PMT17-03728 City of Menifee Permit No.: PMT17-03728
29714 HAUN RD.
4q%CCEL/? MENIFEE, CA 92586 Type: Residential Addition
MENIFEE Date Issued: 10/17/2017
PERMIT
Site Address: 28132 MILLSTREAM CT, MENIFEE,CA Parcel Number: 333-612-017
92585 Construction Cost: $800.00
Existing use: 1 &2 Family Residence Proposed use:
Description of INSTALL 15' U/G GAS LINE FOR FIRE PIT, SLEEVED
Work:
Owner Contractor
AARON BEAVERS BILL&DAVE'S LANDSCAPE MAINTENANCE INC
28132 MILLSTREAM COURT 1153 HARLEY KNOX BLVD
MENIFEE,CA 92585 PERRIS, CA 92571
Applicant Phone:9519436455
BILL LEIDENFROST License Number:751707
BILL&DAVE'S LANDSCAPE MAINTENANCE INC
1153 HARLEY KNOX BLVD
PERRIS, CA92571
Fee Description City Amount(EI
Building Permit Issuance 1 27.00
Inspections not specified 116 116.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Building 1 5.80
$149.80
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_Templatarpt 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 perjurythat I am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure underthe Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Cllam 7 5 i� �1 0 1 ', e No. �� By my signature below I acknowledge that,except for my personal residence
Expires 7/ 3 ) f I lSignature c — — 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 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 www.leanfoca.govcalaw:htrnl.
this permit is issued. �
Policyp Ll
-7G y V ( Date
❑I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which ❑By my signature below 1 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.1 have read this
number are; application and the information I have provided is correct.I agree to comply
Carrier !../—e1 Y �Lr�1`�-h�� with all applicable city and county ordinances and state laws relating to
/I building construction.I authorize representatives of this city or county to
Policy ff Expires 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 UCENSE If
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those provisions.D ► /')j ! T/ Will the applicant or future building occupant handle hazardous material or
tam"/— / mixture containing a hazardous material equal to or greater that the
Applicanto`� amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes ❑No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Willthe 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
ADDITIONTOTHE COSTOF 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 ❑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) ❑Yes ❑No
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 understand my requirements under the State of
California Health&Safety Code,Section 25505 and 25534 concerning
Contractor's 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 Ayes ❑No
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,Improve,demolish or repair any structure,priorto 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 pursuantto the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING IRRP)
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 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
in 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 O portion of the work,and the structure is www.epa oov/read 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 Contractor's 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 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.
BUILDING &SAF��IT/PLAN CHECK APPLICATION
DATE: VA In m PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL RESIDENTIAL C MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA 0SIGN
SUBTYPE: 0 ADDITION
e,O ALTERATION O DEMOLITION O� ELECTRICAL 0 MECHANICAL
O NEW e-PLUMBING O RE-ROOF NUMBERpOF SQUARES
DESCRIPTION OF WORK G 1' rz,e, Y l 5 l
PROJECTADDRESS dl�)U/' ZIP Iu-S U
ASSESSOR'S PARCEL NUMBER 333 - LQ]i� �[� LOT TRACT City of SM�enlfee
OWNER NAME V VVkVILO V\f e.AVe�k S
aaLJG� C p I ', L /ADDRESS
PHONE q
S 1 ' q O� l U8 EMAILReceived
APPLICANT NAME ` L e , L% e -ij t`VL U .3 � /I �+ 1
ADDRESS'y t 1 C (� L'1/ L�,M, 1 C_ k ./L,`�X � i 1. /J- l ` S 7 /
PHONE /Jl f -/ b ! SS EMAIL '-A_(Ik7-0 /V0) DAVr
CONTRACTOR'S NAME ) 1 ) t I) V,e A L4,.(6,SW-WNER BUILDER? '0 YES NO
BUSINESS NAME SA (_
ADDRESS ) l S 3 )��p�-I.L t</&L 6 J(
PHONE Ji S f &� `/ U y O EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ o UV ' SO 7 L SQ FT
APPLICANT'S SIGNATURE DATE 7
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE ACCEPTED BY:
PERMIT FEE SMIP )p GREEN 1�
PLAN CHECK FEE INVOICETOTAL ` ,
goo
OWNER BUILDER VERIFIED 0 YES 0 NO DRIVERS LICENSE# NOTARIZED LETTER 0 YES 0 NO
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'Ap al of these plans shall not be cons ued to be a permit for,or an
app I of,any vjolation of any provision of the federal,state or dty.
1
reg atfons and ordinances. This set of approved plat "ust be kept on the
jobs unfil completion.
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