PMT17-00899 City of Menifee Permit No.: PMT17-00899
29714 HAUN RD.
'/ICCEL/? MENIFEE, CA 92586 Type: Residential New
MENIFEE Date Issued:
10113/2017
PERMIT
Site Address: 30797 VIA LOS ROSAS, MENIFEE, CA Parcel Number: 472-050-009
92586 Construction Cost: $329,286.68
Existing Use: Proposed Use: 1 &2 Family Residence
Description of NSFR DWELLING 2665 SF,671 SF ATTACHED GARAGE,212 SF COVERED PORCH,212 SF
Work: COVERED PATIO
Owner Contractor
HOMES FOR OUR TROOPS YOUNGREN CONSTRUCTION INC
6 MAIN STREET 443 EAST ALVARADO STREET
TAUNTON, MA 02780 FALLBROOK, CA 92028
Applicant Phone: 7607289874
DAVE HENRIKSON License Number:784656
YOUNGREN CONSTRUCTION INC
443 EAST ALVARADO STREET
FALLBROOK, CA 92028
Phone: 9517642302
Fee Description f3,yt Amount
Services, Switchboards, Control Centers&Panels 2 232.00
Receptacle, Switch, Outlet&Fixture 181 1,016.00
Plumbing Fixtures and Vents,fixtures 11 156.00
Gas System 1 116.00
Piping/Repiping Single Family Residential 1 163.00
Plan Check Fee 410 410.00
Residential Water Heater 1 83.00
Sewer 1 150.00
Forced-Air or Gravity-Type Furnace or Burner 1 149.00
Air Handling/Condensing Units SFR 1 133.00
Building Permit Issuance 1 27.00
Additional Plan Review Building 1,256 1,256.40
GREEN FEE 1 14.00
SMIP RESIDENTIAL 1 43.00
New Construction Permit Fee 1 1,514.72
General Plan Maintenance Fee-Mechanical 1 14.10
General Plan Maintenance Fee-Plumbing 1 33.40
General Plan Maintenance Fee-Electrical 1 62.40
General Plan Maintenance Fee-New 1 75.74
Construction
$6,648.76
AA_Bldg_Permit_Template.rpt Page 1 of 2
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 exemptfrom licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. � the following reason:
License Class Licens o. rT_7�f By my signature below I acknowledge that,except for my personal residence
Expires il
"L 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
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 w,,,vw,le¢info.casov/calaw.html.
this permit is issued.
Polity# Date
PROPERTY OWNER OR AUTHORIZED AGENT
have and will maintain workers compensation insurance,as required by
section 3700 of the 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 are: application and the information I have provided is correct.I agree to comply
Carder p a with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# Expires �Z 11 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 emoloy 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 forthwit omply ith th revisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date mixture containing a hazardous material equal to orgreater thatthe
amounts s nfied on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes Ir
0
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($500,000),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)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guideline
CONSTRUCTION LENDING AGENCY ❑Yes
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 bof a school?
(Section 3097 Civil Code) a Yes 0
ou
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements underthe State of
I hereby affirm
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
hazardq ss lal r parting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 ayes 5'itl
Business and Professions Code).Any city or county that requires a permit to a,�jt_ t
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY WINER OR AUTHORI D GENT
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 HINTING(RRPI
License Law(Chapter 9(commencing with Section 70D0)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)orthat 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
❑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.eoa.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-BOG-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 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:
❑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 RRP
Acknowledgement.
REQUEST FOR PERMIT ISSUANCE n I fee
CITY OF
Prior to issuance of new residential Building Permits, approvals from the departments listed
below are required.Approval shall be designated by the original signature of the appropriate
department staff.When all appropriate signatures are obtained, please return permit issuance
form to the Building& Safety department. Please allow up to 48 hours for processing of
building permits.
Permit Number: "EMT
Tract Name: 4-�DA-,
Tract: -PM (OLtzp
Lot:
Address: ����� �( � e,
Custom Home: YES NO Model Home: YES NO
Condo/Apt: YES NO Tract Repetitive: YES ( ) NO
Mobile/Manufactured Home: YES NO ,Ysl
DEPARTMENT DATE APPROVAL SIGNATURE
ENGINEERING 0 —I I —1-76TT(;hT0
PW IINSPECTOR I�,
PLANNING
RIVERSIDE COUNTY FIREI �'f By Email
BUILDING
List of required items to obtain signatures for Permit Issuance:
Engineering-Grading Plan Approved, Rough Grade Certification,Soils Compaction
Planning-Payment of School Fees, provide receipts,Compliance with all prior conditions, including
approval of Minor Plot Plan Application
Riverside County Fire-Please contact Riverside County Fire 951-955-4777
Building-Payment of Permit and Plan Check Fees,verification of all required signatures
CITY OF
Riverside County Fire Department Office of the Fire Marshal Section
ftrvers0e 06+rE 2309M el$i,$M.130.RMi.C 6230t Pe(%33865-02))iaa(At185}1866
Pam06e10 )7-9331n MenuMSR0.,t201P.i nes C 922149131M,176016634866 ru06ID563.2022
Fire Department Clearance/Release
Date: uF' l I I
To: ccarlson@cityofinenifee.us;brivera@cityofinenifee.us:mbinnall@cityofinen1fee.us
Fax:
Tract/Parcel Map M
Permit/Lot#: 1 {ENI uG t`
Job Site Address: 3C I c{ I >f In LA! V,-s^S
n Final For Recordation
Release For Building Permit(s)
fl Shell Final Only(No Tenant)
fl Final For Occupancy
fl Release For Residential Sprinkler Installation
fl Building Plan Check Fees Paid, Water Requirement Met-it water applicable
f 1 Building Plan Check Fees Not Paid
fl Residential Sprinkler Plan Check Fees Paid
f I Residential Sprinkler Plan Check Fees Not Paid
n Other Fees
R Fees Not Required
If you should have any questions, please contact the appropriate Rivers jde County Fire Proteetion Planning office for
further assistance.
Authorizing Signature For Re ease
Pr nt Name
FamC-Reriae0 Sn 11t6
epMEnL�HP/� County of Riverside
W� qo DEPARTMENT OF ENVIRONMENTAL HEALTH
www.rivcoeh.org City of Menlfee
� LAND USE APP11-I611i & Safety Dept. Ll
I� OFFICE USE
3880 Lemon Street- OCTC!
�Suite 200•Riverside•CA•92501—(951)955-8980 T ' � °ZO'7 PE CODE:: r
l� FEE::
❑47-950 Arabia Street•Suite A•Indio•CA 92201 —(760)863-7570
EHS# ON# / LMS# APN:
v C, O 2
TR/PM LOT# USE OF PERMIT:
SECTION A 9
Name
OWNER: Address, city Zi
ZVA
Phone
AGENT/
Company Name A entlContractor "✓/7 Ai
CONTRACTOR: _Ma!tg Address (_/(� Ci �/ �' Zi 22
Phone / Email
PROPERTY INFO: Site Address city /�! Zip
Water A enc /Well Lot Size S
APPLICANTS SIGNATURE: DATE:
SECTION B Below—For Office Use Only
CHECK BOX IF REQUIRED
If any box Is checked,this application shall be considered denied until the information is provided.
❑Holding Tank Agreements Required ' ❑Floor Plan and/or Plumbing Layout Required
❑Certificate of Existing DINTS Required(C-42) ❑Special Feasibility Boring Report Required
❑WQCB Clearance Required ❑Detailed Contour Plot Plan Required(1 to 5 foot intervals)
❑Soils Percolation Report Required
SITE EVALUATION INSPECTION MARKS:
EHS INITIALS/DATE:
SEFLJON C
NEW 1 ❑REPAIR I REPLACEMENT ❑EXISTING ❑PUMP ❑ATU ❑CONNECT TO SEWER I FIXTURE UNITS# BDRMS# 7
Soils Percolation odng Report By Date: Project#
- — 2 4 � PX 3256
C-42 Certiflcation By: Date: License#
Septic tank cap.: Soil Rate: Tested Depth: Max. trench depth:
[ r✓ /. 2 3 3
Sq.Ft. ,ttfonm Area:/Gr7t=^+� Total Linear FL: Line(s):
Length: feet - Each 3 feet wide
Sidewall Allowance: Ft.Rock/ Sq.ft.Running foot Rock below drain line: _In. or lastic Chambers
Leach Unes/bed special design for slope: ❑ N/A ❑Overburden Factor:
Pit Diameter: No.pits: Depth below Inlet IN): Pit Total Depth: Max.allowable depth:
CONSTRUCTION/INSTALLATION REMARKS:
�'
4.
SECTION D
This Application is Approved El Denied regarding the design of the OWTS as indicated on the accompanied plot plan using the requirements set forth In
Section C above.No construction is permitted in the required reserved 100%Expansion area.
EHS Signature: - Date:
EM-92(REV 7116) Distribution:WHITE—Office File;YELLOW—Bldg.Dept.PINK—Appliwnt