PMT17-03192 City of Menifee
29714 HAUN RD. Permit No.: PMT17-03192
CCEL MENIFEE, CA 92586
MENIFEE Type: Mobile Home
Date Issued: 09/P8/2017
PERMIT
site Address: 27755 JEFFERSON AVE,MENIFEE, CA
92585 Parcel Number: 329-202-006
Construction Cost: $65,000.00
Existing Use:
Proposed Use:
Description of PERMANENT FOUNDATION FOR REP
LACEMENT Work: SERIAL#FLE220CA17-37546A/B INSI N A#PF 11097230814E HOME 1026SO FT
Owner
JOHN OPITZ Contractor
27755 JEFFERSON AVE
MENIFEE,CA 92585
Applicant
JOHN OPITZ License Number.
27755 JEFFERSON AVE
MENIFEE,CA 92585
Phone:9099945828
Fee Description
Manufactured Permanent Foundation Amount
Permit Fee 1 240.72 .
1 27.00
The issuance of this permit shall not prevent the building official from thereafter req ir g p
specifications or from preventing builiding operations being carried on thereunder when in violation of the Building Code of of any other
ordinance of City of Menifee.Except as otherwise stated,a e uinn the correction of errors in the laps and
ion
months after issuance,or where the work commenced is suspended oa abandoned for six months,sher which no e I is commenced expire, nd fees plaid shall be
forfemonths
AA_Bldg_Permit_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 r.I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect, the following reason:
License Class License No. By my signature below I acknowledge that,except for my personal residence
Expires Signature in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION Improvements covered by this permit.I cannot legally sell a structure that I
have built as an owner-builder if it has not been constructed in Its entirety by
D 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 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
this permit is issued. Ie in o.ca. ov calaw.html.
Policy# Date I
o I have and will maintain worker's compensation insurance,as required by PRO E TY OWNER OR A ORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which o B ysignature 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 entel to hove identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less
Pr OWNER OR AUIfHORRED AGENT
o I certify that in the performance of the work for which this permit is Issued, l
I shall not emolov 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 1 should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Cade,I shall forthwith comply with those provisions. WIII the applicant or future building occupant handle hazardous material or a
Applicant Date mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes o No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES WIII 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(SC construction
or See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Airines
Qua
CONSTRUCTION LENDING AGENCY D 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 o No
.OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the 5CAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractor's License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material reporting.
Business and Professions Code).Any city or county that requires a permit to DYes O No
construct,alter,improve,demolish or repair any structure,prior to its Date
issuance,also requires the applicant for the permit to file a signed statement PROPERTY OWNER OR AUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING fRRPI
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 apre-197g
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be ork that disturbs
and comply with
an Applicant for a permit subjects the applicant to a civil penalty of not more requiredpractices.dried.This Includes to rental property than($500). q p p rty owners and property
managers who do the paint-disturbing work themselves or through their
D 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.eoa.eov/lead or contact the National Lead Information Center at
not Intended or offered for sale.(Section 7044,Business and Professions 1-800424-LEAD(5323).
Code,The Contractor's State License Law does not apply to an owner of a DAn EPA Lead-Safe Certified Renovatorwill6e 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:
O I,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.
APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK
Ciiee
Buildiity
&Safety Dept. ft
DATE pp ,pp��``,,pp PERMIT/PLAN CHECK NUMBER
TYP`FlG'�,`QOIVTfVIE9C L O RESIDENTIAL — MULTI-FAMILY IO MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
N NEW O PLUMBING ORE-ROOF
APPLICATION NAME INSTALL
DESCRIPTION OF WORK Remove and Replace Mobile Home
PROJECT ADDRESS 27755 Jefferson Ave, Romoland CA 92585
ASSESSOR'S PARCEL NUMBER 329-202-006 LOT _5 TRACT
OWNER NAME John Opitz
ADDRESS PO BOX 5513
PHONE 909 994 5828 EMAIL
APPLICANT NAME John Opitz
ADDRESS PO Box 5513
PHONE 909 994 5828 EMAIL johnopitz@hotmail.com
CONTRACTOR'S NAME OWNER BUILDER? 41 YES ONO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER /,., LICENSE CLASSIFICATION
VALUATION$ (,s O o D�3 SOFT 02y/ L SO FT
APPLICANT'S SIGNATURE L ✓r� - _ DATE - �1
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS UCENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE SMIP / GREEN /
INVOICE ��
AMOUNT PAID AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AM0 NT O CASH O CHECK N O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED AS
O NO LICENSE NUMBER NOTARIZED LETTER O YES O NO
Menifee Building &Sefery Department 29714 Haun A,d, Menifee, CA 92586 951-672-6777
wwo-v.CI LVOfinenlTee.Us
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Property Information Center
Property Information forthe 2014-2015 tax year as of January 1,2014
Property Information Assessed Value Information
Parcel Number. 329202006-2
Property Address: 27755 JEFFERSON AVE Land 16,855
ROMOLAND CA 92505 Structure 8,905
Legal Description: Lot 95 MB 0131008 ROMOLAFull Value 25,760
Property Type: NIA Homeowners'Exemption 7,000
Assessment Description: 1966 RICHARDSON Total Net 18,760
Year Built 1966 Assessment Information
Square Feet: 624.--' Assessment Number: 329202006-2
Bedroom: 1 Tax Rate Area: 026-202
Bath: 1.0 Taxability Code: 0-00
Pool: N Base Year: 1984
Lot Size: NIA Parcel Map
Sales Information View Parcel Map
Last Recorded Document:12/1983
Recording Number. 0259338
Related Property Information
City Sphere: MENIFEE Tax Assessment District N/A
Supervisodal District: MARION ASHLEY
Landuse Designation: CITY
Agriculture Preserve: NOT IN AN AGRICULTURE
PRESERVE
School District: ROMOLAND&PERRIS
UNION HIGH
Water District EMWD
Fema Flood Plan: FLOOD ZONE
http://pic.asrclkree.com/KSearchDetails.aspx?Assessment=329202006 10/2/2017
27755 JEFFERSON ST.
ROMOLAND, CA 92585 SITE PLAN
APN: 329-202-006 o m
V
CITY OF MEIN1IFEE
BUILDING AND SAFETY DEPARTMENT
PLAN APPROVAL
o�
REVIEWED BY
DE
'APprov?l se Plans shall not be construed to be a permit for,or n
a,oroval ny vio' f any provisions of the federal,state or ty
regulation 5nd ordinance . This set of approved plans must b ept on the
jobsite un ompletion.
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