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PMT17-03876 City of Menifee Permit No.: PMT17-03876 29714 HAUN RD. '�CCEGA MENIFEE, CA 92586 Type: Residential Plumbing MENIFEE Date Issued: 10/30/2017 PERMIT Site Address: 24048 BUCKSTONE LN, MENIFEE, CA Parcel Number: 358-550-018 92584 Construction Cost: $300.00 Existing Use: Proposed Use: Description of U/G GAS LINE FOR FUTURE FIRE PIT- 15 FT 3/4 WRAPPED BLACK PIPE Work: Owner Contractor RUSSELL PARKER 24048 BUCKSTONE LANE MENIFEE,CA 92584 Applicant License Number: RUSSELL PARKER 24048 BUCKSTONE LANE MENIFEE, CA 92584 Phone: 9512858339 Fee Description ,O�t Amount($1 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 $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_Pemnit 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 provisions of Chapter9(commencing with section 7000)of Division 3 of the Business and d I am exempt from licensurree�unde�rthhee Contractors 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 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 workers 7044 of a iness and es s Code,is available upon request when compensation,issued by the Director of Industrial Relations as provided for this plic " n is su ed or following website: by Section 3700 of the Labor Code,for the performance of work for which this permit is issued. w info. I. Z I Policy# i Date c"n ❑I have and will maintain workers compensation insurance,as required by IO ERN OR ArTHORIZED AGENT section 3700 of the Labor Code,for the performance of the work for which ❑By my Siena.-,re 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 with all applicable city and aunty ordinances and state laws relating to Carrier build co tructfpn. uthori presentatives of this city or aunty to Policy# Expires ent r above id if rSperty for inspection purposes. aC, (This section need not to be completed is the permit is for one-hundred ��/ //�/�O dollars($100)or less / � NER�QR UTHORIZED AGENT D 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 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 greaterthat the amounts specified an the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 ❑Yes 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 guideline3� CONSTRUCTION LENDING AGENCY ❑Yes : 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 on NS" 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 permittln list.I under requirements under the State of ^ Contractors License Law for the reason(s)indicated below by the Califor H h al Safety de,Sects 5505 and 25534 tooter ing Ah�azaorial repcheckmark(s)I have placed next to the applicable items)(Section 7031.5 /Business and Professions Code).Any city or county that requires a permit to ` teconstruct,alter,improve,demolish or repair any structure,prior to its NE / AUTHORIZED AGENT issuance,also requires the applicant forthe permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors State ON.REPAIR AND PAINTING LRRPJ 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 ❑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-BOG424-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 forthis 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 APPLICATION 441110 R ienifee DATE: bD I PERMIT/PLAN CHECK NUMBER I V' TYPE: O COMMERCIAL Pl RESIDENTIAL O MULTI-FAMILY 0 MOBILE HOME O POOL/SPA 0 SIGN SUBTYPE: 0 ADDITION 0 ALTERATION O DEMOLIT�p`N O ELECTRICAL 0 MECHANICAL O NEW O PLUMBING ORE-ROOF NUMBER O SQUARES DESCRIPTION OF WORK I^1 A A M,q S I I✓1 2 J ` PROJECTADDRESS aA049 '&AckOyne, Lli ' ZIP ASSESSOR'S PARC UMBER V •OICLOT TRACT / (e IT C1 OWNER NAME p�,t ADDRESS 6 7 8 �S} _ /�. PHONE CSC Z EMAIL APPLICANT NAME u ADDRESS PHONE EMAIL CONTRACTOR'S NAME OWNER BUILDER? €;;*S"O NO BUSINESS NAME ADDRESS PHONE EMAIL CONTRACTOR'S STATE LIC NU ER LICENSE CLASSIFICATION VALUATION$ �3�D0 L SQ FT APPLICANT'S SIGNATU DATE R i b ITO Zo/ CITYSTAFF USE ONLY DEPARTMENT DISTRIBUTION ACCE TED BY: CITY OFf ENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE A 1Ar PERMITFEE L SMIP ��j GREEN PLAN CHECK FEE INVOICE TOTAL OWNER BUILDER VERIFIED OYES 0 NO DRIVERS LICENSE# NOTARIZEDLETTER O YES O NO City of Menifee BuNo" Dept. City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-572-6777 www.cityofinenifee.us OCT 3 0 2017 Received '(7 H c�Puy j —I lci�5�,�� �K_''rtltit 16 i �cwc,- Pt P� I y 2 rt, rt V\\ C1TY OF MEMFEE pEPARSMENTIc ND SAFE't'`� , 1 DACE [�' REV1EwED gY ba0ecmcttoc.°can tJ \ edto 'a• dti C sha11 nothe COnsu° 1 state oc the 1 i tans s of the tedero �bekePt on Now", eSeP goaotanVPtOvcson covedPlanSmo 1` — l of set of apP appTo"al of a ordinances.thcs 1� X cegnlatconsand lesion. ' �opscte unt11 come (I Cn P City of Menifee CD Building Dept. OCT 3 0 2017 Received _ � . .