PMT17-01448 City of Menifee Permit No.: PMT17-01448
29714 HAUN RD. Type: Residential Electrical
<A-CCEL A-> MENIFEE,CA 92586
MENIFEE Date Issued: 05/05/2017
PERMIT
Site Address: 28177 MILL STREAM, MENIFEE, CA Parcel Number: 333-612-004
92585 Construction Cost: $600.00
Existing Use: Proposed Use:
Description of 35 L FT GAS&100 L FT ELECTRICAL CONDUIT FOR FUTURE ABOVE GROUND SPA&FIRE PIT
Work:
Owner Contractor
TORREY WLKERSON BILL&DAVE'S LANDSCAPE MAINTENANCE INC
28177 MILLSTREAM 1153 HARLEY KNOX BLVD
MENIFEE,CA 92585 PERRIS,CA 92571
Applicant Phone:9519436455
DAVID LEIDENFROST License Number:751707
BILL&DAVE'S LANDSCAPE MAINTENANCE INC
1153 HARLEY KNOX BLVD
PERRIS, CA 92571
Fee Description Qtv Amount ISI
Plumbing Fixtures and Vents,fixtures 1 116.00
Building Permit Issuance 1 27.00
Inspections not specified 116 116.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 5.80
$265.80
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 building operations being carried on thereunder when in violation of the Building Cade 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
with a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that 1 am under provisions of
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 nd y license is in full force and effect. J the following reason:
License Class�l� LiJ�n iepNo. �S! 26? By my signature below I acknowledge that,except for my personal residence
Expires • 7 I ' 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
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 ww„w.leginfo.ca.gov/calaw.html.
this permit is
C
s issued.
/ /
Policy# l�� C7 ! l / `! L / ! Date
�ave 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 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
q
Carrier V 1.�� •//��/�o/� `" � UN!t \ with all applicable city and county ordinances and state laws relating to
''PP jj l/ building construction.I authorize representatives of this city or county to
Policy#� O p rJ 1 la I L1 I ')Expires enter the above identified property for inspection purposes.
(This section need not to he completed is the permit is for one/ 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 employ 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 sha�FI�fo��hwit�comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
l J c mixture containing a hazardous material equal to or greater that the
Applicant ' Date amounts ss ci8ed on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes ,D 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
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 guidelines
CONSTRUCTION LENDING AGENCY ❑Yes p'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) o Yes P-90
OWNER BUILDER DECLARATIONS I 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 underthe State of
Contractors License Law for the reason(s)indicated below by the California Health al Safety Code,Section 25505 and 25534 concerning
hazardou aterial reporting.
checkmark(5)I have placed next to the applicable item(s)(Section 7031.5 oY
Business and Professions Code).Any city or county that requires a permit to I am-- Date
construct,alter,improve,demolish or repair any structure,prior to its ERTY 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(RRPJ
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 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-certifled 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($500). managers who do the paint-disturbing work themselves or through their
❑I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.epa.gov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered!(or Ot MeftlteG Certified Firm Name:
sale.If,however,the building or improvement is sold within one ye a Dept.
completion,the Owner-Builder will have the burden of proving i���&$BtGty Firm Certification No.:
not built or improved for the purpose of sale. MAY O 5 20il 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 Contractor's State License Law does not apply to an ownn,i,pf aa^ei Y oldur project does not comply with EPA RRP rule please fill out the RRP
RG V Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK A• • •
Menifee
AMR- 11
DATE 5 PERMIT/PLAN CHECK NUMBER QMT I I-O I
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION --",�ELECTRICAL O MECHANICAL
O NEW NUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK ' ,JL r
PROJECTADDRESS C9 V O " ' ( �ASSESSOR'S PARCEL NUMBER 55*5612_ 004 LOT to I TRACT 3 �j 1 I OQ
D
OWNER NAME C'7,J�_S
ADDRESS IN_'
PHONE -70 333 ' Q 7-7 5 EMAIL
APPLICANT NAME -Q AU 7 S T q
ADDRESS('} 1 1 '7� J Q� (�, r1 'C, t`` I�( ` L� '7I
PHONE SJ 3� 5 U 4 OS EMAIL CO1,S VA'CA- _6t 1 k CI,U- - 4il"i es
CONTRACTOR'S NAME �� , 1 �-9A f[V L. dS CA Pr OWNER BUILDER? OYES p-Nb
BUSINESS NAME t ( ^1 P
ADDRESS 1t S_
PHONE 9,51 CI -6 6y s i EMAIL �
CONTRACTOR'S STATE LI,C`NUMB S / Z 0 � LICENSE CLASSIFICATION C
VALUATION$ V� v SQ FT L SQ FT�c^
APPLICANT'S SIGNATURE DATE J 7
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF M�JENIftt BU5151NEE55 LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I SMIP ow-� O �Jv J �p "I ✓
INVOICE PAID AMOUNT
AMOUNT CCASH OCHECKR OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee
City of Menifee Building&Safety Deportment 29714 Noun Rd. Menifee, CA 9A6IFiiflid-&;9afet3/Dept.
www.cityc finenifee.US Inspection Request Line 951-246-6213
MAY 0 5 2017
Received
Hs 41000
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a QUeeN PIS` Z(Z S
�i!IhJi NR�AFETY DEPARTMENT
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tTi7 BY I� b 5
DATE p
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ro iel e:-: use I s n0�pnslr o er it o �
ap=roval of,any violation of any provisions of the federal,state or city 'I
regulations and ordinanceaIl tis6q ap�rdvep plan�ii tpgt ke kkAon�fieA /y t"
iolisite until completion. , ��
-- 7 6 tJ OFFICE COPY I
5 i F
City of Menifee
f Building & Safety Depi,
w ^ j MAY 05 20 1
Received s