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PMT18-03922 City of Menifee Permit No.: PMT18-03922 a+ Apr 29714 HAUN RD. 6 & MENIFEE, CA 92586 Type: Residential Alteration ZZ MENIFEE MENIFEE Date Issued: 0813112018 PERMIT Site Address: 29060 PRESTWICK RD, MENIFEE,CA Parcel Number: 338-024-005 92586 Construction Cost: $25,000.00 Existing use: 1 &2 Family Residence Proposed Use: Description of EXISTING CARPORT TO GARAGE CONVERSION WITH NEW AUTOMATIC GARAGE DOOR, PERMIT Work: EXISTING ENCLOSED PATIO AS LIVABLE SPACE 200 SF, UTILITY ROOM CONVERSION TO BEDROOM 170 SF, ENCLOSE EXISTING PATIO COVER 45 SF, CHANGE SEWER LINE TO ABS,ADD WATER AND GAS LINES FOR LAUNDRY ROOM, GAS LINE FOR STOVE IN KITCHEN, REMOVE WALLS, MISC ELECTRICAL Owner Contractor SSA PROPERTIES c/o JOHN PETERSEN 31947 DAISY FIELD COURT LAKE ELSINORE, CA 92532 Applicant License Number: SSA PROPERTIES Go JOHN PETERSEN 31947 DAISY FIELD COURT LAKE ELSINORE,CA 92532 Phone:9515535542 Fee Description Div Amount lSl Receptacle,Switch, Outlet&Fixture 2 121.00 Plumbing Fixtures and Vents, fixtures 2 116.00 Sewer 1 150.00 Building Permit Issuance 1 27.00 Inspections not specified 305 305.20 Additional Plan Review Building 90 90.00 GREEN FEE 1 1.00 SMIP RESIDENTIAL 1 4.00 New Construction Permit Fee 1 115.00 New Construction Plan Check 1 74.75 General Plan Maintenance Fee-Plumbing 1 13.30 General Plan Maintenance Fee-Electrical 1 6.05 $1,023.30 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_Pennk_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 Contractors 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 Expires residence 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 will maintain a certificate of consent of self-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 7044 of the Business and Professions Code,is 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 info.[ . ov calaw.html. Policy p Date ❑1 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 ❑By my signature below I certify to each of the following:I am the property this permit is 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 and county ordinances and state laws relating to Pali[ » building construction.I authorize representatives of this city or county to y Expires enter the above identified property for inspection purposes. (This section need not to be completed is the permit is for one-hundred ��] 8_ 3' dollars($100)or less —� — Date ❑1 certify that In the performance of the work for which this permit is issued, PROPERTY—OWNER OR AUTHORIZED AGENT I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE X worker's compensation laws of California,and agree that if I should become subject to the worker's compensation provisions of Section 3700 of the Labor HAZARDOUS MATERIAL DECLARATION Cade,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 s Notified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS Is UNLAWFUL,AND SHALL SUBJECT AN 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 or 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 guidelines ❑Yes j�No 1 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 .0 p No 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 understand my requirements under the State of Contractor's License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material reporting. Business and Professions Code).Any city or county that requires a permit to Dyes p construct,alter,improve,demolish or repair any structure,prior to its "' Date y issuance,also requires the applicant for the permit to file a signed statement PROP WNER OR AUTHORIZED AGENTthat he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION REPAIR AND PAINTING fRRP) 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 for 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 was owner of the pro a managers who do the paint-disturbing work themselves or through their p rty,or my employee with wages as their sale 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.gov/lead or contact the National Lead Information Center at not intended or offered forsale.(Section 7044,Business and Professions 1-800-424-LEAD(5323). Cade,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 D An EPA Lead-Safe Certified Renovator will be responsible for this project Property provided that the improvements are not intended or offered for sale.If,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 for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because: ❑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. CONSTRUCTION AND DEMOLITION • VON ENIRE +j WASTE DIVERSION PROGRAM '•' •" City of Menifee-Public Works/Engineering Department 29714 Haun Road, Menifee, CA 92586 City of Menifee Ph:951-672-6777 Date: (, Case Number-PP,CUP,Etc. Project Description: J JLl'-10 �� .. �[✓iJ CIE( -Ll.._ �.� 1..1� �.�1C.1.-j ., APN: Project Address: Zip Code: >7�' 02�' fUS 2_c/C(nO 1�fL�t ✓,�.� IZcI %2s�( Applicant's Name: Daytime Phone: Start Date: .., Applicant's Company Name: Applicant's Title: Date of Completion: Contractor's Name: Daytime Phone: For City of Menifee Only Approved by: /L r4 PERFORMANCE GOALS This project will recycle, reuse, compost, and/or salvage a minimum of 50% by weight of the material and/or waste generated on site. PERFORMANCE • Please read the following requirements, sign below and initial ea,cb.box to acknowledge that you agree to comply with these conditions. Sign here: Form C - Reporting Form, will be completed and submi$e-d-to the Ity of Menifee with legible letters and/or original receipts, including certified weights, for all materials and/or waste recycled, Jreused, composted, salvaged and/or landfilled. Each entry on this form must correlate to a dated receipt to demonstrate that recycling, reuse and/or salvaging occurred. Landfill disposal receipts are also required. All weight information for recycled, reused, composted, and/or salvaged materials MUST be 1 converted to tons, and entered in BOX 1. For assistance in converting volume to weight, go to: http://www.ca I recycle.ca.gov/swfacilities/CDI/-rools/Calcu lations.htm \ All weight information for landfilled and disposed materials MUST be converted to tons and entered I) in BOX 2. To calculate WASTE GENERATION for this project add BOX 1 and BOX 2. Enter this total in BOX 3. j 1 To calculate the final DIVERSION RATE for this project divide BOX 1 by BOX 3 and enter this total in BOX 4. Lolly Ot Menifee Building Dept. PC© Al!! 10 7013 Rev.7/28/1501 ' �' Received Page 3of4 Waste Authorized Hauler Estimated Estimated Materials Management and Disposal Site Weight Weight Comments Method or Diversion Diverted Landfilled Facility (in Ibs) (in Ibs) Asphalt Brick/Masonry Cardboard Carpet/Carpet Pads Concrete Drywall/Gypsum Board Fixtures(doors, toilets, windows Green Waste -'''u Metal Mixed Recyclables bottles, cans, paper) Mixed Plastics# 1-7 no Film Plastic Wood Other-Explain Refuse/Trash Total Each Weight Column and Enter Total into Correct Box ► Box 1 Total TONS Diverted► Box 2 Total TONS Landfilled ► 2 Box 3 Total Waste Generation for this Project(tons) ► L Box 4 ESTIMATED DIVERSION%for this Project ► LEGEND FOR BOX OPTIONS Waste Management Method Authorized Hauler(Contact the Hauler for the project area) Reuse Recycle Waste Management Inland Empire Compost 1-800-423-9986 Salvage http://www.keepinginlandempireclean.com Landfill WM Form 2100 Rev.4/18118 AY Page 2 of 4 40_'41 CONSTRUCTION AND DEMOLITION rer efi, WASTE DIVERSION PROGRAM " City of Menifee-Public Works I Engine of Department 29714 Haun Road, Menifee, CA 92586 City of Menifee Ph: 951-672-6777 Date: Case Number-PP,CUP,Etc.Project Description: APN: Project Address: Zip Code: 7j,l�' !(i'G° -�.C-S 2 JUG:ii /7/LIrSTIJrC/C /Zl� 92 Applicant's Name: Daytime Phone: Estimated Start Date: _. leer rs oo- � , - �s Z 7- 41/,Y Applicant's Company Name: Applicant's Title: Estimated Date of Completion: Contractor's Name: Daytime Phone: For RCDWR Only '/k 1,-,lc`_ %i—/_ ' Approved by: PERFORMANCE GOALS This project will recycle, reuse, compost, and/or salvage a minimum of 50% by weight of the material and/or waste generated on site. PERFORMANCE Please read the following requirements, sign below and initial each box to acknowledge that you agree to comply with these conditions. Sign here: ,? Waste prevention & recycling activities will be discussed at the beginning of each safety meeting The permit applicant shall provide each NEW subcontractor with copies of completed Form B (Recycling Plan) and Form C (Reporting Form). The permit applicant shall provide each subcontractor with a tour of the site's recycling areas. i All recycling containers will be clearly labeled and lists of acceptable and unacceptable materials will be posted throughout the project site. Form B - Recycling Plan must be approved by the City of Menifee prior to issuance of Building Permits. Form C - Reporting Form must be approved by the City of Menifee prior to issuance of Occupancy Permits. Form C - Reporting Form MUST be accompanied by legible letters and/or original receipts including i certified weights, for all materials and/or waste recycled, reused, composted, salvaged, and/or landfilled. Waste Diversion must be calculated in TONS (Total Recycled Tons divided by Total Waste Tons =% Recycling Rate) Step 1 Enter the"Estimated Weight"of each Diverted or Landfilled material in pounds (Ibs). To convert volume to weight, refer to: http://www.calrecycle.ca.gov/swfacilities/CDI[rools/Calculations.htm *Step 2 Total the"Estimated Weights"of Diverted (Ibs)and Landfilled (Ibs) material and enter in Total box designated for each. Step 3 Convert TOTAL Diverted and Landfilled lbs. to TONS (divide by 2000). Enter TOTAL of Estimated Diverted TONS in BOX 1. Enter TOTAL of Estimated landfilled TONS in BOX 2 *Step 4 To calculate Total Estimated Waste Generation for this project, add BOX 1 and BOX 2. Enter this Total in BOX 3. Step 5 To calculate Estimated Diversion Rate for this project divide BOX 1 by BOX 3. Enter this Total in BOX 4. WM Form 2100 Rev.4/18/18 AY Page 1 of 4 Waste Authorized Hauler Actual Actual Materials Management and Disposal Site or Weight Weight Comments Method Diversion Facility Diverted Landfilled (in tons) (in tons) Asphalt Brick/Masonry Cardboard Carpet/Carpet Pads Concrete Drywall/Gypsum Board Fixtures(doors, toilets,windows) Green Waste Metal Mixed Recyclables (bottles, cans, paper) Mixed Plastics#1-7 (no Film Plastic) Wood Other-Explain Refuse/Trash Total Each Weight Column and Enter Total into Correct Box 0- Box 1 Total TONS Diverted► Box 2 Total TONS Landfilled ► Box 3 Total Waste Generation for this Project(tons) ► BOX 4 ACTUAL DIVERSION%for this Project ► LEGEND FOR BOX OPTIONS Waste Management Method Authorized Hauler(Contact the Hauler for the project area) Reuse Recycle Waste Management Inland Empire Compost 1-800-423-9986 Salvage htto://www.keepinginiandempireclean.Com Landfill WM Form 2101 Rev.7/28/15 Page 4 of 4