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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.