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PMT18-02515 City of Menifee Permit No.: PMT18-02515 29714 HAUN RD. <ACCEL/-> MENIFEE,CA 92586 Type: Residential Demolition MENIFEE Date Issued: 05/23/2018 PERMIT Site Address: 28935 CARMEL RD,MENIFEE, CA 92586 Parcel Number: 337-404-010 Construction Cost: $28,000.00 Existing Use: Proposed Use: Description of ABATEMENT OF ASBESTOS CONTAINING MATERIALS DUE TO FIRE, DRYWALL,TILE SHOWER Work: SURRONDS,CARPET, KITCHEN CABINETS,ASBESTOS VINYL FLOORING,STUCCO, ROOF PENETRACTIONS, FAU Owner Contractor FREDERICK SNOW AMERICAN TECHNOLOGIES INC 29180 PIPING ROCK RD 210 W HAYWOOD AVENUE MENIFEE, CA 92586 ORANGE, CA 92865 Applicant Phone: 7142839990 JIMMY NGUYEN License Number:571784 210 W HAYWOOD AVENUE ORANGE, CA 92865 Fee Description Oft Amount($1 Building Permit Issuance 1 27.00 Demolition Permit 1 140.00 $167.00 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 underwhich 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 700D)of Division 3 of the Business and o I am exempt from licensure under the Contractors State License Law for Professions Code and mylicense is in full force and effecL -'1 2 the following reason: t License Class v License No. By my signature below I acknowledge that,except form !'-� 2oi� g g p ycompl Lional Bence Expires b Signature ..� in which I must have resided far a[leas[one year prior to completion of WORKER'S COMPENSATION DECUtfil� N / improvements covered by this permit.I cannot Iegallysell 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 or 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 far which this permit is issued. www.leginfo.ca.eov/calaw.html. Policy# Date )i(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 o By my signature below 1 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 numberare: ��trA� t }I -f- application and the information I have provided is correct.I agree to comply I�Carrier &O f°IA<Ikt S�Cclq ly Xf wrgtf�r (_O with all applicable city and county ordinances and state laws relating to r building construction.I authorize representatives of this city or county to Policy# f00 00M )J Expires '9 l (Zz14 enter the above identified property for inspection purposes. (This section need not to be completed is the permit is for one-hundred dollars($100)or less Date PROPERTY OWNER OR AUTHORIZED AGENT ❑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# 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,I shall forthwith pry%lth those provisions. Will the applicant or future building occupant handle hazardous material or a Applicant Date SI`Z>1/9 mixture containing a hazardous material equal to or greater that the amounts specified on the Hazardous Materials Information Guide? WARNI . AILURETICSECURE WORKER'S COMPENSATION COVERAGE IS Ayes ❑No UNLAWFUL,AND SHALL SUBIECTAN 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 DO LLARS($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 Duality Management the t(SCtionor modification checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Airlines Qua CONSTRUCTION LENDING AGENCY XYes ❑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 XNo OWNER BUILDER DECLARATIONS _ I have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of Contractor's 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 Rem(s)(Section 7031.5 hazardous material re rbng. Business and Professions Code).Any city or county that requires a permit to ,hYas o N 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 PR �} , R OR AUTHORIZED AGENT that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION.REPAIR AND PAINTING IRRPI 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 far most work that disturbs paint in a pre•1978 and the basis for the alleged exemption.Any violation of Section 7032.5 by an residence or childcare facility to be RRP-certified firms and comply with than($500).Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property than managers who do the paint-disturbing work themselves or through their o 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.eov/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-80D-424-LEAD(5323). Code,The Contractor's State License Law does not apply to an owner of a property who,through employees'or personal effort,builds or improves the YsAn EPA Lead-Safe Certified Renovator will be responsible for this project 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. o No EPA Lead-Safe rtified Fir z Is r,7 red for xis pr je /b'e�caus o 1,as owner of the property am exclusively contracting with licensed h��i G � �GZ( � ��-I 7 ! (( T— 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. BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION K MENIFEE DATE: 5/23/18 PERMIT/PLAN CHECK NUMBER Q �/ PLANNING CASE NUMBER TYPE: O COMMERCIAL CI RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION ID DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES DESCRIPTION OF WORK Abatement of asbestos containing materials due to fire: drywall, tile shower surrounds,carpet,kitchen cabinets,asbestos vinyl flooring,stucco, roof penetrations,FAU. PROJECFADDRESS 28935 Carmel ,Rd,M,e'niifee,CA I, ZIP 92586 ASSESSOR'S PARCEL NUMBER "J"✓� — `yV��IV LOT TRACT cqqptj OWNERNAME Fred Snow ADDRESS 29180 Piping Rock Road, Sun City,CA 92586 PHONE (951) 286-0677 EMAIL kg6hgk@ ol.com APPLICANT NAME Jimmy Nguyen ADDRESS 1175 Hall Ave.Riverside,CA 92509 PHONE _(800) 400-9353 EMAIL fimniL.nguyen@atirestoration.com CONTRACTOR'S NAME ATT Restoration OWNER BUILDER? O YES ONO BUSINESS NAME American Technologies Inc. ADDRESS 210 Bayiyood Avenue Orange, CA 92865 PHONE (714) 283-9990 EMAIL Jimm .n en@atirestoration.com CONTRACTOR'S STATE LIC NUMBER 571784 LICENSE CLASSIFICATION ASB B HAVC47 VALUATION$ _�27�G-000 SO.FT 1,404 LSQFT 6534 APPLICANT'S SIGNATURE DATE OTYSTAFFUSEONLY DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS UCENSE NUMBER BUILDING PLANNING ENGINEERING INVOICE TOTAL GREEN SMIP OWNER BUILDER VERIFIED OYES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Department 129714 Haun Rd., Menifee, CA 92586 (9S1)672-6777 G,n oe www.cityofmenifee.us =MENIFE ;�1J