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PMT17-00440 City of Menifee Permit No.: PMT17-00440 29714 HAUN RD. �/�1.CCELA> MENIFEE, CA 92586 Type: Commercial Alteration MENIFEE Date Issued: 02/28/2017 PERMIT Site Address: 29995 EVANS RD, MENIFEE, CA 92586 Parcel Number: 338-121-045 Construction Cost: $3,200.00 Existing Use: Proposed Use: Description of REPAIR/REPLACE DOOR/STUCCO DUE TO DAMAGE DONE BY CAR Work: Owner Contractor - CITY OF MENIFEE TRI-R GEN CONTRACTORS INC 29714 HAUN RD 22175 FISHER STREET MENIFEE, CA 92586 PERRIS,CA 92570 Applicant Phone:9516571129 JOSE EDWARDS License Number:555857 22175 FISHER STREET PERRIS, CA 92570 Fee Description Qtv Amount t$1 Building Permit Issuance 1 27,00 Inspections not specified 258 258.14 Additional Plan Review Building 129 129.07 Additional Plan Review Building 129 129.07 GREEN FEE 1 1.00 SMIP COMMERCIAL 1 1.00 General Plan Maintenance Fee-Building 1 12.91 $558.19 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 with a licensed contractor(s)pursuant to the Contractors State License Law). I hereby affirm under penalty of perjury that I am under provisions of Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contractor's State License Law for Professions Code and my license Is in full force.aad-affect.,.-r--� the following reason: License Class License 1 �.� J U ST By my signature below I acknowledge that,except for my personal residence Expires Signat a 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 DE TION have built as an owner-builder if it has not been constructed in its entirety by o I hereby affirm under pen 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 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.leeinfo.ca.eov(calaw.htmL this permit is issued. Policy#T�l�T�6C� Date PROPERTY OWNER OR AUTHORIZED AGENT ❑I have and will maintain worker's compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work forwhich ❑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 1 have provided is correct.I agree to comply �� __S with all applicable city and county ordinances and state laws relating to Carrier Z�4J building construction.I authorize representatives of this city or county to Polity#;LoU l S3�T�f3/ xpires "�—',� enter the above identified property for inspection purposes. (This section need notto be completed is the permit is for one-hundred Date dollars($100)or less PROPERTY OW NER 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 N worker's compensation f California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the worker's c penoation provisions of Section 3700 of the Labor Code,I shall forthwit omply with those provisions. Will the applicant or future building occupant handle hazardous material or a z� _ ] mixture containing a hazardous material equal to or greater that the Applican /" Date / amounts specified on the Hazardous Materials Information Guide? WAR I .FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes ❑No UN FUL,AND SHALL SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building AND IVIL FINES UP Too HUNDRED THOUSAND DOLLARS($300,000),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 District(SCAQMD)7 See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines CONSTRUCTION LENDING AGENCY ❑Yes ❑No 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 ❑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 exemptfrom the California Health&Safety Code,Section 25505 and 25534 concerning Contractor's License Law for the reason(s)Indicated below by the hazardous material reporting. checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 ciYes ❑No Business and Professions Code).Any city or county that requires a permit to 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 Me a signed statement that he or she is licensed pursuant to the provisions of the Contractor's 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 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.epa.Koy/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 ❑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 7D44,Business and Professions Code: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. Show Receipt Detail Page 1 of 2 RECEIPT City of Menifee MENIFEE 29714 HAUN RD. Menifee,CA 92586 Application:PMT17-00440 Application Type:permits/Commercial/Alteration/NA Address:29995 EVANS RD, MENIFEE, CA 92586 Receipt No. 496219 Payment Method Ref Number Amount Paid Payment Date Cashier ID Received Comments Other $558.19 02/28/2017 WWELCH to be bill through A/R in EDEN Owner Into.: CITY OF MENIFEE 29714 HAUN RD MENIFEE, CA 92586 Work REPAIR/REPLACE DOOR/STUCCO DUE TO DAMAGE DONE BY CAR Description: https://ay.accela.com/portlets/fee/receiptView.do?mode=view&autoPrint=false&receiptnbr... 2/28/2017