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PMT17-03595 City of Menifee Permit No.: PMT17-03595 29714 HAUN RD. 4ACCELI" MENIFEE,CA 92586 Type: Mobile Home MENIFEE Date Issued: 10/10/2017 PERMIT Site Address: 30910 KELLER RD, MENIFEE, CA 92586 Parcel Number: 472-050-026 Construction Cost: $2,975.00 Existing Use: Proposed Use: Description of INSTALL PERMANENT FOUNDATION ON EXISTING MOBILE HOME,52'x 24' Work: SERIAL#: 12613543A HUD#: PFS207131 SERIAL#: 12613543B HUD#:PFS207132 Owner Contractor DAVID CUPP PERMA-BRACE CONSTRUCTION 30910 KELLER ROAD 21690 VINE ST MENIFEE, CA 92586 WILDOMAR, CA 92595 Applicant Phone: 9512459373 WENDY BROWN License Number:636757 PERMA-BRACE CONSTRUCTION 21690 VINE ST WILDOMAR, CA 92595 Fee Description 61yt Amount ISI Manufactured Permanent Foundation 1 240.72 Permit Fee 1 27.00 $267.72 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_8ldg_Permit_Template.rpt Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects with a licensed contractor(s)pursuant to the Contractors State License Law). I hereby affirm under penalty of perjury that I am under oY sions of Chapter9(commencing with section 7000)of Divislon;3 of the Business and ❑1 am exempt from Iicensure under the Contractor's State License Law for Professions Code and my license is In full force and effec the following reason: 1 License Class L�7 Licem® n. 7S _ By my signature below I acknowledge that,except for my personal residence Expires/- 3��/ Signature In which I must have resided for at least one year prior to completion of N improvements covered by this permit.I cannot legally sell a structure that I WORKER'S COMPENSATION DEIX�6have 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 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 wwv�,Ieginfo.ca.gov/caIaw.htmI. ,Ieginfo.ca.eov/wlaw.html. this permit is sued - Policy# Date ave and will maintain workers compensator insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT e ion 37DO 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 on the property owners behalf.I have read this number are: _ C , / application and the Information 1 have provided is correct.I agree to comply Carrier S 7�ef/ ✓/v O with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy# 176 78'110 Expires_ 1-1—le 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 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 subject to the workers co pensatlon provisions of Section 3700 of the Labor Code,1 shall forthwith comply th tho provisions. Will the applicant or future building occupant handle hazardous material or a Dale ._i i i mixture containing a hazardous material equal to or greater that the Applicant i. fil, i !� amounts specified on the Hazardous Materials Information Guide? WARNINIC FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes P(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(SCAQMD)?See permitting checklist, IN SECTION 3706 OF THE LABOR[ODE,INTEREST,AND ATTORNEYS FEES for guidelines CONSTRUCTION LENDING AGENCY ❑Yes 100 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) ❑Yes Is"o 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 understaftd my requirements under the State of California Health SafetyCode,Section 25505 and 25534 concerning Contractors License Law for the reason(s)Indicated below by the a checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous. rlal c 6rt' g. Business and Professions Code).Any city or county that requires a permit to oyes A f � '� Date 0 construct,alter,improve,demolish or repair any structure,prior to its PROP R 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 Iicensure receMng 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 o 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.eoa.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 yearof 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: ❑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. PERMIT/PLANBUILDING & SAFETY Menifee ldisk& DATE PERMIT/PLAN CHECK NUMBER TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY 95 MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOUTION O ELECTRICAL O MECHANICAL J O NEW O PLUMBING ORE-ROOF APPLICATION NAME / f0 /� w/� DESCRIPTION OF WORK en,) J4,0&.�i PROJECTADDRESS 30 I o gellele lenad LAI@ ASSESSOR'S PARCEL NUMBER 416 LOT Z TRACT 10 21 OWNER NAME v I .P )I� • cU4DvD n ADDRESS �� o�I( o "e �lel�.. o4 ey e� PHONE EMAIL Cit of M / n"9 Safety Dept, APPLICANT NAME LING/I� /6tcf.7/ T 10 q ADDRESS oC J O v /il gcJr"t'��`. ! CUI� PHONE I 3 Fr- 7,9� / EMAIL /X I 3^r l C0_17 CONTRACTOR'S NAME By ,-L C,,C_ 7 OWNER BUILDER? O YES O NO BUSINESSNAME ADDRESS PHONE C f�s� J ��S � 9373 EMAIL CQ�// /•/e©-71 CONTRACTOR'S STATE LIC NUMBER 3(p ;2,S� LICENSE CLASSIFICATION y A VALUATION$ SQ FT 7 �'s L SQ FT APPLICANT'S SIGNATURE DATE aTYSTAFF USE ONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE SMIP X GREEN Y INVOICE AMOUNT ^� PAID AMOUNT r� CCASN ^CHECKq vCREDITCARD VISA/MC PLAN CHECK FEES pe PAID AMOUNT d v CASH 0 CHECK# 0 CREDIT CARD VISA/MC OWNER BUILDER VERIFIED OYES O NO LICENSE NUMBER NOTARIZED LETTER is YES O NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586951-672-6777 www.cityofinenifee.us NAME - lJ PHONE_ JOB ADDRESS 3d TRACTJPARCEL MAP Lcyr ASSESSOR'S PARCEL NO. REARPROPERTYLINE City of Menifee l3 afety Dopt. OCT 10 2ov CITY OF MENIFEE ��� ' Received BUILDING AND SAFETY DEPARTMENT PLAN APPROVAL yy� Y � REVIEWED BY ATE M *Approval of these plans shall notbe construed to be a permit for,or an Z approval of,any violation of any provisions of the federal,state or city '^a Hregulations and ordinances. This set of approved plans must be kept on the F jobsite until completion.PQ w Sht,� a w w F—wsr�,'V / A PuUn.3Le veKN FRONT PROPERTY LINE STREET