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PMT18-02652 City of Menifee Permit No.: PMT18-02652 _ 29714 HAUN RD. MENIFEE,CA 92586 Type: Residential Demolition MENIFEE MENIFEE Date Issued: 05/30/2018 PERMIT Site Address: 27952 JEFFERSON AVE,MENIFEE,CA Parcel Number: 329-193-012 92585 Construction Cost: $200.00 Existing Use: Proposed Use: Description of DEMOLITION OF MOBILE HOME-COUNTY PERMIT NUMBER BZA006367 Work: Owner Contractor J DOLORES VERDE-UGALDE 403 W POTTERY STREET LAKE ELSINORE,CA 92530 Applicant License Number. J DOLORES VERDE-UGALDE 403 W POTTERY STREET LAKE ELSINORE,CA 92530 Phone:9517605256 Fee Description Oft Amount i$1 Building Permit Issuance 1 27.00 Inspections not specified 129 129.07 GREEN FEE 1 1.00 General Plan Maintenance Fee-Building 1 6A5 $163.52 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 staled,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 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 legally sell 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 worker's 7D44 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 Cade,for the performance of work for which this permit is issued. www.leginfo.ca:eov/calaw•html. Policy q _Z�%C/. 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 N 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 Carrier with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy q Expires enter the above identified property for inspection purposes. (This section need not to be completed Is the permit is for one-hundred Date S •- ( f� dollars($100)or less PROPEE-RTYY OWNER ORAUTHORIZED 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 If worker's compensation laws of California,and agree that if I should becomeFfAZARDOUS MATERIAL DECLARATION subject to the worker's compensation provisions of Section 3700 of the Labor { Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a Applicant Date 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 D Yes arNo 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 See permitting fro checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES fo ast Airlines Qua CONSTRUCTION LENDING AGENCY ❑Yes ANo I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 10DO 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 1L.OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAOMD 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 al Safety ode,Section 25505 and 25534 concerning hazardous material re/porti checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 ng. C Business and Professions Code).Any city or county that requires a permit to AYe (, Dale construct,alter,improve,demolish or repair any structure,prior to its *'PROPERTY OWNER OR AUTHORIZED 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 Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRPI License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RAP)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 apre-1978 and the casts for the alleged exemption.Any nt to faci of Section of not o residence or childcare facility to be RRP-certified firms and comply with than 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 paint-disturbing work themselves or through their 9L1,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 1-80D-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, o 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 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 `PL✓17 Q LeF-52 . PLANNING CASE NUMBER TYPE: O COMMERCIAL 0 RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES DESCRIPTION OF WORK U cy, to �. PROJECTADDRESS Z`,��:q `z Zip ZS `- ASSESSOR'S PARCEL NUMBER jZq- 19 3- () 17, L-- LOT TRACT OWNER NAME e / - ADDRESS - PHONE 7,35 C_ EMAIL II r c e c APPLICANT NAME c e-r.?c ADDRESS Z c C. (Ylrj r eIZ cSlS'�. PHONE L� S ( - a-Co — 5 6`_ EMAIL �- -•,�r S (6 1" CONTRACTOR'S NAME OWNER BUILDER? AYES O NO BUSINESS NAME ADDRESS PHONE EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION$ Q © SQ FT L SQ FT APPLICANT'S SIGNATURE �/ DATE 'i '-.�O CITY STAFF USE ONLY slr"� _�M ill DEPARTMENT DISTRIBUTION ACCEPTED BY: CITYOFMENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE N (/ INVOICETOTAL � Sa GREEN l . 0-C) SMIP OWNER BUILDER VERIFIED ES O NO DRIVERS LICENSE# F'1 3-72"1 NOTARIZED LETTER OA NS/kO EX ':� laoA1511 City of Menifee Building &Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777 www.cityofinenifee.us City of Menifee Building Dept. eNIFe MAY 3 0 2018 Received PEMo PLOT/SITE PLAN N REAR PROPERTY LINE s c C M r LL LL w _ - w Z Z ne _ w LU 1 6 Q LU u W W � � 1H N AWN00 I I. W' FRONT PROPERTY LINE Property Owners Name yl�) (o d'r c �L vQe Property Address 7:�2 52 = CG c 4 n /l aNj c . 4M n; C(c c n .