PMT17-04134 City of Menifee Permit No.: PMT17-04134
29714 HAUN RD.
<ACCELjA— MENIFEE,CA 92586 Type: Residential Demolition
MENIFEE Date Issued: 11121/2017
PERMIT
Site Address: 30900 OLD WINDMILL RD,MENIFEE,CA Parcel Number: 360-120-021
92586 Construction Cost- $6,000.00
Existing Use: Proposed Use:
Description of DEMO GARAGE CONVERSION AND ATTACHED BEDROOMS 500 SQ FT-CE17-2023
Work:
Owner Contractor
GEORGE CHAVEZ
532 AVOCADO AVE
EL CAJON,CA 92020
Applicant License Number:
GEORGE CHAVEZ
532 AVOCADO AVE
EL CAJON, CA 92020
Phone:6197158029
Fee Description City Amount I$1
Building Permit Issuance 1 27.00
Inspections not specified 129 129.07
$156.07
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_Pennit_Templale.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts forthe projects
I hereby affirm under penalty of perjury that 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 o I am exempt from Iicensure under the 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 m g p y 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
o 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 ,,A,ww.leeinfo.ca.eov/calaw.html.
this 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 ,w y my signature below I certify to each of the following:I am the property
this permit Is issued.My workers compensation Insurance carder 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 ity and county ordinances and state laws relating to
Carrier building constru on.I rize representatives of this city or county to
Policy# Expires enter a abo id M property for inspection purpose .
(This section need not to be completed is the permit is for one-hundred Date -1 �ZI j —7
dollars($100)or less PROP RTY WNER OR AUTHORIZED AGENT
certify_thatin-the.performance.of_thework for which this.permit.is issued, __
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
workers compensati3m laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the work s compen ' n provisions of Section 3700 of the Labor
Code,I shall fo t cam I wi those provisions. Will 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 specified on the Hazardous Materials Information Guide?
WARNING:F)LURE 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($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR _ __ Coasta it require
Management Distr_ic_t ruction or See permitting checklist
IN SECTION 3706 OF THE LABORCODE,INTEREST,AND ATTORNEYS FEES - - Coast Airllnes
Qua
CONSTRUCTION LENDING AGENCY o Yes o 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 1 have read the Hazardous Material Information Guide and the SCAOMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractors License Law for the reason(s)Indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material reporting.
Business and Professions Code).Any city or county that requires a permit to oYes ❑No 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 JRRP)
License Law(Chapter 9(commencing with Section 70001 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
than
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 palm-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.er)a.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 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.
CUILDING-&) SAFETY PERMIT/PLAN CHECK APPLICATION A F Ogg"
DATE: PERMIT/PLAN CHECK NUMBER / - Q
TYPE: O COMMERCIAL Q'RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION 0-bEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O.RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK O LIoLrc,q e Gb A Ue l0 ct-�+r,c 6-e f�
'(s-e�_ V`oo Nt-5,
PROJECT ADDRESS fj(9 FO19 O/7) L.VI✓l j MI ZIP
ASSESSOR'S PARCEL NUMBER ��C7 -I2 c? '-02) LOT TRACT
OWNER NAME C-)60 e-L-A C.6Ut e
ADDRESS -S L pp V O C� 0 A V l= � CG O C-A� 2 d -2 o
PHONE (,Lc? -7 (S- U 0 2 q EMAIL
APPLICANT NAME L-760 WL �JE ,, /I
ADDRESS S 2 UoC do V C� O N � � 202 O
PHONE (OIC7 'f( S 80 Z q EMAIL
CONTRACTOR'S NAME OWNER BUILDER? CASONO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ (p,000 SOFT Sp® LSQFT
APPLICANT'S SIGNATURE DATE
_CITY STAFF USE.ONLY
DEPARTMENT DISTRIBUTION ACCEPTED CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
PERMIT FEE *27 SMIP GREEN
PLAN CHECK FEE INVOICETOTAL
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29 714 HDun Rd. Men ifee, CA 92586951-672-6777
www.cityofinenifee.us