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PMT18-03515 City of Menifee Permit No.: PMT18-03515 29714 HAUN RD. jr MENIFEE, CA 92586 Type: Residential Alteration MENIFEE MENIFEE Date Issued: 09/04/2018 PERMIT Site Address: 27826 BLACKWAWK RD, MENIFEE,CA Parcel Number: 909-936-0731 92584 Construction Cost: $25,000.00 Existing Use: 1 &2 Family Residence Proposed Use: Description of GARAGE CONVERSION TO LIVABLE SPACE,250 SF.WITH ELECTRICAL AND HVAC,PLUMBING. Work: Owner Contractor GREG KNISS MITCHELL CONSTRUCTION 27826 BLACKHAWK RD 25647 FARMINGTON RD MENIFEE, CA 92584 MENIFEE,CA 92584 Applicant phone: 9512266201 MITCHELL CONSTRUCTION License Number:928421 25647 FARMINGTON RD MENIFEE, CA 92584 Fee Description Qty Amount f8l Services,Switchboards,Control Centers&Panels 1 116.00 Plumbing Fixtures and Vents,fixtures 3 116.00 Building Permit Issuance 1 27.00 Inspections not specified 129 129.07 Additional Plan Review Building 65 64.55 Additional Plan Review Building 129 129.07 GREEN FEE 1 1.00 SMIP RESIDENTIAL 1 4.00 New Construction Permit Fee 1 96.33 General Plan Maintenance Fee-New 1 4.92 Construction $689.94 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. AFFl 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 Contractor's State License Law for Professions Cade and my license is in full force ano effect. the following reason: License Class Licens o. By my signature below I acknowledge that,except for my personal residence Expires ,a- -�� 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 DECLARAT have built as an owner-builder if it has not been constructed in its entirety by ❑I hereby affirm under penalty of/ jury one of the following declarations:I licensed contra t�d erstand that a copy of the applicable law,Section have and will maintain a certificate of consent of self-insure for workers 7044 oft rne® rofesslons Code,is available upon request when compensation,issued by the Director of Industrial Relations as provided for this ��a�(t� LSubmitt r at the following website: by Section 3700 of the Labor Cade,for the performance of work for which www I1ifo.ca.eov/call. this permit is issued. Policy# `�• Date ❑I have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR WENT section 3700 of the Labor Code,for the performance of the work for which ❑By my signature rtify to each of the fallowing:I am the property this permit is issued.My workers compensation insurance carrier and policy owner o u act on the property owners behalf.I have read this number are: (�( applicatio. a e information I have provided is correct.I agree to comply Carrier �vl� with all applicable city and county ordinances and state laws relating to / �p ) building construction.I authorize representatives of this city or county to Polity n# Y w (P`'d`Expires 3 o 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 ❑I certify that in the performance of the work for which this permit is issued, =COSTOF t emolov any p ons' any manner so as to become subject to the `yI�CITY BUSINESS LICENSE# s compensatio aw California,and agree that if 1 should become N'HAZARDOUS MATERIAL DECLARATION to the work s c ensati n provisions of Section 3700 of the Labor I hall th ly wi those provisions. R Will the applicant or future building occupant handle hazardous material or a t Date / G� mixture containing a hazardous material equal to or greater that the amoun�sp�9 [fled on the Hazardous Materials Information Guide. URE TO SECURE WORKER'S COMPENSATION COVERAGE 15 ❑Yes JSNo ,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building L FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South NTO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)7 See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidr.Ime5 CONSTRUCTION LENDING AGENCY ❑Yes N I hereby affirm that under the penalty of perjury there is a construction Will tIIIe 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 bry of a school? (Section 3097 Civil Code) ❑Yes XN, OWNER BUILDER DECLARATIONS I have read the Hazardo aterial Information Guide and the SCAQMD I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I rst my requirements under the State of Contractors License Law for the reason(s)indicated below by the California Health d ,Section 25505 and 25534 concerning bazayes to' e ng. chsiness and Professions have placed neM to the applicable item(s)(Section perms oyes �It o / 64 Business and Professions Code).Any city or county that requires a permit to � " Date �G /Q construct,alter,improve,demolish or repair any structure,prior to its PROPE NE 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 Contractors State EPA N VATION,REPAIR AND PAINTING(RRPI License Law(Chapter 9(commencing with Section 7000)of Division 3 of the T�he 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 Ina 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 ❑I,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.eoa.aov/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 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 for this project because: ❑1,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.