PMT18-03941 City of Menifee Permit No.: PMT18-03941
29714 HAUN RD. Type: Residential Alteration
Y/ MENIFEE, CA 92586
MENIFEE MENIFEE Date Issued: 09/0512018
PERMIT
Site Address: 25647 FARMINGTON RD, MENIFEE, CA Parcel Number: 358-100-051
92584 Construction Cost: $15,000.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of AS-BUILT GARAGE CONVERSION TO LIVABLE SPACE WITH PLUMBING, MECHANICAL&
Work: ELECTRICAL,525 SF
Owner Contractor
JONATHON MITCHELL ,
25647 FARMINGTON ROAD
MENIFEE, CA 92584
Applicant License Number:
JONATHON MITCHELL
25647 FARMINGTON ROAD
MENIFEE, CA 92584
Phone: 9512266201
Fee Description Qtz Amount
15t
Receptacle, Switch, Outlet&Fixture 11 166.00
Plumbing Fixtures and Vents,fixtures 3 116.00
Building Permit Issuance 1 27.00
Inspections not specified 258 258.14
Inspections not specified 129 129.07
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 2.00
$699.21
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.
AP._Bltlg_Permil_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 Code and my license is in full farce and effect, the following reason:
License Class f� 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 contra ors.I understand that a copy of the applicable law,Section
have and will maintain a certificate of consent of self-insure for workers 7044 of the B iness and Professions Code,is available upon request when
compensation,issued by the Director of Industrial Relations as provided for this applica n' ubmitted at the fallowing website:
by Section 3700 of the Labor Code,for the performance of work for which
www.le i . a. v cala I,
this permit is issued.
Policy# S Date
/RO OWNER OR AUTHORIZED AGENT
❑I have and will maintain workers compensation insurance,as required by
section 3700 of the Labor Code,for the performance of the work for which 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 r 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 applic le city and county ordinances and state laws relating to
building con ruc[i .I authorize representatives of this city or county to
Polity# Expires enterth ove' a tified raperty for inspection purposes. p�
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PRO R WNER OR AUTHORIZED AGENT
❑I certify that in the performance of the work for which this permit is issued,
1 shall not emolov any persons in any manner so as to become subject to the BUSINESS LICENSE#
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 Dyes KNO
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 KNo
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 school?
(Section 3097 Civil Code) ❑Yes ))4o
OWNER BUILDER DECLARATIONS I have read the zardous Material Information Guide and the SCAQMO
I hereby affirm under penalty of perjury that I am exempt from the permitting the list.I and and my requirements under the State of
California He h fe ode,Section 2550S and 25534 concerning
Contractors License Law for the reason(s)indicated below by the hazardous at ial a ing.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 ❑yes r/
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 PROP 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 E ENOVATION REPAIR AND PAINTING RRP
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the a 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 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.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 forthe 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 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 PERM 1T/PLAN CHECK APPLICATION - MENIFEE
DATE: l PERMIT/PLAN CHECK NUMBER
PLANNING CASE NUMBER
TYPE: O COMMERCIAL XRESIDENTIAL O'MULTI-FAMILY O MOBILE HOME O POOL/S ^
SUBTYPE: VADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHAPiavIO9 Dept.
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES
C
DESCRIPTION OF WORK �a C ✓e /pµl
Receive
PROJECTADDRESS �,��LJ7 /yvtjN9'`dn% 11``�< /Y)cN ee ZIP `i,)5
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME SQ/Y(,t.c �.J
ADDRESS
PHONE C/�/—,�,�f�_�c�CJf EMAIL
APPLICANT NAME
ADDRESS '0v11L /' Ielvf fc �e _
/�
PHONE %,V-4)6-6,O( EMAIL A& u jel1
CONTRACTOR'S NAME OWNER BUILDER? -YES O NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER J LICENSE CLASSIFICATION
VALUATION$ / —6wo FT L SO FT p
APPLICANT'S SIGNATURE DATE 6 `�O
OTYSTAFFUSE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENG .EERING FIRE
INVOICE TOTAL 1 GREEN , - SMIP
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE tt NOTARIZED LETTER O YES O NO
City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777_,
www.cityofinenifee.us `O
NIF6 �,
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