PMT17-03075 City of Menifee Permit No.: PMT17-03075
29714 HAUN RD.
"ACCELA3' MENIFEE,CA 92586 Type: Residential Demolition
MENIFEE Date Issued:
08I30/2017
PERMIT
Site Address: 28041 MURRIETA RD, MENIFEE., CA Parcel Number: 339-051-020
92586 Construction Cost: $200.00
Existing Use: Proposed Use:
Description of DEMO OF EXISTING PATIO COVER 10'X 12'-COUNTY PERMIT#BZ205440
Work:
Owner Contractor
HILDA PEREZ GRIFFITHS CONSTRUCTION&INTERIORS INC
28041 MURRIETA RD 4076 ALAMO STREET
MENIFEE, CA 92586 RIVERSIDE, CA 92501
Applicant Phone:9513427913
GARY GRIFFITHS Lioense Number:643658
GRIFFITHS CONSTRUCTION&INTERIORS INC
4076 ALAMO STREET
RIVERSIDE,CA 92501
Fee Description gyt Amount($)
Building Permit Issuance 1 2700
Demolition Permit 1 140.00
$167.00
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 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_Pennit_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 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 Co d my license is in full force and ejfec the following reason:
License Class !cerise By my signature below 1 acknowledge that,except for my personal residence
Expires n in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DEC
LA ON 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
❑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 well maintain a certificate of consent of self-insure for worker'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 application is submitted or at the following website:
by Section 3700 of the Labor Code,for the performance of work for which www leeinfo.ca.gov/calaw html.
this permit is issued.
Poliryp Date
❑I have and will maintain worker's compensapon 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 orkers compensation' surance carrier and polity owner or authorized to act on the property owners behalf.I have read this
number ar application and the information I have provided is correct.I agree to comply
Cam! with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy If 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
D I certify that in the performance of the work for which this permit is issued, !^ I —7
1 shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE q V
workers ensation o California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subje work s of
provisions of Section 3700 of the Labor
C ,I rt ly w' fps revisions. Will the applicant or future building occupant handle hazardous material or a
A Date mixture containing a hazardous material equal to or greater that the
amounts specifi the Hazardous Materials Information Guide?
WARN] . A RE T LIRE WORKER'S COMPENSATION COVERAGE IS ❑Yes o_ �Ig q�
UNLAWFUL,AND SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant orfuture building
AND CIVIL FINES UP O ONE HUNDRED THOUSAND DOLLARS($300,00D),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Alt Quality nagement District(SC construction
or See permitting checklist
IN SECTION 3706 0E THE LABOR CODE,INTEREST,AND ATTORNEYS FEES fo Coast
AirlQua
CONSTRUCTION LENDING AGENCY ❑Yes ines
I hereby affirm that under the penalty of perjury there is a construction Will the propos uilding or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is Issued outer bou ry of a school?
(Section 3097 Civil Code) ❑Yes � No
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
Contractors License Law for the reason(s)indicated below by the California th&Safe C d€,Section 25505 and 25534 concerning
haza feria)
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 e -
Business and Professions Code).Any city or county that requires a permit to 0
construct,alter,improve,demolish or repair any structure,prior to its PE OR ORIZED AGENT
issuance,also requires the applicantfor the permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATIO AIR 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 preracto
and the basis for the alleged exemption.Any violation of Section 7031.5 by receiving or childcare n for to beork that disturbs
and comply with
than
Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
❑I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.epa.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees or personal effort,builds or Improves the
property provided that the improvements are not Intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
D I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
DA � PERMIT/PLAN CHECK NUMBER -O m s
TYPE: Q COMMERCIAL SIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O%SIGN
SUBTYPE: O ADDITION OeLTERATiON O DEMOLITION O ELECTRICAL O MEC ICAL^
ONM O PLUMBING ORE-ROOF- MBER OF SQUARES
DESCRIPTION OF WORK-
-
PROJECTADDRE
ASSESSOR'S PARCEL NUM , - Cj QOT 4 TRACT
OWNER NAME -
ADDRESS PHONE T_ �rJ 4?-l9 tS EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NA C OWNER BUILDER? O YES 4N8�
BUSINESS NAME
ADDRESS
Et�IAI��
CONTRACTOR'S STATE LIC NUMBE LICENSE CLASSIFICATION
VALUATION$/ - �'�j S F L SO FT /
APPLICANT'S SIGNAT R '-��_ /> / DATE f
DEPARTMENT DISTRIBUTION / CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP /
INVOICE PAID AMOUNT
AMOUNT O CASH Ci CHECK N O CREDIT CARD VISA MC
PLAN CHECK FEES PAIDAMOUNT OCASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER O YES 0 NO
City of menif6e
Bull
ji-- MEMPH ding & safety Dept.
AND SA-r--tTY DEPARTMENT AVG 3 0 20p
Received
and ordinances, Thi >;i ed plans must bekp; ri
ia-mtE until comPletion.
CL
A'P