PMT17-00508 City of Menifee Permit No.: PMT17-00508
29714 HAUN RD. Type: Residential Alteration
"ACCELA- MENIFEE,CA 92586
MENIFEE Date Issued: 0 212 812 01 7
PERMIT
Site Address: 29932 COOL MEADOW DR, MENIFEE, Parcel Number: 339403-006
CA 92584 Construction Cost: $2,850.00
Existing use: 1 &2 Family Residence Proposed use:
Description of SHOWER REMODELANALL ENCLOSURE IN EXISTING BATHROOM 28 SQ FT
Work:
Owner Contractor
RICHARD R. LARSON C C CONSTRUCTION&ASSOCIATES
29932 COOL MEADOW DR 3507 W STETSON AVE#286
MENIFEE,CA 92584 HEMET, CA 92545
Applicant Phone:6198407608
CARLOS AMEZCUA License Number. 918745
3507 W STETSON AVE#286
HEMET, CA 92545
Fee Description 01 Amount I51
Building Permit Issuance 1 27.00
Inspections not specified 387 387.21
Additional Plan Review Building 129 129.07
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 1.00
General Plan Maintenance Fee-Building 1 19.36
$664.64
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 carved 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 Templale.rpl 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 Clas License N .Q ���� By my signature below I acknowledge that,except for my personal residence
Expires �" 'ZCI �Signature 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
WORKERS COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
❑1 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 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 fallowing website:
by Section 3700 of the Labor Code,for the performance of work for which www.leginfo.ca.gov/calaw.litml.permit is issued.
Policy# 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 ofthework 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 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.)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($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
certify that in the performance of the work for which this permit is issued,
1 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 sha hwi h com ly with those provisions. IyI Will the applicant or future building occupant handle hazardous material or a
Applicant Date Z Zp �� mixture containing a hazardous material equal to or greater that the
amounts sp}cified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes aGNo
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended 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 A''ir'',Quu�ality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidon.
CONSTRUCTION LENDING AGENCY ❑Yes o 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 ITI�o
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
1 hereby affirm under penalty of perjury that 1 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 al Safety Code,Section 25505 and 25534 concerning
haz pus material reporting.
checkmark(s)I have placed nett to the applicable items)(Section 7031.5
Business and Professions Code).Any city or county that requires a permit to D _ Date 2T
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 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 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 applicantto 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
D 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,will do( )all of or( )portion of the work,and the structure is www.epa.aov/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 provingthat it was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm Is required for this project because:
❑I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 70",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.
BUILDING
Menifee
DATE L'2� PERMIT/PLAN CHECK NUMBER 1' ► l il- 0050g
TYPE: O COMMERCIAL RESIDENTIAL CMUUI-FAMILY v MOBILE HOME POOL/SPA O SIGN
SUBTYPE: C ADDITION X'ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK L�_
�15•P�t�� �J�LzF�-�J�
PROJECTADDRESS tll Lvoj o Da 9ZS�
ASSESSOR'S PARCEL NUMBER •33 aln LGO3 op& �nLOT � 5 5 TRACT � !
OWNER NAME �tC-��(//a'�-'�`� Ih _ (� ✓ —
ADDRESS 2a1(3 � Cut Mji-,�eu7 fW1i C4
PHONE EMAIL C9-9 V'3p_�Z 6P e6A6 ) C
APPLICANT NAME
ADDRESS ao- CJ'Zs-
PHONE/C{�PS��� [7�y EMAIL � /�to GC G qJS rfnuJ cnA)L (SV
CONTRACTOR'S NAME rD� rj pwc AA50(_ ,rr- OWNER BUILDER? O YES 0
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BUSINESS NAME Cam' � {1NRp AsS� C ma c! n
ADDRESS 3jD� wyL� ,, ,# -2A T C4' 7Z
PHONE /�� 5���� �� (t) EMAIL G L�SCC< COt� -Tlca� �pALait
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION*' SQ FT Z L SQ FT
APPLICANT'S SIGNATURE DATE Z Z
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION $D p CI7Y OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN ' SMIP
INVOICE I PAID AMOUNT
AMOUNT 0CASH 0CHECK IL OCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT CCASH OCHECKLL CCREDITCARD VISA/MC
OWNER BUILDER VERIFIED 0 YES C NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Nlenifee Building& Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.Lis Inspection Request Line 951-246-6213