PMT17-03720 City of Menifee Permit No.: PMT17-03720
29714 HAUN RD.
<NCCELh? MENIFEE,CA 92586 Type: Residential Plumbing
MENIFEE Date Issued: 10/16/2017
PERMIT
Site Address: 29694 BUENA TIERRA, MENIFEE 92586 Parcel Number: 336-222-015
Construction Cost: $5,200.00
Existing Use: Proposed Use:
Description of REPLACING BATHROOM DRAIN LOCATION AND SHOWER, CHANGING EXISTING SHOWER
Work: VALVE, REPLACING TIOLET EXISTING LOCATION-KITCHEN REPLACING 6 FLORESCENTS
LIGHTS WITH CAN LIGHTING.
Owner Contractor
NLPI C S GENERAL CONTRACTING INC
4411 E LA PALM 1237 W 9TH ST
ANAHIEM, CA 92507 UPLAND, CA 91701
Applicant Phone:9092089474
JEFF LAWRENCE License Number:947524
C S GENERAL CONTRACTING INC
1237 W 9TH ST
UPLAND,CA 91701
Fee Description Qtv Amount l8l
Receptacle, Switch, Outlet& Fixture 6 141.00
Plumbing Fixtures and Vents, fixtures 1 116.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 5.80
General Plan Maintenance Fee-Electrical 1 7.05
$297.85
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 slated,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_Permk_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)pursuantto 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 6 Ucens No.—Lit 7SZ Y By my signature below I acknowledge that,except for my personal residence
Expires 3-3�-« Signatur in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATI improvements covered bythis permit.I cannot legallysell a structure that I
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 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 wwvi.IeRinfo.ca.gov/caIaw.htmI.permit is issued. w
Policy# Date
arnave and will maintain worker's tion insurance,as required by compensation PROPERTY OWNER OR AUTHORIZED AGENT
p
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 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 Ci- 5.,�„„tr �a- l ,t y Zt�_...e e with all applicable city and county ordinances and state laws relating to
r, building construction.I authorize representatives of this city or county to
Policy# u( - .39�1-0/-cf Expires 1-13 -M- 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
❑I certify that In the performance of the work for which this permit is issued,
I shall not employ 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 forth l ith co ,ply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applica Date �G''� �j7 mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNI -:FA URE TO SECURE WORKER'S COMPENSATION COVERAGE LS ❑Yes laFo
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(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes tSNo
I hereby affirm that underthe penalty of perjurythere 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 trNo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements underthe State of
I hereby affirm under penalty of perjury that I am exempt from the California Health&Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)Indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable Item(s)(Section 7031.5 Vfes o P40
Business and Professions Code).Any tiny or county that requires a permit to Date /C"(L-1]
construct,alter,improve,demolish or repair any structure,prior to Its PSI 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(RRPJ
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 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.gov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-8DO-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:
❑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
• i APPLICATION
i
Menifet
DATE: f j _ PERMIT/PLAN CHECK NUMBER inT �'� 62> ib
TYPE: 0 COMMERCIAL RESIDENTIAL 0 MULTI-FAMILY C MOBILE HOME O POOL/SPA C SIGN
SUBTYPE: 0 ADDITION C ALTERATION 0 DEMOLITION 0 ELECTRICAL 0 MECHANICAL
C NEW C PLUMBING 0 RE-ROOF NUMBER OF SQUARES-
DESCRIPTION DESCRIPTION OF WORK (� ( 11 4 ( ,)p 4,11
A t ✓1
PROJECTADDRESS .2969// /,/ �lw.c �C ZIP V2!�-'r4
ASSESSOR'S PARCEL NUMBER 3310 ' Z2 L, DIT LOT q' TRACT 17 D
OWNER NAME All -Z
ADDRESS / L
PHONE 7/4/- 5'jf_&]gg EMAIL
APPLICANT NAME 7,_e e4K L
ADDRESS IZ ' (/lr. 1(yr,PHONE EMAIL vv I/✓l ,L< -,*7
CONTRACTOR'S NAME GrJ• / Lea. ...� OWNER BUILDER? 0- YES '1 40
BUSINESS NAME 4/. C! ��
ADDRESS /Z G/. / "
PHONE �9-Z, -A'Al /J/l EMAIL
CONTRACTOR'S STATE LIC NUMBER % 7SZV LICENSE CLASSIFICATION
VALUATION$ 4ow SZ c 0 SO FT L SO FT
APPLICANT'S SIGNATU DATE -
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
ACCEPTED BY:
BUILDING PLANNING ENGINEERING FIRE
PERMIT FEE �� SMIP GREEN
PLAN CHECK FEE INVOICE TOTAL
OWNER BUILDER VERIFIED 0 YES O NO DRIVERS LICENSE# NOTARIZED LETTER 0 YES 0 NO
Ciry of meoifee Building&SofeTy Deoortmenr 29714 HDun Rd, Menifee,CA 92586 951-672-6777
www.cityofmenifee.us
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