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PMT17-02521 City of Menifee Permit No. PMT17-02521 29714 HAUN RD. Type: Residential Alteration <AGCEL/� MENIFEE, CA 92586 MENIFEE Date Issued: 1 0131/2 01 7 PERMIT Site Address: 25936 ROANOKE RD, MENIFEE, CA Parcel Number: 339-061-015 92586 Construction Cost: $26,027.04 Existing Use: 1 &2 Family Residence Proposed Use: Description of EXTEND THE MASTER BATHROOM AND BUILD A NEW WALK IN CLOSET. 156 SQ FT Work: Owner Contractor GERALD&SHARON MASSEY GOLDEN GLOVE CONSTRUCTION 25936 ROANOKE RD 43300 BUSINESS PARK DR STE 104 MENIFEE,CA 92586 TEMECULA,CA 92590 Applicant Phone: 9518937117 MENIFEE, CA License Number:835044 Phone:9516754976 Pee Description Oft Amount 151 Receptacle,Switch, Outlet& Fixture 10 161.00 Building Permit Issuance 1 27.00 Additional Plan Review Building 110 110.00 Additional Plan Review Building 275 275.00 GREEN FEE 1 2.00 SMIP RESIDENTIAL 1 4.00 New Construction Permit Fee 1 119.72 General Plan Maintenance Fee-New 1 5.99 Construction $704.71 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 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 Templatexpt Page 1 of 1 CITY OF MENIFEE L�CENSEO 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 contractors)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 Profess Code and my Icense is in full force and effect. 'y the following reason: Ucense'Class License No. By my signature below I acknowledge that,except for my personal residence Expires,2/li ./1 Signature in which 1 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 O KER'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 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 ,,ww.leeinfo.ca.¢av/calaw.html. this permit is issued. Polity# Date PROPERTY OWNER OR AUTHORIZED AGENT have and will maintain workers compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which o 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 an the property owners behalf.I have read this I number are: application and the information 1 have provided is correct.I agree to comply CC/ c' N� (� with all applicable city and county ordinances and state laws relating to Cartier /1 �r�� /'! building construction.I authorize representatives of this city or county to Policy# ,Si/J0_JLD 'I Expires I! Iq 7 enter the above identified property for inspection purposes. I (This section need not to be completed is the permit is for one-hundred Date dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT L{ ❑I cerUfy that in the performance of the work for which this permit is issued, b`l i I shall not emalov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# ( workers compensation laws of California,and agree that if 1 should become subject to the workers compensation provisions of Section 3700 of the Labor (HAZARDOUS MATERIAL DECLARATION Code,I shall fort twrth comply with those provisions. Will the applicant or future building occupant handle hazardous material or a pplicant Date mixture containing a hazardous material equal to or greater that the agioun fled on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS OP es o UNLAWFUL,AND SHALLSUB1ECi 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)7 See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES _ for guid -- - CONSTRUCTION LENDING AGENCY ❑Yes i! I hereby affirm that under the penalty of perjury there is a construction Will th f rroposed building or modified facility be within 1000 feet of the lending agency for the performance of the work which this permit is issued outer of a school? (Section 3097 Civil Code) ❑Yes N 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 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 Yes ❑N Business and Professions Code).Any city or county that requires a permit to Dale construct,alter,improve,demolish or repair any structure,priorto its 'p PERTYOWN ER 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 7liPA RENOVATION,REPAIR AND PAINTING TRRP) License Law(Chapter 9(cam meriting 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 ❑1,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.eaa.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 ❑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. : APPLICATION Menifee DATEM- _`--j PERMIT/PLAN CHECK NUMBER 'T ` '-92-F52 I TYPE: ❑COMMERCIAL 98ESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ❑SIGN SUBTYPE: ❑ADDITION ❑ALTERATION []DEMOLITION [-]ELECTRICAL ❑MECHANICAL [-]NEW ❑PLUMBING [-IRE-ROOF-NUMBER OFSQUARES DESCRIPTION OF WORK S2 �fl -\j c_ wo\yt,.jTA PROJECTADDRESS ASSESSOR'S PARCEL NUMBER W �� p LOT i 3 L]_ TRACT 'S42-7 PROPERTY OWNER'S NAME C- N r, \A ADDRESS 'Q PHONE q'o\- ` EMAIL APPLICANT NAME \\-•Mor--�,t�C. - , ` ADDRESS`� C(oCj ��.�(`�'t',\Q( 5�• �v'\�C !��.`�'\ �d \�� `C� 9 30 PHONE 1 EMAIL \c.G\E,�\ Y\ \�1 P(\0:7\ •C.O CONTRACTOR'S NAME OWNERBUILDER? []YES NO BUSINESS NAME A (7 _ 1 p ADDRESS S,^0,SS K °L. VX ' PHONE QS, _TR ,2) _ EMAIL CONTRACTOR'S STATE LIC NUMBER %% bnL4L`\ , LICENSE CLASSIFICATION VALUATION $ -2-0,Q.(Q SOFT (-� \Cbko LSQFT APPLICANT'S SIGNATURE DATE DEPARTMENT DISTRIBUTION 2 CITY OF MENIFEE BUSINCESSSyyLICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP 4• IJ INVOICE tW I PAID AMOUNT AMOUNT {"� V OCASH OCHECK# OCREDIT CARD VISAfMC PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISVMC OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO City ofMenlfee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586t& y g enifee afety Dept. t. www.cityofinenifee.us Inspection Request Line 951-246-6213 JUL 19 2017 Received