PMT18-02751 City of Menifee Permit No.: PMT18-02751
AF At 29714 HAUN RD.
`Ar MENIFEE,CA 92586 Type: Residential Plumbing
MENIFEE MENIFEE Date Issued: 06/06/2018
PERMIT
Site Address: 30317 COBURN CIR, MENIFEE, CA Parcel Number: 358-720-031
92584 Construction Cost: $700.00
Existing Use: Proposed Use:
Description of 50 L FT U/G 1 1/4"GAS LINE&1 1/4" ELECTRICAL CONDUIT FOR FUTURE POOL
Work:
Owner Contractor
ERIC WILSON BILL& DAVE'S LANDSCAPE MAINTENANCE INC
30317 COBURN CIR 1153 HARLEY KNOX BLVD
MENIFEE,CA 92584 PERRIS, CA 92571
Applicant Phone:9519436455
DAVID LEIDEFROST License Number: 751707
BILL& DAVE'S LANDSCAPE MAINTENANCE INC
1153 HARLEY KNOX BLVD
PERRIS,CA 92571
Fee Description Dix Amount($1
Plumbing Fixtures and Vents,fixtures 1 116.00
Building Permit Issuance 1 27.00
Inspections not specified 116 116.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 5.80
General Plan Maintenance Fee-Electrical 1 0.00
$265.80
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
I hereby affirm under penalty of perjury that I am under provlslons of with a licensed contractors)pursuant to the Contractors State License Law).
Chapter9(commencing with section 70001 of Division 3 of the Business and o l am exempt from licensure under the Contractor's State License law for
Professions code and my license is in full force and effect. the following reason:
License Class C— License No.� S f By my signature below l acknowledge that,except for mypersonal residence
Expirese L f//sSignature L J� in which l must have resided for at east one year prior to completion of
improvements covered by this permit.i cannot legally sell a structure that 1
WORKER'S COMPENSATION DECLARATION
have bull[as an owner-builder if It has not been constructed in its entirety by
O I hereby affirm under penalty or 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 wwsvieeinfo.ca.eJ calaw.html.
this permit is issued. )
Policy# 7 C- elo U l`/ L� Date
a 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 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.l have read this
number are:; ( `` I1 application and the Information l have provided is correct.I agree to comply
[artier L `'1v�L "� ��V �- F1 l.:✓� /1 with all applicable city and county ordinances and state laws relating to
I building construction.I authorize representatives of this city or county to
Policy# �: �.:L�L!I La ('I Expires `� (� 1 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
T.-
01certify 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# �•+'� "'
workers compensation laws of California,and agree that it I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Cade,I shallf rthwftb comply with those provisions. / Will the applicant or future building occupant handle hazardous material or
Applicant , Date - S 1 7 mixture containing a hazardous material equal to orgreaterthat the
IF amounts specified on the Hazardous Materials Informallon Gulde7
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS oyes �a 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(SCAQMDi7 See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY aYes pl,16
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?
(5ection 3097 Civil Cade) Oyes ;si No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that l 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 Health&Safety Code,Section 15505 and 25534 concerning
checkmark(s)I have placed next to the applicable Item(s)(Section 7032.5 haxarda�z.materlal reporting.
oYes -o Ncs r\ (+
Business and Professions Code).Any city or county that requires a permit to _yam'--��
construct,Biter,improve,demolish or repair any structure,prior to its PROPERTY OWNtWOR-AUT116i 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 Contractors State EPA RENOVATION.REPAIR AND PAINTING IRAPI
License Low(Chapter 9(commencing with Section 7D00)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
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence compensationfpry to beost work that disturbsrms painting wi7B
th
an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.
[ices.Thisre include be RRP-certified owners dcomplyparty
than($S00). required practices.This includes rental property owners and property
managers who do the paint-disturbing work themselves or through their
al,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 ofor( I portion of the work,and the structure is www.eoa.eovAead or contactthe National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-BOG424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a toAn 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. a No EPA Lead-Safe Certified Firm Is required for this project because:
a I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7D44,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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE
DATE: 6 PERMIT/PLAN CHECK NUMBER '
PLANNING CASE NUMBER
TYPE: O COMMERCIAL ) RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION ELECTRICAL O MECHANICAL
ONE//W .tfPLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK v A 5 I /.l l.( fI
I q �j
PROJECTADDRESS ��� C06 LA 2N C\ ZIP S ('
ASSESSOR'S PARCEL NUMBER g� ��� 03, LOT 3 TRACT
OWNER NAME C Ls j e ` S v /v
ADDRESS ,3 bG� C C7 6 L(/Z)u CC c
PHONE I _ _� ) ) LfEMAIL
APPLICANT NAME A V C %^ I T a
ADDRESS f I szs pc -' � I �/�
PHONE 3}-- U EMAIL �/^l l C )( �✓VJ 0_4 � ,
CONTRACTOR'S NAME f \ A-U e- S (( OWNER BUILDER? O YES�NO C V�
BUSINESS NAME i pp `/ C_A-I\,- 1l , ,
ADDRESS ) I S LL./� � 1�fv o � a
11 UT () S ) I
PHONE '�S Ci54 () EMAIL
CONTRACTOR'S STATE LIC NUMBER 'T5I-1(91 LICENSE CLASSIFICATION
VALUATION$ 70 V �-
� S FT L SQ FT(
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY JIL
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF ME EE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE 55 1ooQQ--
INVOICETOTAL �g� 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 (951)672-6777
www.cityofmenifee.us
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CITY OF MENIFEE
BUILDING AND SAFETY DEPARTMENT
PLAN APPROVAL
REVIEWED BY to 4 .
I AT , � N
i Approval of these plans shall not be construed to be a permit for,or an
1 approval of,any violation of any provisions of the federal,state or city
I regulations and ordinances. This set of approved plans must be kept on the
jobsite until compMion.
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