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PMT17-01730 City of Menifee Permit No.: PMT17-01730 29714 HAUN RD. Type: Residential Plumbing '5A—CCELA7 MENIFEE, CA 92586 MENIFEE Date Issued: O6/01/2017 PERMIT Site Address: 26851 CHERRY HILLS BLVD, MENIFEE, Parcel Number: 337-341-019 CA 92586 Construction Cost: $0.00 Existing Use: Proposed Use: Description of INSTALL 110'OF PERMA LINER IN 4"SEWER MAIN, INSTALL(1)3"TWO WAY CLEAN OUT Work: REFERENCE PMT17-01731 Owner Contractor NANCY LEE BROCKMAN PEACH HOME SERVICES INC 26851 CHERRY HILLS BLVD 532 MALLOY COURT CORONA,CA 92880 Applicant Phone:7144628174 JANE RECKTENWALD License Number: 1018348 PEACH HOME SERVICES INC 532 MALLOY COURT CORONA,CA 92880 Fee Description Oyt Amount ISI Building Permit Issuance 1 27.00 $27.00 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 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 contmetor(s)pursuant to the Contractors State License Law). Chapter!)(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 !20 (— License No. Ste(u^'f�CIS By my signature below I acknowledge that,except for my personal residence Expires -6o—ks Signature_ C4= 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 1 have built as an owner-builder if it has not been constructed in Its entirety by o 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 this permit is issued. v ww,leeinfo.ca.eow'calaw.lrtml. Policy A Date �s l have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT section 3700 of the Labor Code,for the performance of the work for which in 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 owner's behalf.I have read this number are: 1 application and the information I have provided is correct.I agree to comply Carrier AVCI )AtLtL�' my\UJ with all applicable city and county ordinances and state laws relating to 6"s- building construction.I authorize representatives of this city or county to Policy#WP_4164LAq a-39kM Expires ka—\-0 enter the above identified pr pert)}far inspection purposes. (This section need not to be completed is the permit is for one-hundred dollars($100)or less PROPERTY OWNER OR kft59ffED AGENT o I certify that in the performance of the work far which this permit is issued, I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSER workers compensation laws of California,and agree that if l should become HAZARDOUS MATERIAL DECLARATION subject to the workers compensaUe rovisIons of Section 3700 of the Labor Code,I shall forthwith comply I ht se prov'sions. Will the applicant or future building occupant handle hazardous material or Applicant Date5-5-0 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 oYes `o,-Na 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($300,000),IN occupant require a permit for the construction or modification from South ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelfnes CONSTRUCTION LENDING AGENCY oYes LITi40 I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the lending agency for the performance of the work which this permit is issued outer boundary of a school? (Section 3097 Civil Code) Oyu ro OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm under penalty of perjury that l am exempt from the permitting checklist.I understand my requirements under the State of Contractors License Law for the reason(s)indicated below by the California Health&Safety Cade,Section 25505 and 25534 concerning checkmark(s)I have placed next to the applicable item hazardous material reporting.$)(Section 7031.5 oYes I,�IJ4o Business and Professions[ode).Any city or county that requires a permit to Date construct,alter,improve,demolish or repair any structure,prior to 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 IRRPI 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-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 o 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.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 oAn EPA Lead-Safe Certified Renovatorwif 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 Finn Certification No: completion,the Owner-Builder will have the burden of proving that It was not built or improved for the purpose of sale. o No EPA Lead-Safe Certified Firm Is required for this project because: 01,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. ' w DATE <<o'- ZOI� PERMIT/PLAN CHECK NUMBER TYPE: COMMERCIAL ✓RESIDENTIAL MULTI-FAMILY MOBILE HOME POOL/SPA SIGN SUBTYPE: ADDITION ALTERATION DEMOLITION ELECTRICAL VNIECHANICAL i NEW PLUMBING RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK Install 110' of perma liner in 4" sewer main._ Install two 3" two way clean outs PROJECT ADDRESS .W5 Cherry Hill Blvd Sun City, CA 92586 1 ASSESSOR'S PARCEL NUMBER % � 0 L,OT. n � . TRACT _ o`✓*' 1 �_j OWNER NAME _ _ ADDRESS Cherry_Hill Blvd. Sun it CA 92586 I i PHONE _ . — . _ .. EMAIL APPPUCANTNAME ADDRESS PHONE 714336.6159 _y ENVAIL _jaDateckQ.att.[t��-. I CONTRAGTOR'SNAME YES JNQ BUSINESS NAME ADDRESS _��2Mallay_QLtQpLOna, CA 928 00 PHONE EMAIL CONTRACTOR'S STATE UC NUMBER $ $ ,. A _. LICENSE CLASSIFICATION VALUATION$ 16.775.12 _ SQ FT � % L SQ FT __ ^ APPUCANT'S SIGNATURE ( DATE 54-17' — —, CITY OF MENlFEfi BUS!\255 LIC£NS;tlV�10ep I I SL i� Pn .A4 t GIP+'<R'.1u :'R3 i GREEN SMIP INVDlCc /a1 _ PAID TVIOUNT I 41 Z,{i�Sa 4r0Rf1Np YtSA11C AMOUNT _ L I PLAN CHECK FEES PAID.ANIOUNT j ASH CK2:.6 a CRI.Dir tARQ YiSa'Hc 1 a%vNiZR BUILDER VERIFIED YES NO OL NUMBER .40TARiZED\E"TER . YES_.NO PLAN AARIOVAIL DATI 'Agpreuai a tha :plans shall not be canstr�aa tc be a?2 a to3,or ar, Q!1 O apprrnal Of,anp-v*dos of any provisions of the kajms,stEwarcity regulations and ordinarim. this set of approved plan rust i e kegt on L)a`. easite untli.omoatlon, y, f3 t 5 s M 47 c> Z 4 i ` T C 01 'y m City of Menifee 2uaoo. wiz A Lsonl �. GN�RRr x 0A liw d rl *mL UF. � � s :f .S J �. -z. ,.i I • .,r V• � NPNPKPP�, �} 1 i s - o s- r N� 8808 May 23, 2017 1:744 0 0.005 0.01 0.02 mi Parcel Addresses 1 + Railroads Street Names i. ' , I .i I , I 0 0.01 0.02 0.04 km Parcels Street Names Freeways&Highways Common Lots Freeways&Highways — Freeway Parcels -Outside City Freeway Highway 201BAerel Cities — Highway Major Arterials BIG ;�; Menifee Boundary Major Arterials