PMT17-00654 City of Menifee Permit No.: PMT17-00654
29714 HAUN RD. Type: Residential Addition
'!-kCCELA— MENIFEE,CA 92586
MENIFEE Date Issued: 0310212017
PERMIT
Site Address: 24072 DEPUTY WAY, MENIFEE, CA Parcel Number: 358-550-003
92584 Construction Cost: $7,300.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL OUTDOOR BRICK FIREPLACE
Work:
Owner Contractor
ENEDINA FEINER VELASQUEZ LANDSCAPE
24072 DEPUTY WAY 29389 LEE LANE
MENIFEE, CA 92584 MURRIETA, CA 92563
Applicant Phone:9516347993
MISAEL VELASQUEZ License Number..983547
VELASQUEZ LANDSCAPE
29389 LEE LANE
MURRIETA, CA 92563
Fee Description Qtv Amount I$1
Building Permit Issuance 1 27.00
Inspections not specified 258 258.14
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 1.00
General Plan Maintenance Fee-Building 1 12.91
$300.05
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 carded 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_Pernit Template.rpt Page 1 of 1
CITY OF MENIFEE
ENSED DECLARATION property who builds or improves thereon,and who contracts for the
I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License-
Chapter9(commencing with section 7000)of Division 3 of the Business•ancf in 1 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 � I2- License No.— `) ✓(� By my signature below I acknowledge that,except for my personal residence
Expires 0: l�Signature s 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 1
ORKER'S COMPENSATION DECLARATION have built as an owner-builder if It has not been constructed in Its entirety by
o 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 www.leginfo.ca.guy/calaw.htmi.permit is issued.
Policy fl Date
PROPE TY OWNER OR AUTHORIZED AGENT
A I have and will maintain workers compensation insurance,as required by
section 3700 of the Labor Code,for the performance of the work for which D 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 (�Tiles W V �. with all applicable city and county ordinances and state laws relating to
2 building construction.I authorize representatives of this city or county to
". J Policy if 9 f 20 —Expires 0 j 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 emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE fJ
workers compensation laws of California,and agree that if I should become RDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
I shall forthcyd m ith those provisions. Will the applicant or future building occupant handle hazardous material or a
leant V Date O d/ mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
ARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes ANo
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 permit for the construction or modification from South
ADDITION 70 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 fo Coast
AirlQua
ines
CONSTRUCTION LENDING AGENCY ❑Yes mes
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 ryNo
OWNER BUILDER DECLARATIONS 1 have read the Hazardous Material Information Guide and the SCAQMD
I 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&Safety Code,Section 25505 and 25534 concerning
hazardous material rep ing.
checkmark(s)I have placed nextto the applicable item(s)(Section 7031.5 ayes N
Business and Professions Code).Any city or county that requires a permit to Date 0 ?'AIAZ
construct,after,improve,demolish or repair any structure,priorto its OP
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 fill
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt from licensure The EPA Renovation,at Repair and Painting(RRP)Rule requires contractors
and the basis for the alleged exemption.Any violation of Section 7031.5 by receiving compensation far most work that disturbs paint in apse-197B
an Applicant for a permit subjects the applicant to a civil penalty of not more residence or childcare facility to be RRP-certified firms and comply with
than($500). required practices.This Includes rental property owners and property
managers who do the paint-disturbing work themselves or through their
o 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( I portion of the work,and the structure is www.eoa.zov/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
property who,through employees'or personal effort,builds or improves the D An EPA Lead-Safe Certified Renovator will be responsible for this project
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. a 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 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.
1
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE al PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL 4-RESIDENTIAL 0— MULTI-FAMILY O MOBILE HOME -- POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHAbliC LDf Menifee
ANEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES Building S Safety Dec .
DESCRIPTION OF WORK �w-9— ( ce,
PROIECTADDRESS 91" ? 9— C , e
ASSESSOR'S PARCEL NUMBER LOT TRACT
t
OWNER NAME
ADDRESS
PHONE EMAIL
APPLICANT NAME G
ADDRESS @j� 1
PHONE 1 1 (J`� iZ —��-gQ 5 EMAIL
ITT`CONTRACTOR'S NAME OWNER BUILDER. O YES O
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER q'/ SLJ LICENSE CLASSIFICATIO ;�7 /
VALUATION$ k - J C� b SQ FT L SO FT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE AMOUNT ' . PAID AMOUNT O CASH OCHECKq n CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT OCASH OCHECK# 0CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of(Menifee Building Q Sofety Deportment 29714 Houn Rd. ;Menifee, CA 92585 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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