PMT18-00871 City of Menifee Permit No.: PMT18-00871
29714 HAUN RD. Type: Residential Plumbing
�ACCF-0 MENIFEE, CA 92586
Gwm.�,x 9da-.+e MENIFEE Date Issued: 02/28/2018
PERMIT
Site Address: 26140 CRESTONE DR, MENIFEE, CA Parcel Number: 335-261-027
92586 Construction Cost: $1,200.00
Existing Use: Proposed Use:
Description of SEWER REPAIR IN FRONT YARD OF HOUSE
Work:
Owner Contractor
LEE DEY SOMATDARY INCORPORATED
26140 CRESTONE DR P 0 BOX 2667
MENIFEE, CA 92586 CULVER CITY, CA 90231
Applicant Phone:7143498239
VICTOR MEDINA License Number:771663
SOMATDARY INCORPORATED
P 0 BOX 2667
CULVER CITY, CA 90231
Fee Description Oft Amount ISl
Sewer 1 150.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 7.50
$185.50
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 slated,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
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 exempt from licensure under the Contractors State License Law for
Professions Code my license is in full force and effect the following reason:
License Cl ssL ��Cb � Ucens No. ' fob By my signature below I acknowledge that,except for my personal residence
Expires 3 "l Signature in which I must have resided for at least one year prior to completion of
WO ICER'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
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 this permit is issued www.le¢info.ca.eov/calaw.html.
.
Policy# �Q ?I^I14 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 o 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 I have provided is correct.I agree to comply
with all applicable city and county ordinances and state laws relating to
Carrier building construction.I authorize representatives of this city or county to
Policy# Expires enter the bovei entified property for inspection pu77/,
s. J . )
(This section need not to be completed is the permit is for one-hundred Date1/E / D
dollars($100)or less PRf5PERTY O NER OR AUTHORIZED AGENT
❑I certify that in the performance of the work for which this permit is issued,
ab
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# a0
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,Ishall ort lt comply)slthf hose provisions. �� ) Will the applicant or future building occupant handle hazardous material or
Applicant /rr'YV Date � (D/ mixture co aining a hazardous material equal to or greater that the
amounts s ecified an the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION VERAGEIS ❑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 THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Q ality Management District(SCAQMD)?See permitting checklist
IN SECTION 37060E THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidel' es
CONSTRUCTION LENDING AGENCY D Yes ci
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 bou ary of a school?
(Section 3097 Civil Code) 0 Yes No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjurythat 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 ealth&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable Item(s)(Section 7031.5 hazardou mateW�l
Business and Professions Code).Any city or county that requires a permit to °Yes No
construct,alter,improve,demolish or repair any structure,prior to its Date
issuance,also requires the applicant for the permit to file a signed statement PROPERTY OW AR OR AUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING fRRPI
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(5500), managers who do the paint-disturbing work themselves or through their
D 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.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 D 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. 0 No EPA Lead-Safe Certified Firm is required for this project because:
❑1,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.
SAFETYBUILDING & APPLICATION _
)OFFDATE: Q) PERMIT/PLAN CHECK NUMBER I &
TYPE: O COMMERCIAL *RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA OSIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW S PLUMBING O RE-ROOF NUMBER OF SQUARES J
DES RIPTION OF WORK Q(,t/� 2e Q,,- iH 'f' !L d 16 O
U�( • G
PROJECT ADDRESS D H.t (7/L• ZIP g1s-
ASSESSOR'S PARCEL NUMBER �JJ'OC�Q �J LOT TRACT T
OWNER NAME e e
ADDRESS /�/ c1'/Ll.L K.-
PHONE (-7 14- ) 9L�¢ ��J 7 EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL/
CONTRACTOR'S NAME
�J �a«.b/" OWNER BUILDER? O YES O NO
BUSINESS NAME//,, �L/4 r ✓ti^ /�/v / ew J
ADDRESS !/ .36 G 6fv- 4 .t /[✓- od e
CP•
PHONE T/b — 6¢54'-6eo EMAIL
CONTRACTOR'S STATE LIC NUMBER 7 7 /6 63 LICENSE CLASSIFICATION CZO - C 76 - C-4 Z
VALUATION$ 11 26 b SO FT 3X,3 L SO FT p�
APPLICANT'S SIGNATURE DATE Z•28" /a
CTTYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE N UMBER ,
�
BUILDING PLANNING ENGINEERING FIRE ^
PERMITFEE C' SMIP GREEN Imo'
PLAN CHECK FEE INVOICETOTAL 85 .r.}Q
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
sir L'✓Lir.CI i�0% 'r^-3I71 f2?.US
2 0 " ' PLOT/TE PLAN
REAR PROPERTY LINE
of_M ifee
ry OF MEN Building Dept.
JILDING AND SAFETY DEPARTMENT FEB 2 8 2018
-AN APPROVAL
deceived
EV EVVED BY
i DATE
coal of these plans shall no'.be construed to be a permit for,or an
-.v ai of.any-violation of any pi:iisions of the federal,state or city ,
1166)ns and ordinances. This se;of approved plans must bg hap
tiie;.ntii completj a�
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FRONT PROPERTY LINE
Property Owners Name
Property Address