PMT17-03348 City of Menifee Permit No.: PMT17-03348
29714 HAUN RD.
'�rnCCELA— MENIFEE, CA 92586 Type: Residential New
MENIFEE Date Issued: 02/26/2018
PERMIT
Site Address: 32250 HALEBLIAN RD, MENIFEE, CA Parcel Number: 372-100-015
92584 Construction Cost: $725,862.08
Existing Use: Proposed Use: 1 &2 Family Residence
Description of CONSTRUCTION OF NEW SINGLE STORY HOME WITH 4 CAR GARAGE, PATIO 1021 SQ FT AND
Work: DRIVEWAY COVER 304 SQ FT
5615/1472
Owner Contractor
JOSE M. MARIN
1690 MILFORD COURT
PERRIS, CA 92571
Applicant License Number:
JOSE M. MARIN
1690 MILFORD COURT
PERRIS, CA 92571
Phone:9518302967
Fee Description OQt Amount l5l
Services,Switchboards, Control Centers&Panels 2 232.00
Receptacle,Switch,Outlet&Fixture 386 2,041.00
Plumbing Fixtures and Vents,fixtures 22 211.00
Gas System 1 116.00
Plan Check Fee 308 307.50
Plan Check Fee 615 615.00
Residential Water Heater 2 106.00
Sewer 1 150.00
Forced-Air or Gravity-Type Furnace or Burner 3 447.00
Air Handling/Condensing Units SFR 3 399.00
Building Permit Issuance 1 27.00
GREEN FEE 1 30.00
SMIP RESIDENTIAL 1 95.00
New Construction Permit Fee 1 3,338.97
New Construction Plan Check 1 2.170.33
General Plan Maintenance Fee-New 1 166.95
Construction
Quimby Single Family Regular 1 1,204.00
$11,656.76
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 2
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 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
improvements covered by this 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
o 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 Cade,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.le info.ca. ov calaw.ht
this permit is issued. (J
Policy# Date zG O
o I have and will maintain worker's compensation insurance,as required by PROPERTY OWN R OR AUTHORIZED AG
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 er 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
with all applicable city and county ordinances and state laws relating to
Cartier 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
dollars($100)or less Date
PROPERTY OWNER OR UTHORIZED AGENT
❑I certify that in the performance of the work for which this permit is issued,
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those provisions. Will 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 15 o 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(SC construction
or modification
permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY oYes ❑No
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 2000 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) ❑Yes O No
/>aUWNER 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 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 oYes ❑No
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 IRRPI
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($SOD). managers who do the paint-disturbing work themselves or through their
V(I,as owner of the property,or my employeewith wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or'Ipl portion of the work,and the structure is www.epa.gov/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 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. o No EPA Lead-Safe Certified Firm Is required for this project because:
A 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.
DATE: �'�' I PERMIT/PLAN CHECK NUMBER"f '" _FI_l- f)'l,6qz
TYPE: O COMMERCIAL ?RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: G ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
NEW O PLUMBING 0 RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORKc;-fid,- -. _ _ - S-�zY-
PROJECTADDRESS �., 21' �i- _ ZIP S;4tI
ASSESSOR'S PARCEL NUMBER - - LOT TRACT
OWNER NAME
9
ADDRESS
PHONE -t �- � 3G -2-i C'..'-..- EMAIL -'.,.:Si, '✓YI��YI :", :•_- :.� �� , vVllf. _
APPLICANT NAME
ADDRESS
PHONE Cs S —,�k` - 2y 4- EMAIL -
CONTRACTOR'S NAME ..' f, awl OWNER BUILDER? AYES NO
BUSINESS NAME L _ (-
ADDRESS � ��{� � •Y� LT� -- �Z�
11 d71� ri �7 I
PHONE ��I— C7Jv'-Z"!(��- ee '' EMAIL ��<> ✓I>I/iI'i�� �Ip� I
CONTRACTOR'S STATE LIC NUMBER 1J,i - LICENSE CLASSIFICATION
VALUATION $ 'g"J J_ O ��� 05/ SQF��F�-.,7rf .. /144 r;� -7-3os ' L SQ FT ��I-7Z��
APPLICANT'S SIGNATURE _ � ---" - DATE ��-
i
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION ' _ CITY OF MENIFEE BUSINESS LICENSE NUMBER
D B1T.-
BUILDING PLANNING ENGINEERING FIRE ACCEPTE N -,A
PERMIT FEE . u 5�.as SMIP GREEN ,00
1
PLAN CHECKFEE INVOICE TOTAL
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER 0 YES O NO
City Of Menifee tR7111e� -ro lam%
Building & Safety Dept.
SEP 2 2 z0?.' c' t"'n
Riverside County Fire Department It
Fire Protection Planning Section
Riverside Moe:2300 Madtet St.,Ste.150,Riverside,CA 92501 PR(951)955 777 Fax(951)955i886
Palm Dasen OR: 77-933 Las Montanas Rd.,k 201 Palm Desert,CA 92211-4131 Ph.(760)863-8886 Fax(760)863-7072
Fire Department Clearance/Release
Date: 2/21/201 S
To: ccarlson ancityofinenifee.us; brivera@cityofinenifee.us; mbinnall@citvofinenifee.us; pwinters cityofinenifee.us;
tbilo@cityofinenifee.us
Tract/Parcel Map#: 17-MENI-04075
Permit/1-oft
Job Site Address: 32250 HALEBAIN RD
rl Final For Recordation
® Release For Building Permit(s)
1—I Shell Final Only(No Tenant)
1- 1 Final For Occupancy
❑ Release For Residential Sprinkler Installation
F Building Plan Check Fees Paid, Water Requirement Met-if water applicable
FI Building Plan Check Fees Not Paid
n Residential Sprinkler Plan Check Fees Paid
JL Residential Sprinkler Plan Check Fees Not Paid
n Other Fees
F Fees Not Required
If you should have any questions, please contact the appropriate Riverside County Fire Protection Planning office for
further assistance.
SONYA BU FSS
Print Name of Plan ReviewerAnspector Approved Release
SONYA BU FSS
Sent By:Pnnl Name
Form C—Revised 3rol M12
: ,,:
REQUEST FOR PERMIT ISSUANCE Menefee
CITY OF
Prior to issuance of new residential Building Permits,approvals from the departments listed
below are required.Approval shall be designated by the original signature of the appropriate
department staff.When all appropriate signatures are obtained, please return permit issuance
form to the Building & Safety department. Please allow up to 48 hours for processing of
building permits. �1
Permit Number:
Tract Name:
Tract: nLot:
Address: '3Z25b R&A Wary\ (Y). M-ev�, fe_e,
Custom Home: YES M NO Model Home: YES NO (�
Condo/Apt: YES ( ) NO Tract Repetitive: YES 1 NO (�
Mobile/Manufactured Home: YES NO N
DEPARTMENT DATE APPROVAL G ATURE
ENGINEERING
PW IINSPECTOR Z Z
v
PLANNING
RIVERSIDE COUNTY FIRE aa By Email
BUILDING a.al -laoll
List of required items to obtain signatures for Permit Issuance:
Engineering-Grading Plan Approved, Rough Grade Certification,Soils Compaction
Planning-Payment of School Fees, provide receipts,Compliance with all prior conditions,including
approval of Minor Plot Plan Application
Riverside County Fire-Please contact Riverside County Fire 953-955-4777
Building-Payment of Permit and Plan Check Fees,verification of all required signatures City of Menifee
Building Dept.
,EB 2 1 2018
Received