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PMT17-04034 City of Menifee Permit No.: PMT17-04034 29714 HAUN RD. `�CCEL/4? MENIFEE, CA 92586 Type: Residential Addition MENIFEE Date Issued: 1 110 912 01 7 PERMIT Site Address: 29305 WILDCAT CANYON RD, MENIFEE, Parcel Number: 351-250-018 CA 92587 Construction Cost: $1,200.00 Existing Use: 1 &2 Family Residence Proposed use: Description of STACK STONE FIREPLACE WITH 110'FEET OF GAS LINE WITH SHUTOFF Work: Owner Contractor EDWARD CORTEZ 29305 WILDCAT CANYON RD MENIFEE, CA 92587 Applicant License Number: EDWARD CORTEZ 29305 WILDCAT CANYON RD MENIFEE,CA 92587 Phone:9514304638 Fee Description sty Amount[S1 Gas System 1 116.00 Building Permit Issuance 1 27.00 Inspections not specified 129 129.07 Additional Plan Review Building 13 12.91 GREEN FEE 1 1.00 SMIP RESIDENTIAL 1 1.00 General Plan Maintenance Fee-Building 1 6.45 $293.43 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_Permil_Template.rpt Page 1 of 1 CITY OF MENIFEE LICENSED D�TION property who builds or Improves thereon,and who contracts for the projects I hereby affirm under penalty of perjury that 1 am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law). s5 Chapter!)(commencing with section 7000)of Division 3 of the Business and am exempt from Ilcensure under the Contractors State License Law for Professions Code and my license is in full force and effeR the following reason:sr 61.71y/z:-4&JAj 2Z 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 t e following website: by Section 3700 of the Labor Code,for the performance of work for which this permit is issued. www.le info 'a. ov alaw.htm Policy# Date //^ 7 ^L el t ❑I have and will maintain workers compensation Insurance,as required by P OPERTY OWNER OR HORIZED ENT section 3700 of the Labor Code,for the performance of the workfor which 'l Y my signature below rtify- ch 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 identifie propertyf inspection purposes. (This section need not to be completed Is the permit is for one-hundred Date dollars($100)or less PRO RTY OWN OR AUTO ZED NT ❑I certify that in the performance of the work for which this permit is issued, I shall not emnlov 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 ILHAZARDOUS MATERIAL DECLARATION subject to the workers compensation provisions of Section 3700 of the Labor "' Code,I shall forthwith comply with those provisions. WIII the applicant or future building occupant handle hazardous material or a Applicant Date mixture containing a hazardous material equal to or greater that the amounts s ecified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 ❑Yes ^,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($500,000),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 D Yes �lo I hereby affirm that under the penalty of perjury there is a construction WIII the proposed building or modified facility be within 10D0 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 410 l�OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD permitting checklist.I understand my requirements under the State of I hereby affirm under penalty of perjury that I am exempt from the California Contractor hazardous s License Law for the reason(s)indicated below by the 5505 and 25534 concerning rdous a Health al Safety Code,Secti o checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 h material reporting. Business and Professions Code).Any city or county that requires a permit to "ies ❑N construct,alter,improve,demolish or repair any structure,prior to its Date issuance,also requires the applim PROPERNERD UTHO RED NT•nt for 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 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 ownerof the property,or my employee with wages as theirsole employees.For more information about EPA's Renovation Program visit: compensation,will do -Ill 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 1-800-424-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: as owner of the property am exclusively contracting with licensed to tractors 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 CHECK APPLICATION Menifee DATE: PERMIT/PLAN CHECK NUMBER TYPE: O COMMERCIAL ixRESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL 43 L W PLUMBING O RE-ROOF NUMBER OF SQUARES DESCRIPTION OF WORK LL ';9_ PRQJECTADDRESS '• -' J� (;j) „ I ma'slegr ZIP ASSESSOR'S FARCE LNUMBER LOT 1V TRACT OWNER NAME ADDRESS �)` PHONE !'��_ L _ 7� 3� EMAIL APPLICANT NAME — ADDRESS 1� PHONE EMAIL CONTRACTOR'S NAME OWNER BUILDER? C;YES NO BUSINESS NAME ADDRESS 1.- PHONE !qSW EMAIL •?' — l Cbl' CONTRACTOR'S STATE LIC NUMBER �?z j LICENSE CLASSIFICATION VALUATION$ SQ FT L SO FT APPLICANT'S SIGNATURE DATE —CITYSTAFF 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 OYES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777 www.cityofmenifee.us • !�1 I � " i ' I I r I I i � I I I 'WI� I Sit ^� m 1 I S ' I I - o UJ v .o ` v....- -�.I71 ...ro--� m a 1 I I I - I �� { , •-lam � � ' N - ! `'� _v C., i An - - - m - - I� � - --; --- , L I LW 73 ' t�'� I I I I ! � • I� n C� c/J1 - - 1ry 1 ' I I i 1 I f I t I I i I I 1 i : I I I � ' � I i I ry iAc - 1 1i lS (i�l• .ci jam'�� C •{ I- __ I' sel : I _ I 1 5 f 1 I ! " t I 111 gg '� kit IM 7-1 L I I'LI I _I 1 .I I 1