Loading...
PMT18-03249 City of Menifee Permit No.: PMT18-03249 " v 29714 HAUN RD. MENIFEE, CA 92586 Type: Residential Alteration MENIFEE MENIFEE Date Issued 06/28/2018 PERMIT Site Address: 29915 CROSS HILL DR, MENIFEE, CA Parcel Number: 351-191-008 92587 Construction Cost: $0.00 Existing use: 1 &2 Family Residence Proposed use: Description of SPECIAL INSPECTION FOR CODE CASE CE18-0732 Work: Owner Contractor KARINA JIMENEZ , 29915 CROSS HILL DRIVE MENIFEE, CA 92587 Applicant License Number: MENIFEE, CA Phone:9517514554 Fee Description Qtv Amount f$) Building Permit Issuance 1 27.00 Inspections not specified 129 129.07 $156.07 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 slated,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_Templatespt 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 70D0)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 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 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 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 for which www.leginfo.ca.gov/calaw.htmi.permit is issued. Policy# Date ❑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 ❑By my signature below I 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 with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy# Expires enyer the above identified property for inspection purposes. 9 (This section need not to be completed is the permit is for one-hundred dollars($100)or less � Date PRO ERTY OWNER OR UTHORIZED GENT ❑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# 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 shall forthwith comply with those provisions. WIII 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 ❑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($100,000),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(SCAQMD)?See permitting checklist IN SECTION 3706 OF THE 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 for the performance of the workwhich this permit is issued outer boundary of a school? (Section 3097 Civil Code) ❑Yes ❑No OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm under penalty of perjury that am exempt from the permitting checklist.I understand my requirements under the State of California Health al Safety Code,Section 25505 and 25534 concerning Contractors License Law forthe reason(s)indicated below by the hazardous material reporting. checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oyes ❑No Business and Professions Code).Any city or county that requires a permit to Date construct,alter,improve,demolish or repair any structure,priortoits 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(RRP)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 a pre-1978 and the basis for the alleged exemption.Any violation of Section 7031.5 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 paint-disturbing work themselves or through their ❑1,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 1-800-424-LEAD(5323). Code;The Contractors 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 thatthe 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. ❑No EPA Lead-Safe Certified Firm is required for this 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 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: PERMIT/PLAN CHECK NUMBERPVT 11b GRADING/PLANNING CASE NUMBER/OTHER RELATED CASES TYPE: O COMMERCIAL ,RESIDENTIAL O MULTI-FAMILY O MOBILE HOME 0- POOL/SPA O SIGN SUBTYPE: 'O ADDITION ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES DESCRIPTION OF WORK e (r_,� -TI) S e ,JC IS OCCUPANCY GROUP CONSTRUCTION TYPE SPRINKLERS O YES O NO PROJECTADDRESS Q�q� � �Z ,` 1 ZIP ASSESSOR'S PARCEL NUMBER � �^ 1 11 a)&T TRACT City - Building Dept. OWNER NAME /') /� ,J i � ADDRESS � os / 2 JUN 2 8 2018 PHONE EMAIL�3-�o'�n Received- APPLICANTNAME i /T m e ADDRESS ,3 21 C `e L{,J , PHONE J _ / J I -�J EMAIL i V' �i/pQ, C7 CONTRACTOR'S NAME OWNER BUILDER? 0 YES O NO BUSINESS NAME ADDRESS PHONE EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION$ SO FT L SO FT APPLICANT'S SIGNATURE- DATE OTYSTAFFUSEONLY DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE INVOICE TOTAL 45 n.0-1 GREEN 'r SMIP Ne OWNER BUILDER VERIFIED O YES 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 ENIFE N �/ � n 4 � Rl�'l� J 1 m Q2 12�2YY11S5��1-� �U�� �C� YYI � S �VLQ oddaec, 2a°1 cage- Po Cig- 16 - 023a- C'ty Of Menifee Building Dept. JUN 2 8 2018 Received ee.�1�-mac JURAT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of R}v 19c Subscribed and sworn to (or affirmed) before me on this ` 4 day of ate---G 20 0S by t4_16'IR-. "K. A-0-1-e�a •S proved to me on the basis of satisfactory evidence to be the persop(19) who appeared before me. B. MCGOWAN COMM.#2118160 a tom_ �a L 1.,csiv.ILs�,. a E,, gyp' NOTARY PUBLIC-CALIFORNIA +D* RIVERSIDE COUNT.' { Signature c _ (Seal) SUM My Gomm.EzpiresV July 292J19 F TIONAL INFORMATION INSTRUCTIONS The wording of all Jurats completed In Cahlomia after January 1,2015 must be in the form as set forth within this Just There are no exceptions If a Jumi to be completed does not follow this form,the notary must correct the verbiage by using a jurat slamp containing the correct wording oratfaching a separate jurat form such as this one with does contain the proper wording. In addition, the notary must require an oath or of analfan from the DESCRIPTION OF THE ATTACHE OCUMENT document signer regarding the truthfulness of the contents of the document. The ' document must be signed AFTER the oath or affirmation.If the document was previously signed,it must be to-signed in front of the notary public during the Jurat process (Title or description of attached document) • State and county Information must be the stale and county where the Ile or description of attached document continued) document signer(s)personally appeared before the notary public. Date of notarization must be the date the signer(s) personally eared which must also be the same date the jurat process is corn led. Number of Pages_Document Date Print th ame(s) of the document signer(s)who personally appear at the time of arization. • Signature of the tary public must match the signature on file with the Additional information office of the county rk. • The notary.seal imp sion must be clear and photographically reproducible.Impression m not cover text or lines.If seal impression smudges, re-seal if a sumcie area permits, otherwise complete a different jurat form. - Additional informali Is not required but could help to ensure this jurat is misused or attached to a different document. Indicate title or type of attache ocument,number of pages and date. • Securely attach this document to the signed document ' a staple. 2015 Version www.NotaryC]asses.com 800-873-9865