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PMT17-04555 City of Menifee Permit No.: PMT17-04555 29714 HAUN RD. Type: Commercial Alteration �CCELA—> MENIFEE, CA 92686 MENIFEE Date Issued: 12127/2017 PERMIT Site Address: 28237 LA PIEDRA RD, MENIFEE,CA Parcel Number: 364-070-031 92584 Construction Cost: $4,000.00 Existing Use: Proposed Use: Description of TEMPORAY EVENT FOR GOSCH AUTO GROUP AT MSJC,49 X 60'TENT AND GENERATOR Work: Owner Contractor MT SAN JACINTO COMMUNITY COLLEGE GOSCH AUTO GROUP 1499 N STATE ST 150 CARRIAGE CIR SAN JACINTO,CA 92583 HEMET, CA 92545 Applicant Phone:9516583181 STEPHANIE KITTLESON License Number: 17-PEOP-00040 150 CARRIAGE CIR HEMET, CA 92545 Phone: 9516583181 Fee Description Qtv Amount f$1 Building Permit Issuance 1 27.00 Inspections not specified 129 129.07 Additional Plan Review Building 129 129.07 General Plan Maintenance Fee-Building 1 6.45 $291.59 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_BIdg_Permit 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 70D0)of Division 3 of the Business and ❑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 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 legallysell a structure that I 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 vyyy,�,,le info.ca. ov calaw.html, this permit is issued. Policyq Date ❑I have and will maintain workers compensation insurance,as required by PROPE HWY OWNUTH0RIZED AG ENT 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 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 1 have provided is correct.I agree to comply with all applicable city and county ordinances and state laws relating to Carder building construction.I authorize representatives of this city or county to Polity# Expires 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 PROPlIRTY OWN R. R AUTHORIZED AGENT o I certify that in the performance of the work 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 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 forth wi r co Date mply 'tri those provisions. ��_ S,.' —, Will the applicant or future building occupant handle hazardous material or a Applicant ' 1 mixture containing a hazardous material equal to or greater that the amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SE l ORKER'S COMPENSATION COVERAGE IS o Yes ci 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 for guidelines CONSTRUCTION LENDING AGENCY ❑Yes ❑No I hereby affirm that under the penalty of perjury there is a construction WIII 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) Vol! Yes ❑No OWNER BUILDER DECLARATIONS O{ ,`eO. I have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm under penalty of perjury that I am exemp permitting checklist.I understand my requirements under the State of Contractors License Law for the reason(s)indicated below gyrc a �L Q`` California Health&Safety Code,Section 25505 and 25534 concerning checkmark(s)I have placed next to the applicable Item(s)(Sectio 315` hazardous material reporting. Business and Professions Code).Any city or county that requir mit to � es o No construct,alter,improve,demolish or repair any structure,prio to its o Date issuance,also requires the applicant for the permit to file a signed stateme PROPERTY OWNER OR AUTHORIZED AGENT that he or she is licensed pursuant to the provisions of the Cant c[ `� � EPA RENOVATION,REPAIR AND PAINTING IRRP) License Law(Chapter 9(commencing with Section 7000)of DNi ' n i tKe The EPA Renovation,Repair and Painting(RRP)Rule requires contractors Business and Professions Code)or that he or she is exempt fro lic nsure 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 radices.This includes rental property than($500). q. P P p rty owners and property 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.eoa.aov/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: 01,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 outthe RRP Acknowledgement. Menifee DATE PERMIT/PLAN CHECK NUMBER 5 TYPE: Z COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL NEW OPLUMBING ORE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK PROJECTADDRESS 24bZ3-4 Lc� �eAra enl e CA ASSESSOR'S PARCEL NUMBER LOT TRACT OWNERNAME .Q \ ADDRESS 2 �} Lr-,*, \ — a4nr <-- PHONE Q S\-��}• �jp\,� EMAIL G. e cL APPLICANT NAME ADDRESS 1 PHONE qST/n��" _3 1 ib I EMAIL • } k-1250YI LDS k(na•l ,(- CONTRACTOR'S NAME OWNER BUILDER) O YES G�NO BUSINESS NAME LA 1 r� /� -7y ,��I, ADDRESS] vr+ L-J"A N �/'}�-'�i 0l 1:bD 7 PHONE -/ � 9� -� QD'p-p EMAIL S\IMID \0 \ n .W CONTRACTOR'S STATE LIC NUMBER tV`A LICENSE CLASSIFICATION (.} VALUATION$ KY SQ FT L SO FT APPLICANT'S SIGNATURE DATE . 7777777 DEPARTMENT DISTRIBUTION Ci YnF AUNIFFE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP INVOICE PAID AMOUNT O O AMOUNT OCASH CHECKq CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT 0CASH 0CHECK# 0CREDIT CARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777 "VWW.Cityofinenifee.us Inspection Request Line 951-246-6213