PMT17-04463 City of Menifee Permit No.: PMT17-04463
29714 HAUN RD. Type: Residential Alteration
'5ACCEL/-> MENIFEE, CA 92586
MENIFEE Date Issued: 12/18/2017
PERMIT
Site Address: 23700 NORMA DR, MENIFEE, CA 92587 Parcel Number: 350-261-032
Construction Cost: $20,000.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of SPECIAL FIRE DAMAGE INSPECTION
Work:
Owner Contractor
KRIS HANSEN JULZ CORPORATION
22300 SORREL AVE 26871 HOBIE CIRCLE#B-7
MURRIETA, CA 92562
Applicant Phone:7605615016
MICHALE MCQUINN License Number:955780
JULZ CORPORATION
26871 HOBIE CIRCLE#13-7
MURRIETA, CA 92562
Fee Description QtV Amount(5)
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 building operations being carded 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_Peonit 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 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 ❑I am ezemptfrom Iicensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
a \
License Class QQ License No. t�1 J By my signature below I acknowledge that,except for my personal residence
Expires 1�3) Signature p, I\�1 In which I must have resided for at least one year priorto 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
in 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 www.leeinfo.ca:eov/calaw.html.
this permit is issued.
Policy# Date
❑I have and will maintain worker's 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 worker's compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
number are: application and the Information I have provided Is correct.I agree to comply
S 5]ON� with all applicable city and county ordinances and state laws relating to
Carrier—ram--'r —7 �+, building construction.I authorize representatives of this city or county to
Policy# a- (PJ q 3 ` Expires Z� -201 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
❑I certify that in the performance of the work for which this permit is issued,
shall not emolov any persons in any manner so as to became subject to the CITY BUSINESS LICENSE#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,1 shall fort wi h comply with those provisions. �f y rrr�����^ Will the applicant or future building occupant handle hazardous material or a
Applicant Ir Date /U' �� �D / mixture containing a hazardous material equal to or greater that the
/ amounts specified on the Hazardous Materials Information Guide.
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑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 Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE.LABOR CODE,INTEREST,AND ATTORNEYS FEES forguid'e' es -
CONSTRUCTION LENDING AGENCY ❑Yes -g�N0
1 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 bou dary of a school?
(Section 3097 Civil Code) ❑Yes 7No
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 Health al Safety Code,.5ection 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the
ardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 ❑ es
Business and Professions Code).Any city or county that requires Eires a perq�t Date
tp �NA.o�
construct,alter,improve,demolish or repair any stru oA IiOC 000
PRO RTY O OWNER OR AUTHORIZED AGENT
issuance,also requires the applicant for the permit to StAlding 000nt
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 1viSiT 107 The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)or that he or she is exe ��60��li n �(/ 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). PPin/l1v VQG managers who do the paint-disturbing work themselves or through their
❑I,as owner of the property,or my employee wigeSaHhe��le" m 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 1-800-424-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.
& SAFETY PERMIT/PLAN CHECK APPLICATION Yevje[.
Menifee
DATE: cam/ PERMIT/PLAN CHECK NUMBE
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION 0 ELECTRICAL 0 MECHANICAL
O NErW O PLUMBING C RE-ROOF
lnNUMBER OFFnSQAAUARES
DESCRIPTION OF WORK W 1�� LInV1' �"i
PROJECTADDRESS �3 `J ZIP I Z-� jg
ASSESSOR'S PARCEL NUMBER c� -2b� LOT V TRACT
OWNER NAME
ADDRESS
PHONE EMAIL
APPLICANT NAME v�' \���/.� C`�—• rn \
ADDRESS Z�7 S' 1RA �aA
PHONE 90l^ �(pj^ �3 y n EMAIL �L-f� JNJ/ V S ! �i (? III��I ( VI
CONTRACTOR'S NAME 3vL�i � j' OWNER BUILDER? OYES hNO
BUSINESS NAME ` cog f I
ADDRESS-�7Z (O 101
PHONE Y �' b EMAIL
p
CONTRACTOR'S STATE LIC NUMBER -I LICENSE CLASSIFICATION
VALUATION$ 2 Of 0 0 (0 SO FT L SO FT
APPLICANT'S SIGNATURE DATE
CITY_STA_FF USE ONLY An
RTM
DEPAENT DISTRIBUTION ACCEPTED BY: Ile
CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERINS, FIRE
PERMIT FEE (S�Q . SMIP GREEN
PLAN CHECK FEE INVOICE TOTAL
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us
9julz Corp
Julz Corporation
26871 Hobie Circle Ste. B-7 Phone: 760-561-5016
Murrieta, CA 92562 Fax: 760-561-5030
12/18/17
To whom it may concern:
Mike Mcquinn has permission to apply and sign for building permits on my behalf.
Please feel free to contact me if here are any questions.
ulio Medeiros
CEO
Julz Corporation
760-802-3373
City of Menifee
Building Dep4.
DEC 16 2017
Received
r CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT
i
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which this certificate is.attached,and not the truthfulness,accuracy,or validity of that document.
State of California
I
County of
Riverside
IIIII
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I Varla y phan Cam
On before me, Lily Notary Public,
`j (ncre insert name and title oflhe officer)
personally appeared � s\\K)
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who proved to me on the basis of satisfactory evidence to be the person(s)whose name(s) is/are subscribed to
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which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph
is true and correct.
!� V IQ
ILY VARLAPHAN CAM?
WV TN S` a�m h rid official sea ial l. U COMM.#2219828
f y� (� .+ NOTARY PUBLIC•CALIFORNIA
-� RIVERSIDE COUNTY 0
(Notary Seal)
COMM.EXPIRES OCT.26,2021'`
'I pl
Sienn cal. uay Public
'I ADDITIONAL OPTIONAL INFORMATION �I
i
INSTRUCTIONS FOR COMPLETING THIS FORM i
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DESCRIPTION OF THE ATTACHED DOCUMENT appeurs above in the notay section or a separate acknmrledgment form rant be
j prnperh, completed and attached to that document. The duly crception is it a
1�ti\a Curs dncnment is to be recorded outside ofCalifinniu. In such instances. am,alternative
adounrtedgment rerbioge as mow be printed on such a docurncm.so long as the
('I ide or description of attached document)
rrri+iogc does nor require the nolalT to do something that is illvynl Jirr H nntrny in
CnhJitrnin(i.e. cart f ing the cnahoriced cupactff of the.dglrer). Please check the
(Title or description ol'attnchcd document continued)
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