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PMT18-04134 City of Menifee Permit No.: PMT18-04134 29714 HAUN RD. MENIFEE,CA 9258E Type: Residential Alteration MENIFEE MENIFEE Date Issued: 0 8/2 012 01 8 PERMIT Site Address: 28389 PACIFIC CT,MENIFEE, CA 92584 Parcel Number: 333-510-016 Construction Cost: $1,000.00 Existing use: 1 &2 Family Residence Proposed use: Description of SPECIAL INSPECTION TO ASSESS ELECTRCIAL DAMAGE FOR CODE CASE CE18-0680 Work: Owner Contractor UNG AHI LAM APP DAPPER INC 7532 1/2 GARVALIA AVE 4415 MERGED AVE ROSEMEAD,CA 91770 BALDWIN PARK, CA 91706 Applicant Phone:6262360388 BAIXIAO SONG License Number: 1028712 APP DAPPER INC 4415 MERGED AVE BALDWIN PARK, CA 91706 Fee Description 01tt Amount 1E1 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_Pe=it Template.rpt Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects with a licensed contractors)pursuant to the Contractors State License Law). I hereby affirm under penalty of perjury that I am under provisions of 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 Cade and my license is in full force and effect. the following reason: License Class }� License No. � '� 1�7r Z By my signature below I acknowledge that,except for my personal residence Expires 07 i,I 1 o Signature in which I must have resided for at leas[one year prior to completion of improvements covered by this permit.I cannot legally sell a structure that I IN 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 workers 7044 of the Business and Professions Code,is available upon request when compensation,issued by the Director of Industrial Relations as provided for this application is submitted or at the fallowing website: by Section 3700 of the Labor Code,forthe performance of work forwhich www.leginfo.ca.gov/calaw.html. this permit is issued. Po�lity# — O 0 Date %4 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 owner's behalf.I have read this number are: �T / application and the information 1 have provided is correct.I agree to comply ��n 1.'—�-�, I�� I� `h4Ul ar Yl f e L 0✓'+ n� with all applicable city and county ordinances and state laws relating to Ca building construction.I authorize representatives of this city or county to Po U IRA(f ol; -7—e0 Expires OG/�If�1 0/ enter the above identified property for inspection purposes. (This section need not to be completed is the permit is for one-hundred Date dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT ❑I certify that in the performance of the work for which this permit is issued, I shall not employ 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 tabor Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a / �/ mixture containing a hazardous material equal to or greater that the Applicant i�p7 •4? Q a a-- Date amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 ❑Yes VNo 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 3705 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines CONSTRUCTION LENDING AGENCY ❑Yes '�Mo 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 Cade) ❑Yes Nfio OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of California Health al Safety Code,Section 25505 and 25534 concerning Contractor's License Law for the reason(s)indicated below by the checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 ha rdous material reporting. za Business and Professions Code).Any city or county that requires a permitto '41es ❑No /' (C pp OWNER OR UT ORI Date 9 6 1O bu l6 construct,alter,improve,demolish or repair any structure,priorto its PROPERTY OWNER OR AUTHORIZED AGE issuance,also requires the applicant forthe 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 1RRP) 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 Cade)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( I all of or( )portion of the work,and the structure is www.epa.gov/lead or contact the National Lead Information Centerat 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: ❑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 brax' •vl ) Acknowledgement. BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION DATE: u 2 o b0 / PERMIT/PLAN CHECK NUMBER PLANNING CASE NUMBER TYPE: O COMMERCIAL VIRESIDENTIAL 0- MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION `IRALECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES DESCRIPTION OF WORK e >c i-rix ,A o W2Y 1 ,Y,e r96tS2_ PROJECTADDRESS G ZIP g2S�LF ASSESSOR'S PARCEL NUMBER LOT TRACT OWNER NAME UN Np ADDRESS -) ' �/2 Yz L�G �,•G ve -Gec�z j 1-7 PHONE Lj L_A p7� �2�L EMAIL APPLICANT NAME ADDRESS PHONE EMAIL CONTRACTOR'S NAME Pj L I OWNER BUILDER? O YES tAO BUSINESS NAME T vi c . ADDRESS / 1 6/ n tZSrYI1n y L: L ,wc� e �a 1 7 Z PHONE f 14 - L 5 6 - D j3> EMAIL kPI j>(I�GrX C`o yhC„ ,cow - CONTRACTOR'S STATE LIC NUMBER /0'247 1 Z LICENSE CLASSIFICATION VALUATION$ 11 DOB, o o SO FT L SO FT APPLICANT'S SIGNATURE ''YL" , 4 DATE OTYSTAFFUSEONLY DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE INVOICE TOTAL GREEN SMIP OWNER BUILDER VERIFIED OYES O No DRIVERS LICENSE# NOTARIZED LETTER O YES O NO City of Menifee Building &Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777 �m www.cityofinenifee.us � _MENIFEE'