PMT17-03519 City of Menifee Permit No.: PMT17-03519
29714 HAUN RD. Type: Residential Alteration
'c-�CCEL/> MENIFEE, CA 92586
MENIFEE Date Issued: 11/06/2017
PERMIT
Site Address: 28298 VIENNA CT,MENIFEE, CA 92584 Parcel Number: 372-392-022
Construction Cost: $30,003.18
Existing use: 1 &2 Family Residence Proposed use:
Description of GARAGE CONVERSION TO LIVABLE SPACE,262 SF,WITH ELECTRICAL AND HVAC, ENCLOSE
Work: EXISTING ENTRY WAY, 164 SF,WITH ELECTRICAL
Owner Contractor
ANDRE&ROSEMARY PARADIS
28298 VIENNA COURT
MENIFEE,CA 92584
Applicant License Number:
MENIFEE,CA
Fee Description gtv Amount I$
Receptacle, Switch, Outlet&Fixture 25 236.00
Air Handling/Condensing Units SFR 1 133.00
Building Permit Issuance 1 27.00
Additional Plan Review Electrical 110 110.00
Additional Plan Review Electrical 110 110.00
GREEN FEE 1 2.00
SMIP RESIDENTIAL 1 4.00
New Construction Permit Fee 1 138.01
General Plan Maintenance Fee-New 1 6.90
Construction
$766.91
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 MENIF
LICENSED DECLARATION. operty who builds or improves thereon,and who contracts for the projects
I hereby affirm under penalty of perjury that I am under provisions of ith a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 70D0)of Division 3 of the Business and clam exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class License No. By mysignature 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
❑I hereby affirm under penalty of perjury one of the following declarations:I licensed cokBusinend
rstand that a copy of the applicable law,Section
have and will maintain a certificate of consent of self-Insure for workers 7044 of thofessions Code,is available upon request when
compensation,issued by the Director of Industrial Relations as provided for this applic or at the following website:
by Section 3700 of the Labor Code,for the performance of work for whichthis permit is Issued. www.le tml.
Policy# Date
P RERTYORIZED AGENT
❑I have and will maintain workers compensation insurance,as required by
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 owner or authorized to act on the property owners behalf.I have read this
number are: application and the Information I have provided is correct.I agree to comply
Carrier with all applicable and c unty ordinances and state laws relating to
building constru on.I a orize representatives of this city or county to
Policy# Expires enter ab identl d property for inspection purposes. / I
(This section need nut to be completed is the permit is for one-hundred Date �/N
dollars($100)or less
W OR AUTHORIZED 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
subjectto 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:FAIL)RETO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes o 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(SX00,000),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
- -INSECDON3706,DF THE LABOR CODE,..INTEREST,AND ATTORNEYS FEES for guidelines -
—
CONSTRUCDONLENDINGAGENCY ❑Yes ❑No
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 10DO 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 ❑No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
ereby affirm under penalty of perjury that I am exempt from the California Health&Safety Code,Section 25505 and 25534 concerning
ConVactors License Law for the reason(s)Indicated below by the hazardous material reporting.
checkma,k(s)1 have placed next to the applicable item(s)(Section 7031.5 ciYes ❑No
Business and Professions Code).Any city or county that requires a permit to 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(FIRM
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
❑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.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 ❑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:
o 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.
CUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE: 1,0 PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL PRESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: WADDITION eALTERATION O DEMOLITION O ELECTRICAL O MECHANN,)XDt Menitee
O NEW O PLUMBING ORE-ROOF NUMBER OF SQUARES BUll ccll'ing & Safety D pt.
DESCRIPTION OF WORK cal_ OCT 0 3 2
PROJECTADDRESS ZIP a12S L-/
ASSESSOR'S PARCEL NUMBER Z '�'Z��- LOT TRACT
OWNERNAME Of3cL4
ADDRESS Zzzok.Z6
PHONE EMAIL vVLY�SGA/ >t• �i (2%ANA-tL , (.pM
APPLICANTNAME
ADDRESS 'Z� !' /1/1.�uGc�L.Aa- ��C�•J hY7i—�L71 ^TG'"t't`�' -�` I z_
PHONE aSL -1U.-C EMAIL y-�,PAJ1tX I . C..r,O
CONTRACTOR'S NAME OWNER BUILDER? VYES O NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ SO FT �) Z L SQ FT
APPLICANT'S SIGNATURE DATE 2 —��
CITY STAFF USE ONLY _
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
•
BUILDING PLANNING ENGINEERING FIRE ACCEPTED BY:
PERMIT FEE SMIP a- GREEN
PLAN CHECK FEE INVOICE TOTAL 1 I
.91
OWNER BUILDER VERIFIED OYES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us