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PMT18-03987 City of Menifee Permit No.: PMT18-03987 AV Ar 29714 HAUN RD. MENIFEE, CA 92586 Type: Residential Alteration MENIFEE MENIFEE Date Issued: 0 8/1 312 01 8 PERMIT Site Address: 28804 E WORCESTER RD, MENIFEE,CA Parcel Number: 337-134-006 92586 Construction Cost: $30,000.00 Existing Use: 1 &2 Family Residence Proposed Use: Description of SPECIAL INSPECTION TO ASSESS FIRE DAMAGE CAUSED BY FIRE TO SFR,GARAGE, KITCHEN, Work: ROOF,TRUSSES Owner Contractor SHAWN MCLAUGHLIN G& N CONSTRUCTION INC 28804 E WORCESTER RD 2570 W 237TH STREET STE B MENIFEE,CA 92586 TORRANCE, CA 90505 Applicant Phone:3105341921 - MARK GRINDLE License Number:733551 G&N CONSTRUCTION INC 2570 W 237TH STREET STE B TORRANCE, CA 90505 Fee Description rjtty Amount 151 Building Permit Issuance 1 27.00 Inspections not specified 129 129.07 $156.07 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_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 taw). Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from Iicensure under the Contractor's State License Law for Professions Cade aq my license is in full force and effect. the following reason: License Class License No. 73 3 SSI By my signature below I acknowledge that,except for my personal residence Expires Signature AZ /Jr' 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 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 i issued. www.IeRinfo.ca.Rov/calaw.htmI. Policy 0 Date P PROPERTY OWNER OR AUTHORIZED AGENT ao have and will maintain workers compensation insurance,as required by section 3700 of the Labor Code,for the performance of the workfor 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 an the property owner's behalf.I have read this number are: '�y �2rIz A application and the Information I have provided is correct.I agree to comply Carrier h df r ./ 11$l/ 7 h �a(''I Nn O f Rde t h with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy Jt C64-72g9 fq Expires enter the above identified property for Inspection purposes. (This section need notto be completed is the permit is for one-hundred dollars($100)or less Date PROPERTY OWNER OR AUTHORIZED AGENT 0I certlfythat in the performance of the work for which this permit is issued, r ' ��f I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# O40 4 , workers compensation laws of Califomia,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 //��qq""yy//pphh��with comply with those provisions. p Will the applicant or future building occupant handle hazardous material or a Appllcantf' Z/.L>/(,f�/ Date O—� 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 1kyes ❑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 UPTO 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 Qualify Management District construction or 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) 0 Yes XNo OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD 1 hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of Contractors License Lawfor the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning checkmark(s)I have placed nextto the applicable item(s)(Section 7031.5 Hazardous material reporting. Business and Professions Code).Any city or county that requires a permit toes,�7L!❑No construct,alter,improve,demolish or repair any structure,prior to its '"' �� Date PROPERTY OWNER OR AUTHORIZED AGENT Issuance,also requires the applicant forthe 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 IRRPI License Law(Chapter9(commencing with Section 7000)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 Iicensure 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 o 1,as owner of the property,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.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 Ucense Law does not apply to an owner of a 0 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: o 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 N(G�fi ICi r (rt F L L �LGu �' Acknowledgement. cfl C o'`- BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE ii Gee• DATE: g ' — I(p PERMIT/PLAN CHECK NUMBER I �( PLANNING CASE NUMBER , TYPE: O COMMERCIAL a(RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA 0 SIGN SUBTYPE: O ADDITION OALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES DESCRIPTION OF WORK IDS I(1C UC n P1 t' PROJECTADDRESS �n Fad N/Ur(es4Fc Q ZIP Z� ASSESSOR'S PARCEL NUMBER rr��j7� I ��T IS TRACT C�4 OWNER NAME 1 ('(1 ',n ADDRESS A r E d PHONE if) -0 p i3- 0 EMAIL APPLICANT NAME ADDRESS PHONE EMAIL M , CONTRACTOR'S NAME 14'-(U(-&Je jerLjdjDr OWNER BUILDER? SC.gSIO C BUSINESS NAME V'\ q ` p ADDRESS 2 S f 7 Wc✓ y ��( 2 3 " 51--r i CJG� /O�SLL�7 PHONE 2l0 L 8 8 7 7\ 3 EMAIL CONTRACTOR'S STATE`LIC NUMBER 733 SSI LICENSE CLASSIFICATION VALUATION$ SO FT L SQ FT p APPLICANT'S SIGNATURE DATE DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE (LT'o INVOICE TOTAL GREEN SMIP OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER 0 YES O NO City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777 -� www.cityofinenifee.us r" rr'Oz- r; E ENIFL° .p