PMT18-04042 City of Menifee Permit No.: PMT18-04042
29714 HAUN RD. Type: Residential Alteration
cI sv' All MENIFEE,CA 92586
MENIFEE MENIFEE Date Issued: 08/15/2018
PERMIT
Site Address: 28134 GOETZ RD, MENIFEE,CA 92587 Parcel Number: 341-020-024
Construction Cost: $10,000.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of ALTERATION TO EXISTING HOME TO INCLUDE,STUCCO OVER EXISTING SIDING 900 SO FT OF
Work: HOME&CARPORT,25 OUTLET CHANGE OUTS AND RE-WIRE, 40 GAL ELECTRIC WATER
HEATER, CHANGE OUT ALL SINKS AND TUBS, CHANGE OUT ANGLE STOPS, DRYWALL AND
INSULATION REPLACEMENT
Owner Contractor
SCOTT HADLEY-HT PROPERTIES LLC HT PROPERTIES, LLC
31902 AVENIDA EVITA 31902 AVENIDA EVITA
SAN JUAN CAPISTRANO,CA 92675 SAN JUAN CAPISTRANO,CA 92675
Applicant Phone:7146245771
SCOTT HADLEY License Number: 18-PEOP-00028
HT PROPERTIES, LLC
31902 AVENIDA EVITA
SAN JUAN CAPISTRANO, CA 92675
Phone:7146245771
Fee Description Oft Amount
Receptacle, Switch,Outlet&Fixture 25 236.00
Residential Water Heater 1 83.00
Building Permit Issuance 1 27.00
Inspections not specified 258 258.14
GREEN FEE 1 1.00
General Plan Maintenance Fee-Building 1 12.91
$618.05
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_Pennit 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(commencingwith section 7000)of Division of the Business and 4 ham 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
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 contraction.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 this applicatioJissuitted ratthe following website:
by Section 3700 of the Labor Code,for the performance of work for whichwww.le info.c tml.
this permit is issued. G
Policy# Date /r7
PROPERTY O E OR AUTH IZ AGENT
❑I have and will maintain worker's compensation insurance,as required by
section 3700 of the Labor Code,forthe performance of the work forwhich ❑By my signature below I c 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
with all applicable city and county ordinances and state laws relatingto
Carrier building construction.I authorize representatives of this city or county to
Policy# Expires .enter the above identified property for inspection purposes.
(This section need not to he completed is the permit is for one-hundred Date
dollars($300)or less PROPERTY OWNER OR AUTHORIZED AGENT
in I certify that in the performance of the work for which this permit is issued,
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,1 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 greaterthatthe
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes in 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 UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permitfor 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 ❑No
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility he 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) D Yes ❑No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that 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 al Safety Code,Section 25505 and 25534 concerning
hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oyes in NO
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 PROPERTY 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 Contractor's State EPA RENOVATION.REPAIR AND PAINTING(RRP)
License Law(Chapter 9(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 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 s owner ofthe 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( J portion of the work,and the structure is www.epa.aoy/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 Contractor's 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 for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
/,*<A owner of the property am exclusively contracting with licensed
u—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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE
DATE: v PERMIT/PLAN CHECK NUMBER p�
PLANNING CASE NUMBER
TYPE: O COMMERCIAL ESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEWS' rO PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK c..2" C.Lc OV�t� ���e/�.r ( _ )
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PROJECTADDRE55 20 3`j U e'+-� 2.� N� ZIP c„6-alI
ASSESSOR'S PARCEL NUMBER OaO'l�T LOT L TRACT5�
OWNER NAME
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PHONE 2- EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILDER? YES O NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION� l��U�S FT ,JU�LLSQFT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION �CEPTED BY, CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
INVOICE TOTAL 1 = qj.0ar I GREEN Imo. SMIP
OWNER BUILDER VERIFIED 0 YES O NO DRIVERS LICENSE N NOTARIZED LETTER C' YES O NO
City of Menifee Building &Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
G,TY Op
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\ AUG 15 2018
Received
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LLCA File# 2 0 0 9 169 10 3. 6 9
Mate of California
Secretary of State
`eP• in the pDORSED the FILED
LIMITED LIABILITY COMPANY of the state of Califomia
ARTICLES OF ORGANIZATION JUN 16 2009
A$70.00 filing fee must accompany this form.
IMPORTANT—Read instructions before completing this form.
ILp dd,,-�11 Use Only
ENTITY NAME (End the name with the words"Limited Liability Company."or the abbreviations"LLC"or"LLe.N'W!RQ1QNlited"and"Company"
may be abbreviated to"Ltd."and'Co.,"respectively.)
1- NAME OF LIMITED LIABILITY COMPANY
HT Properties LLC
15
PURPOSE (The following statement is required by statute and should not be altered-)
2. THE PURPOSE OF THE LIMITED LIABILITY COMPANY IS TO ENGAGE IN ANY LAWFUL ACT OR ACTIVITY FOR WHICH A LIMITED LIABILITY
COMPANY MAY BE ORGANIZED UNDER THE BEVERLY-KILLEA LIMITED LIABILITY COMPANY ACT.
INITIAL AGENT FOR SERVICE OF PROCESS (If the agent is an individual,the agent must reside in California and both Items 3 Intl 4 must be
completed- If the agent is a corporation,the agent must have on file with the California Secretary of State a certificate pursuant to Corporations Code
section 1505 and Item 3 must be.completed(leave Item 4 blank).
3. NAME OF INITIAL AGENT FOR SERVICE OF PROCESS
Scott Hadley
4. IF AN INDIVIDUAL,ADDRESS OF INITIAL AGENT FOR SERVICE OF PROCESS IN CALIFORNIA CITY
STATE ZIP CODE
31902 Avenida Evita San Juan Capistrano CA 92675
MANAGEMENT(Check only one)
S. THE LIMITED LIABILITY COMPANY WILL BE MANAGED BY:
1-1 ONE MANAGER
MORE THAN ONE MANAGER
ALL LIMITED LIABILITY COMPANY MEMBER(S)
ADDITIONAL INFORMATION
6. ADDITIONAL INFORMATION SET FORTH ON THE ATTACHED PAGES,IF ANY,IS INCORPORATED HEREIN BY THIS REFERENCE AND MADE A PART
OF THIS CERTIFICATE-
EXECUTION
7. 1 DECLARE I AM THE PERSON WHO EXECUTED THIS INSTRUMENT,WHICH EXEC ON I fu�Y ACT AND DEED.
6/15/2009
DATE
SIGNATURE OF AGANIZER
Karla Figueroa
TYPE OR PRINT NAME OF ORGANIZER
LLC-1(REV-"
APPROVED BY SECRETARY OF STATE