PMT17-01498 City of Menifee Permit No.: PMT17-01498
29714 HAUN RD. Type: Residential Alteration
<�kCCEL/R^? MENIFEE, CA 92586
MENIFEE Date Issued:
OS/12f2017
PERMIT
Site Address: 26731 OPALESCENT DR, MENIFEE, CA Parcel Number: 360-810-018
92584 Construction Cost: $20,000.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 6 CAN LIGHTS,6 UNDER CABINET LIGHTS, RELOCATE 220V/30A CIRCUIT FOR OVEN
Work: WITH 12'CONDUIT
Owner Contractor
JAN JORDAN J D F CONSTRUCTION INC
26731 OPALESCENT DRIVE 1114 E TRUSLOW AVE
MENIFEE, CA 92584 FULLERTON,CA 92831
Applicant Phone:7145261120
J D F CONSTRUCTION INC License Number: 956749
1114 E TRUSLOW AVE
FULLERTON, CA 92831
Fee Description O,_yl Amount Isl
Receptacle, Switch,Outlet&Fixture 13 176.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Electrical 1 8.80
$212.80
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of erors 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
CM OF MENIFEE
LICENSED DECLARATION pr erty who builds or improves thereon,and who contracts for the projects
1 hereby affirm under penalty of perjury that I am under provisions of
wit a licensed contmctor(s)pursuant to the Contractors State License Law).
Chapter!)(commencing with section 7000)of Division 3 of the Business and ❑ am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is In
full force and effect. 1-7 a following reason:
License Class �-�V C-2016 I License IJ{7 /� By my signature below I acknowledge that,except for m g g p y personal residence
Expires _3�' 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 worker's 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 ,Nyew,leainfo.ca.¢ov/calaw.html.
this permit is issued. /
Policy# �LA doo 8 65 Date
T 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 owner's behalf.I have read this
numb application\' application and the information I have provided is correct.I agree to comply
Carrier 1 A-�1s �CMi r fC, with all applicable city and county ordinances and state laws relating to
��7J building construction.I authoriresentatives ofthis city or county to
Policy# L-AG66-665 Expires 45`�.S-� 7 enter the
/�atigy de/n�t�ifip� operty for inspection purposes.
(This section need not to be completed is the permit is for one-hundred "'� Date�-lz 47
dollars($lOD)or less PROPERTY OWNER OR AUTHORIZED AGENT
❑1 certify that in the performance of the work for which this permit is issued, O7 L/O`
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# S 7
workers compensation laws of California,and agree that if I should become AZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions f Section 3700 of the Labor
Code,I shall fort/hwi�b.e y with t r i ions. i� Will the applicant or future building occupant handle hazardous material or a
Applicant/ Date b-�L- I� mixture containingahazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNIN :FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ay
es JgN0
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 antQuality Management District(sC[ion or See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes )tNo
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 bou diary of a school?
(Section 3097 Civil Code) ❑Yes qNo
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
hazardous materiMIng.
checkmark(s)I have placed nett to the applicable item(s)(section 7031.5 '�yYes ❑No
Business and Professions Code).Any city or county that requires a permit to FAn
Date�— Z'I7
construct,alter,improve,demolish or repair any structure,prior to its Eg WNER OR THORIZED 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 StateENOVATION,REPAIR AND PAINTING(RRPI
License Law(Chapter 9(commencing with Section 7000)of Division 3 of thePA Renovation,Repair and Painting(RAP)Rule requires contractors
Business and Professions Code)or that he or she is exempt from licensureing compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 bynce or childcare facility to be RRP-certified firms and comply with
thanApplicant for a permit subjects the applicant to a civil penalty of not morered practices.This includes rental property owners and property
than($500). gers who do the paint-disturbing work themselves or through their
❑1,as owner of the property,or my employee with wages as their sole oyees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is .epa.gov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions ,424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of aEPA Lead-Safe Certified Renovator will be responsible forthis project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered forCertified Firm Name:
sale.If,however,the building or improvement is sold within one year ofFirm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. I b('No EPA Lead-Safe Certified Firm is required for this project because:
❑I,as owner of the property am exclusively contracting with licensed 6 V
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 ARP
Acknowledgement.
APPLICATION
BUILDING & SAFETY PERMIT/PLAN CHECK
Menifee
DATE 5 ILz PERMIT/PLAN CHECK NUMBER — `
TYPE: O COMMERCIAL KRESIDENTIAL O MULTI-FAMILY O MOBILE HOME O.POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES /n,,''
DESCRIPTION OF WORK L/ j'1,e.Yl VA Oct 2 QX(
PRO1ECiADDRE55 7j City Ot Menlfe
e ty De If.
ASSESSOR'S PARCEL NUMBER ?�1�n-�b-61�6 LOT �06 TRACi
OWNER NAME �G-A1 2 2O1T
ADDRESS a3 `
PHONE �,5/- a3 - �/.�jQ EMAIL
APPLICANT NAME / Q-() S-C
ADDRESS,-5�0 1 C k v%.'\
PHONE ��-S-e2 Co // y EMAIL
CONTRACTOR'S NAME F l,�G D OWNER BUILDER? O YES, NO
BUSINESS NAME V
ADDRESS t '( y\L
PHONE qQ EMAIL
CONTRACTOR'S STATE LIC NUM E /Sb LICENSE CLASSIFICATION QJ 0,Ib �C, L3 7
VALUATION $ B SQ L SO FT
APPLICANT'S SIGNATURE DATE. �- ��
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN r SMIP
-gD INVOICE PAID AMOUNT 1a O O O CASH CHECK# CREDITCARD VISA/MC
AMOUNT ava
PLAN CHECK FEES PAID AMOUNT I 0CASH 0CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDERVERIFIED OYES O NO DLNUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building &Safety Department 29714 Houn Rd. Menifee; CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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