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PMT17-00918 City of Menifee Permit No.. PMT17-00918 29714 HAUN RD. <ACCEL/-> MENIFEE, CA 92586 Type: Mobile Home MENIFEE Date Issued: 0 5/1 012 01 7 PERMIT Site Address: 26044 OKUMA RD, MENIFEE, CA 92584 Parcel Number: 360-290-002 Construction Cost: $2,000.00 Existing Use: Proposed Use: Description of SITE PREP FOR NEW MOBILE HOME,2100 SF Work: Owner Contractor ANNET ENTERPRISES INC 41690 CORPORATE CENTER DRIVE MURRIETA, CA 92562 Applicant License Number: MENIFEE, CA Fee Description QY Amount I$) Manufactured Residential Site Prep 1 196.00 Permit Fee 1 27.00 Plan Check Fee 51 51.25 Plan Check Fee 103 102.50 Additional Plan Review Building 148 148.37 $525.12 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 ❑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 Class License No. By my signature below I acknowledge that,except for my personal residence Expires Signature in which I must have resided for at least one year prior to completion of WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I 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 worker's 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 following website: by Section 3700 of the Labor Code,for the performance of work for which this permit is issued. www.le?info.ca.aov/calaw.htmL Policy If Date ❑I have and will maintain worker PROPERTY OWNER OR AUTHORIZED AGENTs compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which psy 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 C 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 with all applicable city and county ordinances and state laws relating to Carrier building construction.I autho'ze representatives of this city or county to Polity# Expires ?RDOUS bove'dentifi roperty for inspection purposes. (This section need not to be completed is the permit is for one-hundred Date 1-7 dollars($100)or less OWNER 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 ClESS LICENSE# workers compensation laws of California,and agree that if I should become MATERIAL DECLARATION subject to the workers compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a Applicant Date mixture containing a hazardous material equal to or greater that the amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes ❑No 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 IN SECIONDITION 306OFTO THE TLAB OF OR CODE,INTEREST, DAMADATTOGES AS ROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist IN SECTION 37060E 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 bou9dary of a school? (Section 3097 Civil Code) ❑Yes No 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 6y the California Health&Safety Code,Section 25505 and 25534 concerning checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 ,hey and natenal reporting. Business and Professions Code).Any city or county that requires a permit to e u I Date S- u construct,alter,improve,demolish or repair any structure,prior to its PR NER O AUTHORIZED AGENT issuance,also requires the applicant for the permit to file a signed statement that he or she is licensed pursuantto the provisions of the Contractors State EP REN VATION REPAIR AND PAINTING FIRM License Law(Chapter 9(commencing with Section 7000)of Division 3 of the T e EEE Renovation,Repair and Painting(RRP)Rule requires contractors Business and Professions Code)orthat he or she is exempt from licensure rEeElving compensation for most workthat disturbs paint in apre-1978 and the basis forthe 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.gov/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 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 c tractors 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.