PMT18-03389 City of Menifee Permit No.: PMT18-03389
29714 HAUN RD.
MENIFEE,CA 92586 Type: Residential Electrical
MENIFEE MENIFEE Date Issued: 0 710 612 01 8
PERMIT
Site Address: 29777 FAR SHORE DR, MENIFEE,CA Parcel Number: 333-700-008
92584 Construction Cost: $800.00
Existing Use: Proposed Use:
Description of INSTALL GAS LINE FOR SPA AND FUTURE BBQ AND ELECTRICAL.
Work:
Owner Contractor
DAVID LEIDENFROST BILL&DAVE'S LANDSCAPE MAINTENANCE INC
2977 FAR SHORE DRIVE 1153 HARLEY KNOX BLVD
MENIFEE,CA 92584 PERRIS,CA 92571
Applicant Phone:9519436455
BILL&DAVE'S LANDSCAPE MAINTENANCE INC License Number.751707
1153 HARLEY KNOX BLVD
PERRIS,CA 92571
Fee Description O_yt Amount($1
Receptacle, Switch,Outlet&Fixture 1 116.00
Plumbing Fixtures and Vents,fixtures 1 116.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 5.80
General Plan Maintenance Fee-Electrical 1 5.80
$271.60
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_Pennit Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION propertywho builds or Improves thereon,and who contacts for the projects
I hereby affirm under penally of perjury that l am under provisions of with a licensed contraclods)pursuant to the ContractonSDte License Law).
Chapter9(commencing with section 70001 of Division 3 of the Business and D 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 1 7 L
By my signature below I acknowledge that,except formYPersonal residence
Expires 7z5@nature / in which l must have resided(or at least one year prior to completion of
y Improvements covered by this permlC I cannot Iegally Self!Structure that I
WORKER'S COMPENSATION DECLARATION
have bulls as an owner-builder if it has not been eonstructedln Its entirety by
01 hereby affirm under penalty of perjury one of the following declarations:) licensed contractors.I understand that a copy or the applicable law,Section
have and will maintain a certificate of consent ofselfinsure 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 forwhfch
this permit rsissued. ) 1 lvsvu.leeinfo.ca.Cov/calau.htmi.
Policya C L I'3 U `�i/ ! L/ 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 O By my signature below l certify to each of the following:I am the property
this permit is Issued.My worker's compensation insurance carrier and policy owner orauthorited to act on the property owner's behalf.shave read this
number are:. ` r application and the information l have provided is cornea.l agree to comply
Carrier L �'��C-� 1 Y�� �•;- �) 11'w �. C with all applicable city and county ordinances and state laws relating to
t� / (i j` ry♦ building construction.I authorize representatives of this dryor county to
Policy Is G CJ Gee!YJ1L/Expires enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Dale
dollars(5100)or less PROPERTY OWNER 04AUTHDRIZED AGENT
o l certify 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 r�1✓✓ �`++'' 1
worker's compensation laws of California,and agree that if l 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. WIII the applicant or future building occupant handle hazardous material or a
�-• C�// S ( mixture containing a hazardous material equal to or greater that the
applicant , Date /
amounts specified on the Hazardous Materials Information Guido
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS DYES 'N.
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
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit(or the construction or modification from South
IN SECTION 3706 OF THE LABOR CODE INTEREST,AND ATTORNEYS FEES Co e Quality Management DHtdc[(SCAQMD)7 See permining checklist
for Cuid guidelines
CONSTRUCTION LENDING AGENCY Dyes ONo
I hereby affirm that under the penalty of perjury there is a construction WIII the proposed building or modi0edfacility 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) Dyes ;d No
OWNER BUILDER DECLARATIONS 1have read the Hazardous Material Information Guide and the SCA LMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty OF perjury lhatlam exempt from the California Health&Safety Code,Section 25505 and 2S534 concerning
Contractor's License Law for the reason(s)Indicated below by the hazardousmatedol reporting.
checkmark(s)I have placed next to the applicable Imm(s)(Section 7031.5 Dyes -0 No
Business and Professions Code).Any city or county that requires a permit to _ ' �.
construct,alter,Improve,demolish or repair any structure,prior to its PROPERLY 0WNEIi'OR-AUTFIORMEDASEN7
issuance•also requires the applicant for the permit to rile a signed statement
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION.REPAIR AND PAINTING(FIR _
License Law(Chapter 9(commendng with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt from licensure The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
recervrng compensation far most work that disturbs paint in a pre-19713
and the basis for the alleged exemption.Any violation or Section 7031.S 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
o1,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 oforI )portion of the work,and the structure is ..epa.eav/lead or contactthe National Lead Information Center at
not intended or offered forsale.(Section 7044,Business and Professions 1-900-424•LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a 0An EPA Lead-Safe Certified Renovator will be responsible far this project ``•
property who,through employeey or personal effect,builds orimprooms the ova/
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•BUIlderwill have the burden of proving that it was
not built or improved for the purpose of sale, ONO EPALeadSafe Certified Firm is required for this projectbelause: A
D I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Seaton 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
T
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION � MENIFEE
:mil.
DATE: �7Z16PERMIT/PLAN CHECK NUMBER
GRADING/PLANNING CASE NUMBER/OTHER RELATED CASES
TYPE: O COMMERCIAL WIRESIDENTIAL 0 MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: (F)ADDITION O ALTERATION O DEMOLITION () ELECTRICAL O MECHANICAL
ONEW OPLUM13ING ORE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK R F ( Q-
OCCUPANCY GROUP q c 1 CONSTRUCTION TYPE SPRINKLERS OYES ONO
PROJECTADDRESS 1 / 7 -) /--AL Sk(� /j e ZIP p
ASSESSOR'S PARCEL NUMBER ��//�-
I?> -\ go - LOT TRACT
OWNER NAME r 1 JF- dam-- y. I 1'� 0 ,,rl
ADDRESS / 7
PHONE C� - /8� \�I `2 0 0 ( ,E<aMA,IILL , { `
APPLICANT NAMED ✓T V 1 0 � V I `V J L- r U S n�n n �7
ADDRESS `(` �� �"�Q -( \\�{ Q v v�, I S 9d� /
PHONE �J ' � -9 - Ll � Q-5 EMAIL
CONTRACTOWSNAME & Il Ue OWNERBUILDER? OYESONO
BUSINESS NAME S A/"— ` �- e n C, )
ADDRESS (,'` 1 I �� l' 1 yv ¢�V 1, �^ CA /p 5 1
PHONE IJ 1 � rl 'j�7�� EMAIL
CONTRACTOR' ST,A.,TTE/LIC 6�NUMBER `51 ?67 LICENSE CLASSIFICATION
VALUATION L /� SQ FT L SQ FT
APPLICANT'S SIGNATURE l DATE � c /
cirysTAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
INVOICETOTAL GREEN SMIP
OWNER BUILDER VERIFIED OYES O NO DRIVERS LICENSE# NOTARIZEDLETTER O YES O NO
City of Menifee Building &Safety Department 129714 Haun Rd., Menifee,CA 92586 (951)672-6777
www.cityofm en ifee.us
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BUILDING AND SAFETY DEPARTME� de
PLAN APF.PRQYA
REVIEWED BY _
- OrllD,; 4 DATE Q
'Approval of these plans shall not be construed to be a permit for,or an
approval of,any violatiortof any provisions of the federal,state or city
! regulations and ordinances. This set of approved plans must be kept on the
jobsite until completion. �1
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