PMT17-03771 City of Menifee Permit No.: PMT17-03771
29714 HAUN RD. Type: Residential Alteration
'(;kCC1HU ? MENIFEE, CA92586
MENIFEE Date Issued:
10/27/2017
PERMIT
Site Address: 23560 CASSANDRA DR, MENIFEE, CA Parcel Number: 350-231-043
92587 Construction Cost: $4,500.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALLATION OF RESIDENTIAL FIRE SPRINKLERS TO MH
Work:
Owner Contractor
GILBERTO C RIOS ,
23560 CASSANDRA DR
MENIFEE,CA 92587
Applicant License Number:
GILBERTO C RIOS
23560 CASSANDRA DR
MENIFEE,CA 92587
Phone:9513589173
Fee Description ON Amount is
Residential Sprinkler 1 614.00
$614.00
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 building 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_Perrrmit_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 perjurythat 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 Iicensure 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
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell 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 workers 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.leginfo-ca.goy/calaw.htmi.permit is issued.
Policy# Date
❑I have and will maintain workers 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 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
numberare: application and the information I have provided is correct.I agree to comply
Carrier with all applicable city and county ordinances and state laws relating to
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 C'/'/4' Date l —�/-27]1'7
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
❑I certffy 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 forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
Applicant Date amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 D 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($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 ❑No
I hereby affirm that under the penalty of perjury there Is a construction Will the proposed building or modified facility be within 1DDD 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
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 al Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below bythe
hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5
OYes ❑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(RRP)
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 cam ply 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.Rov/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:
❑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.
I'VIENIFEE FIRE DEPARTMENT PERMIT/PLAN REVIEW SCRHNING FORM
Menifee
PROJECT NAME
PROJECT ADDRESS 3 5 o SS/aN ✓+ `C
ASSESSOR'S PARCEL NUMBER 3 >O - a 31 _ a Y3 LOT TRACT
APPLICANT NAME CL`b-e_A,3 L �toS
YES NO
❑ ❑ 1. Are these changes for a new owner/tenant? If yes,owner shall submit a Certificate of Occupancy and or tenant
improvement.
❑ X 2. Does this project include changes to the site(e.g.parking,striping,relocation of fire hydrants,fire lane)OR an addition
of gates that restrict access to any structure,OR include the construction of a new structure OR increase the footprint
of an existing building?If yes,submit a fire access/gate plan.
❑ 3. Will the new building,addition,or tenant improvement contain one of the following occupancies:Institutional,High
Rise(height of building Is t 75ft.from the lowest point of fire access to highest occupied floor),Factory/Manufacturing.
Assembly(t 50 people gathered for drinking,dining,education,religion,etc.),Educational(grades K-12),or Multi-
family Residential(3 or more units?)If yes,submit architectural plans.
❑ ;;1, 4. Will new buildings,additions or tenant improvement contain storage.ormerchandizing areas(either racks or solid pile)
t 500 sq.ft.where the storage is t 12 high or t 6ft.for plastics,tires and/or flammable liquids?If yes,submit high-piled
storage plans that includes the commodities classification report
❑ 5. Does the project involve the installation or modification to the fire extinguishing system located in a commercial hood?
If yes,submit fire extinguishing system plans for the hood.
❑ 6. Does the project involve the installation or modification of an industrial refrigeration system?(fixed system where
refrigerant is circulated to extract heat,not an HVC system)If yes,submit a Refrigeration Disclosure Form
❑ jl;i• 7. Are Chemicals or compressed gases stored and/or used on the property?If yes,submit a Chem,class report.
❑ ❑ 8. Will there be any obstructions or decorative materials that could potentially affect the existing fire sprinkler coverage?
If yes,approved engineer/contractor shall submit sprinkler plans as separate submittal.
❑ Rj 9. Are there any processes,storage,handling,etc.of any of the following listed items?
A"NO"answer means the business will NOT have any of the below listed operations/storage/use,etc.
A"YES"answer must have the applicable items checked below.(floor plan should specify the locations of those items)
❑ AUTOMOBILE WRECKING YARD ❑ MEDICAL OR INDUSTRIAL GAS INSTALLATION
❑ BATTERYSYSTEMS/STORAGE/CHARGING ❑ WELDING,CUTTING,OR HOT WORKS OPERATIONS
❑ DRY CLEANING OPERATIONS ❑ MATCHES(manufacture or store in excess of 14,000 individual matches)
❑ GARAGE MOTOR VEHICLE SERVICE/REPAIR OF ❑ HAZARDOUS MATERIALS(any chemical which is required to have a
FUEL-DISPENSING STATION material safety data sheet(MSDS),including petroleum products)
❑ COMBUSTIBLE FIBER STORAGE 100 cubic feet(e.g. ❑ INSTALLATION OF LIQUIFIED PETROLEUM GAS(LPG)TANK
Fibrous materials,cotton,wastepaper,straw,moss,etc.) (ABOVE OR BELOW GROUND,PERMANENT OR TEMPORARY
❑ DUST PRODUCING OPERATIONS(wood working,milling,grinding, ❑ SPRAYING OR DIPPING OPERATIONS(flammable or combustible
Pulverizing,grain elevator,flour mill,etc.) liquids applied with a sprayer or used in tanks
❑AEROSOL PRODUCTS(storage t Soo pounds net weight) ❑ Other
The owner of his/her authorized agent is responsible to ensure that all occuoants.Present and future,comply with the reporting and
storage,use and handling requirements for any processes/materials described above.
I understand that a"NO"answer to any ofthe above questions may subject this business to on-site verification by the Menifee Fire
Department.Failure to property disclose the usage of hazardous materials may result in civil or criminal action being taken against you.I certify
under penalty of ppeerjrjury,under the law he State of California,that the foregoing is true and correct.
Date! i S O / Signature of owner or authorized agent Print Name and Title
d CRY of Menifee
g ae ep .
City of Menifee Fire Department 29714 Haun Rd. Menifee, CA 92586
I p
www.Cityafinenifee.us OCT 2 0 Chi/ �J 41�1
ME IFH�FIIRE DEPARTMENT PERMIT/PLAN CHECK APPLICATION
City of Menifee
Building & Safety Dept. Menl fee
DATE: 261 PERMIT/PLAN CHECK NUMBER
TYPE: 4NEW O TENANT IMPROVEMENT O ALTERNATE METHODS&MATERIALS
SUPOMP MV. eSPRINKLER O WATER SYSTEM O PROTECTION SYSTEMS O HAZMATSYSTEMS
nO HIGH PILE/SOLID PILE O ACCESS&WATER O SPECIAL EVENT OR OTHER INSPECTION
PROJECTNAME } re S Klti( r ZIP a -9-7
PROJECTADDRESS 14-n rq b'r
ASSESSOR'S PARCEL NUMBER LOT TRACT
CONTACT INFORMATION / OWNER O APPLICANT O. CONTRACTOR
NAME -,z
BUSINESS f
ADDRESS C F1 SS a- �-Y-\- '4`r ZIP
PHONE 3S8- 9r73 EMAIL
CONTRACTOR'S STATE LICENSE NUMBER 44;0 CLASSIFICATION
APPLICANT SIGNATURE DATE
ALARM ❑SPRINKLER MONITOR ONLY
O New 0 Tenant Improvement ❑FIRE ALARM SYSTEM_#OF DEVICES(INITIATING&NOTIFICATION)
O Alternate Methods&Materials
SPRINKLER "IF MULT/PLE5YSTEM5,USTSYSTEM#AND TOTAL#OF HEADS FOR EACH SYFEM ON SEPARATESHEET
New 0 Tenant Improvement _#OF RISER_#OF SPRINKLERS HEADS
O Alternate Methods&Materials ❑NFPA 13 COMMERCIAL ❑ESFR COMMERCIAL ❑NFPA 13D RESIDENTIAL ❑NFPA 13R RESIDENTIAL
WATER SYSTEM ❑UNDERGROUND SYSTEM_#OF RISERS _#OF HYDRANTS
O New 0 Tenant Improvement ❑FIRE PUMP TEMPORARY ❑ABOVE GROUND SYSTEM EMERGENCY
O Alternate Methods&Materials
❑UNDERGROUND REPAIR ❑STANDPIPES/ HOSE VALVES
PROTECTION SYSTEMS ❑HOOD/DUCT SUPPRESSION(e.g.Ansul System,PyroChem System)
O New O Tenant Improvement ❑SPECIAL EXTINGUISHING(e.g.foam/liquid,FM200,COr,Dry Chemical
O Alternate Methods&Materials
❑SMOKE CONTROL SYSTEM
OTHER SYSTEMS ❑REFRIGERATION SYSTEM ❑SPRAY BOOTHS #OF BOOTHS ❑BATTERY SYSTEM ❑DUST COLLECTION
O New 0 Tenant Improvement SYSTEM
0 Alternate Methods&Materials ❑ INSDUSTRIAL OVENS_#OF OVENS ❑ EMERGENCY RESPONDE RADIO COVERAGE ❑GAS SYSTEMS(e.g.
medical/industrial)
HAZMATSYSTEMS ❑ABOVE GROUND STORAGE TANK ❑INSTALL ❑REMOVAL_#OFTANKS ❑CHEMICAL CLASSIFICATION REVIEW
0 New O Tenant Improvement ❑UNDERGROUD STORAGE TANK ❑INSTALL ❑REMOVAL_#OF TANKS ❑ALTERATIONS TOGAS STATIONS(e.g.
O Alternate Methods&Materials vapor recovery,dispenser changes,anything over than tanks)
HIGH PILE/SOLID TOTAL SQUARE FOOTAGE OF STORAGE INCLUDING AISLEWAYS_#
0 New O Tenant Improvement
O Alternate Methods&Materials
ACCESS&WATER ❑PERMANENT EMERGENCY SITE ACCESS&WATER SUPPLY ❑TEMPORAY FIRE ACCESS&WATER SUPPLY
O New O Tenant Improvement ❑FUEL MODIFICATION
O Alternate Methods&Materials
SPECIAL EVENT OR OTHER INSPECTION:DESCRIBE EVENT/INSPECTION(INCLUDE DATES)
City of Menifee Fire Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityefimenifee.us
'Ll" Menifele,
gcvlallffga Cx. Ya�ei r i9epal,41sr2,�(t
Date Routed: 10/20/2017 Routed By: PARADISE
Due: 11/03/2017
Ro,Wed �(Cn): I st 3 2na ❑ 3rd ❑ Plan Check
❑ Engineering
❑ Planning
K dire
Permit Number: PMT17-03771
Project Name: FIRE SPRINKLERS- RIOS RESIDENCE
Address: 23560 CASSANDRA DRIVE
APN 350-231-043
Tract Lot(S) 71
Applicant Name: GILBERT RIOS
Phone: 951-358-9173 Email: GRIOS@BURRTEC.COM
Departman� Response Date: io 2s i
Reviewed
By:
Approved: Yes ❑ No Approved by:
Comments
ti
Redlines ❑ Yes ❑ 0