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PMT18-03587 City of Menifee Permit No.: PMT18-03587 29714 HAUN RD. Type: Residential Demolition _i MENIFEE, CA 92586 MENIFEE MENIFEE Date Issued: 01/03/2019 PERMIT Site Address: 25241 BUNDY CANYON RD, MENIFEE, Parcel Number: 362-290-005 CA 92584 Construction Cost: $500.00 Existing Use: Proposed Use: Description of DEMO 12 X 60 CHAMPION MOBILE HOME Work: COUNTY PERMIT(S)#01210/255771 Owner Contractor MICHAEL SMITH 28496 RIPPLE BROOK LANE MENIFEE, CA 92584 Applicant License Number: MICHAEL SMITH 28496 RIPPLE BROOK LANE MENIFEE, CA 92584 Phone: 7142221186 Fee Description Qtv Amount(SI Building Permit Issuance 1 27.00 Demolition Permit 1 140.00 GREEN FEE 1 1.00 $168.00 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_Permit_Templatexpt Page 1 of 1 L CITY OF MENIFEEICENSED 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 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 WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I I hereby affirm under penalty of perjury one of the following declarations;I have built as an owner-builder if it has not been constructed in its entirety by have and w€II maintain a certificate of consent ofself-insure for worker's licensed contractors.I understand that a copy of the applicable law,Section compensation,issued by the Director of Industrial Relations as provided for his pthe Business and Professions Code,i available upon request when by Section 3700 of the Labor Code,for the performance of work for which this application is submitted or at the following website: this permit is issued. www.le €nfo.ca. ❑v calaw.html. Policy# Date ❑I have and will mainta€n 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 its issued.My worker's 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 d county ordinances and state laws relating to building construct! .I uthorize representatives of this city or county to Policy# Expires enter the above a red property for inspection purposes. (This section need not to be completed is the permit is for one-hundred ,� dollars($too)or less Date + n I certify that in the performance of the work for which this permit is Issued, PR Y OWNER OR AUTHORIZED AGENT I shall not emol0v 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 subject to the workers COm Pen sati0n provisions of Section 3700 of the Labor HAZARDOUS MATERIAL DECLARATION 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 argreater that the amouWARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes 0 nts s cified on the Hazardous Materials Information Guide? UNLAWFUL,AND SHALL SUS)ECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN will the intended use of the building by the applicant❑r future building ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)?See permitting checklist CONSTRUCTION LENDING AGENCY for guide in s ❑Yes ❑ 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 boo ary of a school? (Section 3097 Civil Code) ❑Yes VW0 OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understan y requirements under the State of Contractor's License Law far the reason(s)indicated below by the California Health&Safety Cod ection 25505 and 25534 concerning checkmark(s)i have placed next to the applicable item(s)(Section 703 1.5 hazardamater€alXot'Business and Professions Code).Any City or county that requires a permit to oYes ❑construct,alter,improve,demolish or repair any structure,prior to its P Dateissuance,also requires the applicant for the permit to file a signed statement PROPERTYOW ERRIZED AGENT that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION REPAIR AND PAINTING(RRP) License Law(Chapter 9(Commencing 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 and the basis far the alleged exeMption.Any violation of Section 7031.5 by receiving compensation for most work that disturbs paint in a pre-1978 an Applicant for a permit subjects the applicant to a civil penalty of not more residence or childcare facility to be RRP-certified firms and comply with than($500). required practices.This includes rental property owners and property managers who do the paint-disturbing workthemselves orthrough their n 1,as owner of the property,or my employee with wages as thelr sale employees.For more information about EPA's Renovation Program visit: compensation,wi11 do( )all of a ( )portion of the work,and the structure is www.epa-nov/lea 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 Contractor's State License Law does not apply to an owner of a property who,through employees'or personal effort,builds or improves the Ei An EPA Lead-Safe Certified Renovator will be responsible for this project property provided that the Improvements are not intended or offered for sale.11,however,the building or improvement is sold within one year of Certified Firm Name: completion,the Owner-Builder will have the burden of proving that It was Firm Certification No.: not built or improved far the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because: rt 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.