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PMT18-03094 City of Menifee Permit No.: PMT18-03094 29714 HAUN RD. Jr MENIFEE, CA 92586 Type: Residential Alteration MENIFEE MENIFEE Date Issued: 0 710 2/2 01 8 PERMIT Site Address: 28571 TULITA LN, MENIFEE,CA 92584 Parcel Number: 388-052-006 Construction Cost: $74,995.20 Existing use: 1 &2 Family Residence Proposed use: Description of ROOM ADDITION OF 630 SQ FT Work: Owner Contractor GENARO ESTRADA , 28571 TULITA LANE MENIFEE,CA 92584 Applicant License Number: GENARO ESTRADA 28571 TULITA LANE MENIFEE, CA 92584 Phone: 9512460483 Fee Description OQt Amount 1E1 Receptacle, Switch, Ouflet&Fixture 39 306.00 Plumbing Fixtures and Vents,fixtures 5 126.00 Additional Plan Review Building 55 55.00 Additional Plan Review Building 220 220.00 Additional Plan Review Building 129 129.07 $836.07 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. Bldg_Permit Template.rpt Page 1 of 1 CITY OF ME IFEE LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects with a licensed contractor(s)pursuant to the Contractors State Ucense Law). I hereby affirm under penalty of perjury that I am under provisions of Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contractor's State License Law for Professions Code and my license is in full force and effect. the fallowing 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 improvements covered by this permit,I cannot legally sell a structure that I WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by ❑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 workers 7044 of the Business and Professions Cade,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.leninfo.ca.eov/calaw.html. Policy# 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 ❑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 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 tW above identified pro erty for inspection purposes. )Cy (This section need not to be completed is the permit is for one-hundred /J ?- 2 ^(() 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 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 15 ❑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($100,0001,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(SCAQMD)7 See permitting checklist IN SECTION 3706 OFTHE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines CONSTRUCTION LENDING AGENCY ❑Yes ❑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 forthe performance of the work which this permit is issued outer boundary of a school? (Section 3097 Civil Code) ❑Yes ❑No Fnend NER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD eby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of ractor's License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning hazardous material reporting. kmark(s)I have placed next to the applicable item(s)(Section 7031.5 Dyes ❑No ness and Professions Code).Any city or county that requires a permit to Date truct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED AGENT nce,also requires the applicant for the permit to file a signed statement he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRPI nse Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors ness and Professions Code)or that he or she is exempt from licensurereceiving compensation for most work that disturbs paint in a pre-1978 the basis forthe alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with pplicant for a permit subjectsthe applicant to a civil penalty of not more required practices.This includes rental property owners and property ($500). managers who do the paint-disturbing work themselves or through their as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit: pensation,will do( )all of or( J portion of the work,and the structure is www.epa.gov/lead or contact the National Lead Information Center at intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323). e;The Contnctor's State License Law does not apply to an owner of a in An EPA Lead-Safe Certified Renovator will be responsible forthis 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. In No EPA Lead-Safe Certified Firm is required forthis project because: ❑I,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 r: DATE: _ PERMIT/PLAN CHECK NUMBER - 0b PLANNING CASE NUMBER TYPE: O COMMERCIAL Z RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: R ADDITION O ALTERATION O DEMOLITION (' ELECTRICAL O MECHANICAL O NEW O PLUMBING 0 RE-ROOF NUMBER OF SQUARES DESCRIPTION OF WORK gi4 30 $ PROJECTADDRESS a�s7'/J., 7dn �yIA(. /Twilit CA. ZIP 7 QASSESSOR'S PARCEL NUMBER v � PMLOT TRACT OWNER NAME AQ-Naro ADDRESS eP- �S PHONE qrl � - EMAIL APPLICANT NAME 11 p ADDRESS aSs > TdkA Im. M-csjd�c0 PHONE / �� -Q 7 0 EMAIL Qj p CONTRACTOR'S NAME OWNER BUILDER? f$YES Q NO BUSINESS NAME ADDRESS PHONE EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION $ .Sa SQ FT �� L SQ FT / APPLICANT'S SIGNATURE DATE 0TYSTAFFUSE ONLY DEPARTMENT DISTRIBUTION ACCEPTED BY: �' \ CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GJ INVOICE TOTAL r w'I I�-0; GREEN SMIP OWNER BUILDER VERIFIED KYES 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.cityofinenifee.us _.ENIFEM I`