INSTALL NEW CEILING FAN/LIGHT, RELOCATE DIRTY
Work: ARM FOR SINK DRAIN, INSTALL NEW SHOWER VALVE
Owner Contractor
THOMAS DELLIBAC A A A RESTORATION INC
29900 CAMINO CRISTAL 29850 2ND STREET
MENIFEE,CA 92584 LAKE ELSINORE,CA 92532-2420
Applicant Phone:9514715828
LANCE REMINGTON License Number. 834839
A A A RESTORATION INC
29850 2ND STREET
LAKE ELSINORE, CA
Fee Description Oty Amount($1
Receptacle, Switch,Outlet&Fixture 1 116.00
Plumbing Fixtures and Vents, fixtures 3 116.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 5.80
$266.80
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 staled,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'n_Templale.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 following reason:
License Class J C��C-✓! UceAnsg.No. By my signature below I acknowledge that,except for my personal residence
Expires 3/ :20/ ignaturP/l in which I must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATION 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: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 workers 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 ,,vww ww.leginfo.ca.gov/calaw.html.permit is issued.
Policy It Date
❑I have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 ofthe 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 carrier and policy owner or authorized to act on the property owners behalf.I have read this
number arsC�GS e: application and the information I have provided is correct.I agree to comply
Q�`S�5�t�D with all applicable city and county ordinances and state laws relating to
Cartier �S
/5 building construction.I authorize representatives of this city or county to
Policy# �StX��ro`'T 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
❑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#
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,I shall forthwi comply i h those provisions. Will the applicant or future building occupant handle hazardous material or a
Zl'+f 7 mixture containing a hazardous material equal to or greater that the
Applica Date amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SEC RE WORKER'S COMPENSATION COVERAGE IS ❑Yes XNo
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN Will the Intended use of the building by the applicant or future building
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
forguidelines
CONSTRUCTION LENDING AGENCY ❑Yes ,dNo
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 y(No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of -
I hereby affirm under penalty of perjury that I am exempt from the
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
hazardous mate'al reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 yes ❑
Business and Professions Code).Any city or county that requires a permit to Date ' Zo17
construct,alter,improve,demolish or repair any structure,prior to its 6P96PERTY OWNER OR A R(ZED 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 Contractors 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 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 orthrough 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 pr( )portion of the work,and the structure is www.epa.eov/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).
Cade;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:
❑1,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 RAP
Acknowledgement..
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
MIMI
Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL 'RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION VELECTRICAL O MECHANICAL
O NEW X PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Mbi1 e— m d Jcz_- /kTevt '�07-
51AYL ct: rt CAA 4n �A L.�S�fi � 5
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER LOT TRACT eDlfeB
Building & Safety Dept.
OWNER NAME �d L� a �
6 p JAN 0 5 2017
ADDRESS �(�Z?C) �„vi„r`0 '� S't
PHONE EMAIL Received
APPLICANT NAME w ce. w
ADDRESS Clf
rJ
PHONE i,� EMAIL
CONTRACTOR'S NAME �,Y F- u '; a OWNER BUILDER? O YES A NO
BUSINESS NAME p r� W 2.� :�; -� a✓L fir,
ADDRESS ��gS � ,n01 53" .`Kn�C'
PHONE y7 aag EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION Imo. C
VALUATION$ C5 . SO FT L SQ FT
APPLICANT'SSIGNATUR DATE 1 S ZOE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION y CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP /X
INVOICE PAID AMOUNT O O
AMOUNT S• CASH CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH 0CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityof nenifee.Lis Inspection Request Line 951-246-6213
City of Menifee
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PLAN APPROVAL { ;
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DATE
—*kpprovaFof4hese{�yns shaUlwt coc tared to be a permit for,T a! 71i
approval of,any violation of any provisions of the federal,state or city
v regulations and ord'mances4y",set of approved plans must be. ton the '
jobsite until completion. `\ � yr
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