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PMT17-01320 City of Menifee Permit No.: PMT17-01320 29714 HAUN RD. Type: Residential Addition <A-CCEL/> MENIFEE, CA 92586 MENIFEE Date Issued: 0712712017 PERMIT Site Address: 23807 NEWPORT DR, MENIFEE, CA Parcel Number: 350-281-033 92587 Construction Cost: $28,300.03 Existing Use: 1 &2 Family Residence Proposed Use: Description of DETACHED 24'x 24'GARAGE WITH ELECTRICAL Work: Owner Contractor DELORES STEINWAND-MYERS JACK RANDALL ROY 23807 NEWPORT DRIVE 27057 RANGEWOOD STREET MENIFEE, CA 92587 MENIFEE,CA 92586 Applicant Phone:9512328010 JACK ROY License Number:485256 JACK RANDALL ROY 27057 RANGEWOOD STREET MENIFEE, CA 92586 Fee Description City Amount IEl Services, Switchboards,Control Centers&Panels 1 116.00 Receptacle, Switch, Outlet&Fixture 10 161.00 Building Permit Issuance 1 27.00 Inspections not specified 258 258.14 Additional Plan Review Building 440 440.00 Additional Plan Review Building 165 165.00 GREEN FEE 1 2.00 SMIP RESIDENTIAL 1 4.00 New Construction Permit Fee 1 130.18 General Plan Maintenance Fee-Electrical 1 13.85 General Plan Maintenance Fee-New 1 6.51 Construction $1,323.68 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_Permil_Template.rpt Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects with a licensed contractor(s)pursuant to the Contractors State License Law). I hereby affirm under penalty of perjury that I am under provisions of Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contractor's State License Law for Professions Code and m icense is in full force and effect. the following reason: Ucense Class License� j� `�~ By my signature below I acknowledge that,except for my personal residence xpirel.7 .g� Signature in which I must have resided for at least one year prior to completion of WORKER'S COMPENSATION DECLA T 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 fallowing 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 I 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.leeinfo.ca.eov/calaw.html. Policy# Date ❑I have and will maintain workers compensaton 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 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.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 dollars($10O)or less Date I , PROPERTY OWNER OR AUTHORIZED AGENT . certify that in the performance of the work for which this permit is issued, / shall not emolov any persons in any manner so as to become subject to the CI3y BUSINESS LICENSE# V workers compensation laws of California,and agree that if I should became HA RDOUS MATERIAL DECLARATION 1 ct to the workers compensation provisions of Secti won 37770�/0 of��th��eJJL//a�'�-bor Cod ,I shall fD I ith comply with those provisions. WIII the applicant or future building occupant handle hazardous material or a plicant �—t Date mixture containing a hazardous material equal to or greater that the amounts��'sp}}}cified on the Hazardous Materials Information Guide? A :FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE L5 ❑Yes A/No UNLAWFUL,AND SHALLSUBIECi AN EMPLOYER TO CRIMINAL PENALTIES Will th intended use of the building by the applicant or future building AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),I occupant require a permit for the construction or modification from South ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FO Cocas[Air Quality Management District(SCAQMD)?See permitting checklist IN SECTION 37060FTHE LABOR CODE,INTEREST,AND ATTORNEYS FEES —for guidelines - -- - CONSTRUCTION LENDING AGENCY - ❑Yes 0 1 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 o OWNER BUILDER DECLARATIONS I have Xd 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 2SS34 concerning a rdous matOria'�porting. chsiness and I have placed next toy city applicable that r(Section permit s ❑N 7- Z� —17 Business and Professions Code).Any city or county that requires a permit to '� Date ! G construct,alter,improve,demolish or repair any structure,prior to its PRdP NER 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 E A OVATION REPAIRANDPAINTING 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 Cade)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 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 1-800-424-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: ❑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. Menifee DATE - ? - r PERMIT/PLAN CHECK NUMBER 390 TYPE: O COMMERCIAL VRESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL F-/NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK ' Lolke PROJECTADDRESS 2 80-7 Nel-U r ASSESSOR'S PARCEL NUMBER G LOT TRACT OWNER NAME I Ores �1° S ADDRESS r� Building & Safety Dept. L PHONE � EMAIL APR 2 7 2017 APPLICANT NAME ADDRESS 2 `70 PHONE q,J 1 Q.32 •'ZO(0 EMAIL 501e.4 QCa CONTRACTOR'S NAME jioA OWNER BUILDER? d YES O BUSINESS NAME ADDRESS g2-7D PHONE 1 �/'LZ•bD�V EMAIL CONTRACTOR'S STATE LIC NUMBER --4525C.P LICENSE CLASSIFICATION VALUATION$ SO FT L.O L SO FT APPLICANT'S SIGNATURE DATE IrIpr- DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN I r SMIP INVOICE PAIDAMOUNT , AMOUNT OCASH 0 CHECK# 0CREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT 1 OCASH 0CHECK# 0 CREDIT CARD VISA/MC OWNER BUILDER VERIFIED OYES d NO DLNUMBER NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Department 29714 Noun Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213