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PMT17-01269 City of Menifee Permit No.: PMT17-01269 29714 HAUN RD. Type: Residential Addition S�CCEL/-> MENIFEE, CA92586 MENIFEE Date Issued: 06/29/2017 PERMIT Site Address: 24247 BUCKSTONE LN, MENIFEE, CA Parcel Number: 358-561-020 92584 Construction Cost: $7,120.00 Existing Use: 1 &2 Family Residence Proposed Use: Description of WALL TR 31392 PROVINCE Work: 6'X 80 L FT,5 PILASTERS LOT 90 Owner Contractor BROOKFIELD PROVINCE,LLC BROOKFIELD LOS ANGELES BUILDERS INC 12265 EL CAMINO REAL#180 12265 EL CAMINO REAL STE 180 SAN DIEGO,CA 92130 SAN DIEGO,CA 92130 Applicant Phone:7144276868 KIRK PHAIR License Number.960237 BROOKFIELD LOS ANGELES BUILDERS INC 12265 EL CAMINO REAL STE 180 SAN DIEGO,CA 92130 Fee Description Ow Amount M) Building Permit Issuance 1 27.00 Wall/Fence, non-standard 1 133.00 GREEN FEE 1 1.00 SMIP RESIDENTIAL 1 1.00 General Plan Maintenance Fee-Building 1 6.65 $168.65 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 perjurythat 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 o I am exempt from Iicensure underthe 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 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 www.leginfo.ca.gov/calaw.html.pennit is issued. Policy# Date ❑I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT 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 worker's 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.I 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 ❑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# 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 forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a Applicant Date mixture containing 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 AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN Will the intended use of the building 6y the applicant or future building ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)?See permitting checklist _ for..guidelines. CONSTRUCTION LENDING AGENCY ❑Yes o No I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the lending agency forthe performance of the work which this permit is issued outer boundary of a school? (Section 3097 Civil Code) ❑Yes ❑No OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning checkmark(s)I have placed next to the applicable item hazardous material reporting.$)(Section 7031.5 oyes ❑No Business and Professions Code).Any city or county that requires a permit to Date construct,alter,improve,demolish or repairany structure,priorto 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[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 Iicensure receiving compensation for most workthat disturbs paint in a pre-1978 and the basis for the alleged exemption.Any violation of Section 7031.5 byan residence or childcare facility to be RRP-certified firms and comply with than($500).Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property than 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 requited for this project because: ❑1,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. BUILDING & SAFETY FERMI PLAN CHECK APPLICATION DATE 04/07/2017 PERMIT/PLAN CHECK NUMBERTWO r O' 1G/ TYPE: ❑COMMERCIAL ✓❑RESIDENTIAL MULTI-FAMILY ❑MOBILEHOME POOL/SPA ❑SIGN SUBTYPE: ❑ADDITION []ALTERATION []DEMOLITION []ELECTRICAL []MECHANICAL ❑✓ NEW []PLUMBING ❑RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK Province Phase 9 Garden Wall and 5 Pilasters PROJECT ADDRESS 24247 Buckstone Lane Menifee, Ca 92584 ASSESSOR'S PARCEL NUMBER 358-561-020 LOT 90 TRACT 31392 PROPERTY OWNER'S NAME Brookfield Province LLC ADDRESS 12265 El Camino Real Suite 180, San Diego PHONE (858)794-6116 EMAIL kirk.phair@brookfieldrp.com APPLICANT NAME Brookfield Province LLC ADDRESS 12265 El Camino Real Suite 180 San Diego,Ca 92130 PHONE (858)794-6116 EMAIL kirk.phair@brookfieldrp.com CONTRACTOR'S NAME Brookfield Los Angeles Builders, Inc. OWNER BUILDER? ❑✓ YES❑NO BUSINESS NAME Brookfield Los Angeles Builders, Inc. ADDRESS 3200 Park Center Drive, Suite 1000, Costa Mesa, CA 92626 PHONE (909)322-9924 EMAIL brad.eskildsen@brookfieldrp.com CONTRACTOR'S STATE LIC NUMBER 960237 LICENSE CLASSIFICATION B VALUATION $ $7,120.00 SO FT 440 L SO FT/ 80 APPLICANT'S SIGNATURE DATE �! ?!/ 1 7 DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS UCENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE PAID AMOUNT AMOUNT ?CASH CHECK p ��CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT () CASH O CHECK# O CREDITCARD VISA/MC OWNER BUILDER VERIFIED G YES O NO DL NUMBER NOTARIZED LETTER G YES C NO City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.u5 Inspection Request Line 951-246-6213