PMT17-02477 City of Menifee Permit No.: PMT17-02477
29714 HAUN RD. Type: Residential Plumbing
�ACCEL/? MENIFEE,CA 92586
MENIFEE Date Issued: 07/17/2017
PERMIT
Site Address: 24100 BEVERLY DR,MENIFEE,CA Parcel Number: 341-180-033
92587 Construction Cost: $2,500.00
Existing Use: Proposed Use:
Description of REPLACE LEACH LINES TO EXISTING SEPTIC SYSTEM
Work:
Owner Contractor
KIM FIORI DIAMOND W EXCAVATING
24100 BEVERLY DR 21285 SHOEMAKER DRIVE
MENIFEE,CA 92587 WILDOMAR,CA 92595
Applicant Phone:9516745476
PAULA WILLETTE License Number: 554199
DIAMOND W EXCAVATING
21285 SHOEMAKER DRIVE
WILDOMAR,CA 92595
Fee Description Qtv Amount lSl
Sewer 1 150.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 7.50
$185.50
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 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 forthe projects
I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contractor's State License Law for
Professions Cod,"nd my license is In full force and effect. the following reason:
License Class f�.' Lie No. ( By my signature below I acknowledge that,except for my personal residence
Expires I Signature S=A Q At in which 1 must have resided for at least one year prior to completion of
improvements covered bythis 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 forworker'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 applicatlon 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. www.leginfo.ca.gov/calaw.htmi.
Policy# Date
ram,/have and will maintain worker's compensa don 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
number are: application and the information I have provided is correct.I agree to comply
Carrier with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# Expires 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 employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those provisions. WIII the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the.
Applicant Date amounts ecified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 ❑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 CIVI L FINES UP TO ONE HUNDRED THOUSAND DOLLARS($500,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Duality Management District(SCAQMD)7 See permitting checklist
far guide-nes
CONSTRUCTION LENDING AGENCY ❑Yes PNo
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 boyndiary of a school?
(Section 3097 Civil Code) ❑Yes /L No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAOMD
I hereby affirm under penalty of perjury that am exempt from the permitting checklist.I understand my requirements underthe State of
Contractor's License Law far the reasons)indicated below by the hazardo California Health&Safety Code,Section 25505 and 25534 concerning
ceckmark(s have placed next to the applicable items)(Section 7031.5 Dyes eri
Business and Professions Code).Any city or county that requires a permit to eporti pate�`1 •—1 ,
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED AGENT
issuance,also requires the applicant for the permitto file a signed statement
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION.REPAIR AND PAINTING(RRPI
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 orthrough 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.eoa.aov/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 Contractor's State License Law does not apply to an owner of a o 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 Contractor's 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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION - .
Menifee
DATE 7-17-17 PERMIT/PLAN CHECK NUMBER 1 -O3
TYPE: []COMMERCIAL []RESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION []DEMOLITION ❑ELECTRICAL ❑MECHANICAL
❑NEW ❑PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Replace leach lines
PROJECTADDRESS 24100 Beverly 84mti?a. Q 77
ASSESSOR'S PARCEL NUMBER 3Lj I -I pQ —y'53 LOT 111-2 TRACT
PROPERTY OWNER'S NAME Kim F11 or
ADDRESS 24100 BeverlyStreet
PHONE EMAIL
APPLICANT NAME Paula Willette
ADDRESS 21285 Shoemaker Dr.
PHONE 951-674-5476 EMAIL wildomar@aol.com
CONTRACTOR'S NAME PaulaWillette OWNERBUILDER? ❑YES❑NO
BUSINESS NAME Diamond W Excavating
ADDRESS 21285 Shoemaker Dr., Wildomar, CA 92595
PHONE 951-674-5476 EMAIL wildomar aol.com
CONTRACTOR'S STATE LIC NUMBER 554199 LICENSE CLASSIFICATION C-42
VALUATION$ $2,500 Q FT L SO FT
APPLICANT'S SIGNATURE DATE 7-17-17
DEPARTMENT DISTRIBUTION CITY OF MENIF E BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN $MIP
INVOICE PAID AMOUNT
AMOUNT �• OCASH OCHECK# OCREDITCARD VISA/MC
LP'
AN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213