PMT18-01574 City of Menifee Permit No.: PMT18-01574
29714 HAUN RD.
't1�CCEL/R7. MENIFEE, CA 92586 Type: Residential Electrical
MENIFEE Date Issued: 0410412018
PERMIT
Site Address: 29614 LIGHTSHORE CV,MENIFEE,CA Parcel Number: 333-560-026
92585 Construction Cost: $800.00
Existing Use: Proposed Use:
Description of U/G 100 L FT 3/4"GAS LINE&60 L FT ELECTRIC LINE FOR BBQ AND FIRE PIT
Work:
Owner Contractor
ERIC HURLEY BILL&DAVE'S LANDSCAPE MAINTENANCE INC
29614 LIGHT SHORE CV 1153 HARLEY KNOX BLVD
MENIFEE,CA 92585 PERRIS, CA 92571
Applicant Phone:9519436455
DAVID LEIDENFROST License Number:751707
BILL&DAVE'S LANDSCAPE MAINTENANCE INC
1153 HARLEY KNOX BLVD
PERRIS,CA 92571
Fee Description CRY Amount f$1
Receptacle,Switch,Outlet& Fixture 1 116.00
Plumbing Fixtures and Vents,fixtures 1 116.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 5.80
General Plan Maintenance Fee-Electrical 1 5.80
$271.60
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_Permit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or Improves thereon,and who contracts for the projects
hereby affirm under penalty of perjury that I am under provisions of with a licensed contractors)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from Iicensure under the Contractor's State License Law for
Professions Code and my license U In full force and effect. .7 the following reason:
f
License Class
��77 ��C -��aa� Licensr�No.
� S� By mysignaNre below lacknowledge that,except for my personal residence
Expires__�Slgnature L. in which l must have resided for at least one year prior to completion of
improvements covered by this permit l cannot legally sell a structure that)
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if It has not been constructed in Its entirety by
O l hereby affirm under penalty of perjury one of the following declarations:i licensed contractors.l 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 caw w leginfo.ca•¢ov/calaw.hcml.
this permit is issued.
Policy G �� i W r L/ Date
D l 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 O By my signature below l 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
Carrier ''1 UL L F/v �- j l� f( with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy li � L% �%LI Q/('IJ L Ll Expires 1 I � I 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
O l certify that in the performance of the work for which this permit is issued,
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE If
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 shaftFfmthh��t r comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date �� S 7 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 oyes a 0
UNLAWFUL.AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES WIIl 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(5CAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY DYes 9,N
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) D Yes ;o No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby aff(rtn under penalty of perjurythatlam 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 al Safety mode,Section 15505 and 25534 concerning
hazardr,;smaterlal reporting.
checkmark(s)I have placed next to the applicable Item(s)(Section 7031.5 oYes--D No '\ (+
Business and Professions Code).Any city or county that requires a permit to —�� Date_ v �J
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWN R7NTHDt�D 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 Contactors State EPA RENOVATION.REPAIRAND PAINTING fRRP1
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 Iicensure receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of section 7D31.5 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).
managers who do the pain[-disturbing work themselves prthrough their
O I,as owner of the property,or my employee with wages as their sole employees.For mare information about EPA's Renovation Program visit:
compensation,will do( )all of or( I portion of the work,and the structure is www.eoa.eoy/lead or contact the National Lead Information Center at
not intended or offered fur sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractors State Uceme Law does not apply to an owner of aAn EPA Lead-Safe Certified Renovator will he 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. D No EPA Lead-Safe Certified Firm is required for this project because:
a I,as owner of the property am exclusively contracting with licensed
contactors 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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE
DATE: PERMIT/PLAN CHECK NUMBER IO- 015T+
L
PLANNING CASE NUMBER
TYPE: O COMMERCIAL RESIDENTIAL C MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION C DEMOLITION ELECTRICAL O MECHANICAL
O NEW ePLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK Il
0 3 b11 cC� J�` �`
PROJECTADDRESS pc 7 61 LJ2 tl�l ti. � h ��� CCU V ZIP FLSp S
ASSESSOR'S PARCEL NUMBER , ! LOT �� TRACT `D4to^
OWNER NAME '�_ Ir(:_ 1
ADDRESS K 6 L_I' k � S U r Wue'-
G r
PHONE 1 J 1 G �A 0 0 EMAIL
APPLICANT NAME c `s A\j � —t
ADDRESS I J�3+ �'� `C— U/<
PHONE Ll ,S s EMAIL \�O �c.) I
CONTRACTOR'S NAME \J L
/S OWNER BUILDER? O YES G-M-
BUSINESS NAME \ 1. aWO G
ADDRESS } S
PHONE 1 4 -5 f8 y U S EMAIL
CONTRACTOR'S STATE LIC NUMBER 7 S 7 U ? LICENSE CLASSIFICATION C 7
VALUATION$ V O SO FT L SO FT
APPLICANT'S SIGNATURE DATE
CITY S7AFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: may__ CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE '11J��_
INVOICE TOTAL GREEN SMIP
OWNER BUILDER VERIFIED C YES O NO DRIVERS LICENSE# NOTARIZED LETTER 0 YES C NO
City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777.
www.cityofinenifee.us fi'�.
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Building Dept-
APR 0 It 2018
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r-AUESNUORD.SAFETY DEPART6`E
PLAN APPROVAL
G" 0 1 -
A� Vta 'ADoroval of these plans shall not be construed to be F -rm—Arofan
approval of,any violation of any provisions of the federal sate c Op
regulations and ordinances. This set of approved plans rr.u,- - -xar-.he
jobsite until completion.
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