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PMT17-04121 City of Menifee Permit No.: PMT17-04121 29714 HAUN RD. -'ACCEL:A-21' MENIFEE, CA 92586 Type: Mobile Home MENIFEE Datelssued: 11/17/2017 PERMIT Site Address: 33625 SWEETWATER CANYON RD, Parcel Number: 384-080-003 MENIFEE,CA 92584 Construction Cost: $7.500.00 Existing Use: Proposed Use: Description of DEMOLITION OF EXISTING MOBILE HOME DUE TO FIRE DAMAGE 1248 SO FT Work: Owner Contractor ROBERT JACOBSON LANK ENTERPRISES INC 33625 SWEETWATER CANYON RD P 0 BOX 891416 MENIFEE, CA 92584 TEMECULA, CA 92589 Applicant Phone: 9516767114 CARLY ROZZO License Number.458947 LANK ENTERPRISES INC P0 BOX 891416 TEMECULA, CA 92589 Fee Description QQtrr Amount I51 Building Permit Issuance 1 27.00 Demolition Permit 1 140.00 $167.00 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 Permit_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 perjurythat I am under provisions of Chapter9(commencing with section 7000)of Division 3 of the Business and in 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 ft '/ License No. C� (b By my signature below I acknowledge that,except for my personal residence Expires -30 Signature Q IwD in which I must have resided for at least one year prior to completion of UQJ 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 this perm www.lezinfo.ca.¢pv/calaw.html. permit iissued. Policy# Date PROPERTY OWNER OR AUTHORIZED AGENT ❑I have and will maintain worker's compensation insurance,as required by 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: (+1J� [. �yOU� application and the information 1 have provided is correct.I agree to comply Carrier Lf"t--p'6LjQ.Q \ with all applicable city and county ordinances and state laws relating to � building construction.I authorize representatives of this city or county to Policy# RI U ll`t m p Expires � — ' � ' d 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 e I-ceri fyAhat-ln-the-performance of-the-work-for-which-this-permit-is Issued, L.-1.I-y.�1_ I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# V_JW/0P- worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the worker's compens 'on provisions of Section 3700 of the Labor Code,I shall hwit [amply w 'trhose provisions. Will the applicant or future building occupant handle hazardous material or a Applicant ~/ t�� mixture containing a hazardous material equal to orgreater that the ^' Date amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO URE WO D' R4 COMPENSATION COVERAGE IS ❑Yes ki.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 SECTION3706'OF THE LABOR CODE INTEREST,AND_ATTORNEYS FEES- - for guide' es CONSTRUCTION LENDING AGENCY ❑Yes u Np 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 aschool? (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 haza pus m tenal r rtmg. checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 N Business and Professions Code).Any city or county that requires a permit to n�J -Date Ih construct,alter,improve,demolish or repair any structure,prior to its PR6rfkTy OWWA OR AUV IZE " GD.4 ENT 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 Contractor's 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 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.S 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 in 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 1-80G-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. DATE: PERMIT/PLAN CHECK NUMBER?M (-7-0 LWaI TYPE: _COMMERCIAL • RESIDENTIAL O MULTI-FAMILY &MOBILE HOME O POOL/SPA O SIGN SUBTYPE: C ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES DESCRIPTION OF WORK \ M PROJECTADDRESS SIsJ�Q`CN11�nYYCpY �fl(�IM/� . ( y��ZIP G ASSESSOR'S PARCEL NUMBER LOT LOT TRACT OWNER NAME ADDRESS 2 PHONE 11 --�Y,�-- EMAIL l APPLICANT NAME l JL S in G• ADDRESS TO e_�DV i'6 (l j� 0 E G PHON (Q�(,Q-1��f' EMAIL CONTRACTOR'S NAME g C_4•OWNER BUILDER? O YES WNO BUSINESS NAME ADDRESS ,4t T PHONE QG( �g' (Q -1 114 EMAIL CONTRACTOR'S STATE LIC NUMBER 4FQ�QL11 LICENSE CLASSIFICATION C 4-),- VALUATION$ :�-L!r SQ PetsLSQ FT APPLICANT'S SIGNATURE DATE lI �ll -CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION y CITY OF oI BUSINSL�N$ENUMBER BUILDING PLANNING ENGINEERING FIRE ACCEPTED 8Y: 'J�r/-/ �O®,L VIJ PERMIT FEE SMIP GREEN PLAN CHECK FEE INVOICE TOTAL IVI OWNER BUILDER VERIFIED 0 YES O NO DRIVERS LICENSE ii NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Department 29714 Houn Rd, Menifee, CA 92586 951-672-6777 www.cityo fm enifee.us