PMT18-03570 City of Menifee Permit No.: PMT18-03570
29714 HAUN RD. Type: Residential Plumbing
ff® MENIFEE, CA92586
INENIFEE MENIFEE Date Issued: 07/18/2018
PERMIT
Site Address: 24557 COMANCHE CREEK DR, Parcel Number: 358-720-013
MENIFEE, CA 92584 Construction Cost: $500.00
Existing Use: Proposed Use:
Description of RUN U/G 100 L FT-V GAS LINE FOR GAS FIRE PIT
Work:
Owner Contractor
DANIEL&NATALIE BROWN
24557 COMANCHE CREEK DR
MENIFEE, CA 92584
Applicant License Number:
DANIEL&NATALIE BROWN
24557 COMANCHE CREEK DR
MENIFEE, CA 92584
Phone: 9518131891
Fee Description QQt Amount fE)
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
$149.80
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 BIdg 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 in 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
this permit is issued. WWW.Ieginfo.ca.gov/calaw.html.
Policy p Date
❑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 ❑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 author ed to act on the property owners behalf.I have read this
number are: application and a information I have provided is correct.I agree to comply
Carrier with all applica city and county or 'nances and state laws relating to
building const u do Iauthoriz entatives of this city or county to
Policy# Expires entert a entified erty fo inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date —7 f L w t
dollars($300)or less PROPE NER OR AUTHORIZED AGENT
o 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 If
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. 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 IS in 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 work which 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 Heaterial reporting.
al Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the .
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous mate
oyes ❑No
Business and Professions Code).Any city or county that requires a permit to
Date
construct,alter,improve,demolish or repair any structure,prior to its 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 Contractors State EPA RENOVATION.REPAIR AND PAINTING(RRPj
License Law(Chapter 9(commencing with Section 70001 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 orthrough 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.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 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. ❑No EPA Lead-Safe Certified Firm is required for this project because:
of 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:JUiY 18, 2018 PERMIT/PLAN CHECK NUMBER 81 O
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW <PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK 100 linear feet of 1-inch gas line run from the meter to the backyard
PROJECTADDRESS 24557 Comanche Creek Dr, Menifee ZIP 92584
ASSESSOR'S PARCEL NUMBER 359-7QtVC0' LOT 12 TRACT
OWNER NAME Daniel and Natalie Brown
ADDRESS 24557 Comanche Creek Dr, Menifee, CA 92584
PHONE 951-813-1891 EMAIL book.em.dano@hotmail.com
APPLICANT NAME Daniel Brown
ADDRESS 24557 Comanche Creek Dr, Menifee, CA 92584
PHONE 951-813-1891 EMAIL book.em.dano@hotmail.com
CONTRACTOR'S Joe Hoffman OWNER BUILDER? A(YES ONO
BUSINESS NAME _ an Landscapes and Design
ADDRESS
PHONE 951-712-9875 EMAIL I.oe@ioeho nanlandscape.com
CONTRACTOR'S STATE LIC NUMBER 668951 LICENSE CLASS]FICATION
VALUATION$ 6 Q o Q FT L SQ Fr 100
APPLICANT'S SIGNATURE DATE July 18, 2018
CITY STAFF USE ONLY �.
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIFE ACCEPTED BY:
PERMIT FEE SMIIP GREEN
4 �� I
PLAN CHECK FEE I INVOICETOTAL
OWNER BUILDER VERIFIED OYES O NO DRIVERS LICENSE# NOTARIZED LETTER 0 YES O NO
City of Menifee Building&Sofety Deportment 29714 Houn Rd. Menifee, CA 92536 951-672-6777
www.cityofinenifee.us
City of Menifee
Building Dept. tvl3i ��mxa �te't�
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