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PMT17-00084 City of Menifee Permit No.: PMT17-00084 29714 HAUN RD. 'mil- ccr=LA> MENIFEE, CA 92586 Type: Residential Plumbing MENIFEE Date Issued: 01/13/2017 PERMIT Site Address: 29433 HIDDEN LAKE DR, MENIFEE, CA Parcel Number: 340-190-073 92584 Construction Cost: $1,000.00 Existing Use: Proposed Use: Description of INSTALL NEW SHOWER VALVE MASTERBATH Work: Owner Contractor PAULA GERDE A A A RESTORATION INC 29433 HIDDEN LAKE DR 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 O_yt Amount lSl Plumbing Fixtures and Vents,fixtures 1 116.00 Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 General Plan Maintenance Fee-Plumbing 1 5.80 $149.80 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 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_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 contractor(s)pursuant to the Contractors State License Law). Chapter9(commencing with section 7000)of Division 3 of the Business and D 1 am exempt fmm licensure under the Contractors State License Law for Professions Code and my license is in full force and effect. the following reason: License Class C 1 Ucens Id.' Z_c ( -1 By mysignature below lacknowledge that,except for my personal residence Expires Signatur .9i in which I must have resided for at least oneyear priorto completion of improvements covered by this permit.I cannot legally sell a structure that 1 WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by D 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 forworkers 7044 of the Business and Professions Code,is available upon requestwhen 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.Ieainlb.ca.Roy/caIaw.html. Policy# Date .XI 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 1 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 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 /�s3T ,1 building construction.I authorize representatives of this city or county to Policy# y i � 'S7lieO Expires yam//a617 enter the above identified property for inspection purposes. (This section need not to be completed is the permit is for one-hundred dollars($100)or less Date PROPERTY OWNER OR AUTHORIZED AGENT IsI certify thaem in the performancepersons in any r so a to become subjectt is issued, ��2 Q I shall not emolov any persons in any mannerso as to become subject to the CITY BUSINESS LICENSE# .7i 7' 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 forth ith comp) with those provisions. Will the applicant or future building occupant handle hazardous material or Applican il�s�s-.� Dace ` ! )'7 mixture containing a hazardous material equal to or greater that the a 1— amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS D Yes XNo UNLAWFUL,AND SHALL SUBIECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building AND CIVIL FINES UP 70 ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management hecoDistrict(SCtionor odipermitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES fo Coast Airlines Qua CONSTRUCTION LENDING AGENCY ❑Yes ff"O4o 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 XNo 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 Cade,Section 25505 and 25534 concerning checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous mates I reportin Business and Professions Code).Any city or county that requires a permit to 1'16'es D N construct,alter,improve,demolish or repair any structure,prior to its Date 3 issuance,also requires the applicant for the permit to file a signed statement OPERTY OWPfE OR HORIZED AGENT that he or she Is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRP) 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 apse-1978 and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to he RRP-certified firms and comply with an Applicant for a permit subjects the applicant to a civil penalty of not more required orcti ildcar fincludes rental than($500). q P property owners and property managers who do the paint-disturbing work themselves or through their D 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.eoa.eov/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-80D-424-LEAD(5323). Code;The Contractors State License Law does not apply to an owner of a D 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. D No EPA Lead-Safe Certified Firm is required for this project because: u 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 If your project does not comply with EPA RRP rule please fill out the RRP Acknowledgement. BUILDING & SAFETY PERMIT/.PERMIT/PLAN CHECK • . • • "Menifee DATE I 13 1"7 PERMIT/PLAN CHECK NUMBER TYPE: ❑COMMERCIAL ]oRESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL [—]MECHANICAL ❑NEW JZ PLUMBING ❑RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK PROJECTADDRESS 33 }�',�LSU•T c ASSESSOR'S PARCEL NUMBER Igo 001� LOT TRACT ��f PROPERTY OWNER'S NAME ADDRESS PHONE EMAIL APPLICANT NAME !4AR o -k;pyT La*\ck Y�,, ADDRESS o ar-Jd -'2nk5'j- L4Xe� i PHONE -"/�j/- L/'7/ - j�a� EMAIL CONTRACTOR'S NAME �'�'�. ("( `,� OWNERBUILDER? ❑YESP§NO BUSINESS NAME AA A '- -p5-q ion ADDRESS 4(92F56 ayirL 5 LqY. -- yLnry-e-- CA IC9,53a PHONE EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION$ I QCDc.> SO FT L SQ FT APPLICANT'S SIGNATU Z DATE 1 Z.5 17 DEPARTMENT DISTRIBUTION I/Q CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN { SMIP INVOICE PAID AMOUNT AMOUNT I OCASH OCHECK# OCREDIT CARD VISA/MC L N CHECK FEES PAIDAMOUNT 0CASH 0CHECK# OCREDITCARD VISA/MC UILDER VERIFIED OYES 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.cityofinenifee.us Inspection Request Line 951-246-6213 �� to{ � `?�/� 56.0�� +-[arc,' . 7 .' �-.• �� v I� L'\ ! V.i��70�1.1 %3 A Il5 h ao � • � t0'f O H t rm m I v � u N �O a —1 Pt� } a E/j CD D m n Z P.o - � Z CD.: — � m� a d CD CD I /D v ED m m J r 'PM1'fl'lon, 000gf G CIS