PMT17-01973 City of Menifee Permit No.: PMT17-01973
29714 HAUN RD.
<ACCELA-? MENIFEE,CA 92586 Type: Residential Addition
""- MENIFEE Date Issued: 1 011 712 01 7
PERMIT
Site Address: 28865 WICKERD RD, MENIFEE, CA Parcel Number: 372-120-007
92584 Construction Cost: $97,405.84
Existing Use: Private Garage Proposed Use:
Description of CONSTRUCTION OF NEW GARAGE 1248 SQ FT,W/ATTACHED RV GARAGE 1000 SQ FT
Work: W/ELECTRICAL
Owner Contractor
DANIEL WORKMAN A M P MANUFACTURED HOME SPECIALIST INC
31140 DURHAM DR 27630 CONNIE WAY
MENIFEE, CA 92584 SUN CITY, CA 92586
Applicant Phone:9513138484
DENISE SKINNER License Number:997499
A M P MANUFACTURED HOME SPECIALIST INC
27630 CONNIE WAY
SUN CITY, CA 92586
Fee Description Qtv Amounti$1
Services, Switchboards, Control Centers& Panels 1 116.00
Receptacle, Switch, Outlet& Fixture 39 306.00
Building Permit Issuance 1 27.00
Inspections not specified 258 258.14
GREEN FEE 1 4.00
SMIP RESIDENTIAL 1 13.00
New Construction Permit Fee 1 448.07
General Plan Maintenance Fee-Electrical 1 21.10
General Plan Maintenance Fee-New 1 22.40
Construction
$1,215.71
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 sift months,shall expire,and fees paid shall be
forfeited.
AA_Bldg_Pennit_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
Chapter4(commending with section 7000)of D' ' io 3 of a Bus ss and ❑I am exempt from licensure under the Contractors State License Law for
Professimy license is in full fo a and a the following reason:
License ice se N By my signature below I acknowledge that,except for my personal residence
ExpiresSignature _ in which I must have resided for at least one year prior to completion of
improvements covered bythis permit.I cannot legallysell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if It has not been constructed in Its entirety by
ereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section
ve 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 wwwleainfo.ca.gov/calaw.html.
this permit is is(;/yefdd.�I
Policy# 1)11�3 L Date
PROPERTY OWNER OR AUTHORIZED AGENT
❑I have and will maintain workers compensation insurance,as required by
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
with all applicable city and county ordinances and state laws relating to
Carrier �c l t= building construction.I authorize representatives of this city or county to
Policy k 2,y // /(,Expires_ — I — 1 q 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 p ns in any manner so as to become subject to the CITY BUSINESS LICENSE If
workers compen n la s of Ca ifornia, agree t if I should become HAZARDOUS MATERIAL DECLARATION
subject to the wdikers c mpJ'� on p v ions ction 3700 of the Labor
Code,1 shall with CSIy s rovi ' Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to orgreater thatthe
Applicant Date amounts specified on the Hazardous Materials Information Guide?
WARNING: AIL RE TO SEC RKER'S COMPENSA ON DO
EIS ❑Yes ❑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 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 for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) o Yes ❑No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the California Health&Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Oyes ❑No
Business and Professions Code).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(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 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
❑I,as owner of the property,or my employee with wages as theirsole 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/[ead 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.