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.