PMT18-04170 City of Menifee Permit No.: PMT18-04170
29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Demolition
MENIFEE MENIFEE Date Issued: 08123/2018
PERMIT
Site Address: 27115 SCOTT RD, MENIFEE,CA 92584 Parcel Number: 384-100-012
Construction Cost: $8,500.00
Existing Use: Proposed Use:
Description of DEMO EXISTING HOUSE, 1169 SF,ABANDON AND FILL EXISTING SEPTIC TANK
Work:
Owner Contractor
JOHN WERTHWEIN H F G PACIFIC EXCAVATION INC
PO BOX 910 28690 CAPANO BAY COURT
SIERRA MADRE, CA 91025 MENIFEE,CA 92584
Applicant Phone:9516722357
HARRY GRAUN License Number:902479
H F G PACIFIC EXCAVATION INC
28690 CAPANO BAY COURT
MENIFEE, CA 92584
Fee Description Oft Amount ISl
Building Permit Issuance 1 27.00
Demolition Permit 1 140.00
GREEN FEE 1 1.00
$168.00
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).
Chapter-9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from Iicensure under the Contractors State License Law for
Professions Code and my license is In full force and effect, the following reason:
License Class l {TT_Li n e o. By my signature below 1 acknowledge that,except for my personal residence
Expires, .� /i r7 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
have built as an owner-builder if it has not been constructed in Its entirety by
❑I hereby affirm urlder 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 following website:
by Section 3700 of the Labor Code,for the performance of work for which
this permit Is issued. www.leeinfo.ca.eov/calaw.html.
Policy# Date
❑I have and will maintain workers 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 fallowing:I am the property
this permit is issued.My workers 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 Lam- ]L" N with all applicable city and county ordinances and state laws relating to
d p /, building construction.I authorize representatives of this city or countyto
Policy#_ p 3 O �j39 Expires
mp / Y enterthe above identified property far inspection purposes.
J
(This section need notto be completed is the permit is for eo( 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#
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the Jwlh�ccompply
menation provisions of Section 3700 f the Lab r
Code sha o wit those provisions. / Will the applicant or future building occupant handle hazardous material or a
App1(can� Date mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARN] G: AILURE TO SECURE WORKER'S COMPENSATIO COVER GE IS oyes ❑No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PEN LTIES 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
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)7 See permitting checklist
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) in Yes In 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
Contractors 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 In No 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 Contractors 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 icensure receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Section 7032.5 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 I,as owner of the property,or my employee with wages as theirsole 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.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-80D-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a
property who,through employees'or personal effort,builds or Improves the o An EPA Lead-Safe Certified Renovator will be responsible for this project
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 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 PERMIT/PLAN CHECK APPLICATION MENIFEE
..
DATE: u 153PERMIT/PLAN CHECK NUMBER Q
PLANNING CASE NUMBER
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O I?&q2 ,( Menl�QN
SUBTYPE: O ADDITION O ALTERATION DEMOLITION O ELECTRICAL O M&kkk eP'-
O NEW O PLUMBING 0 RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK @iw- f^✓OU S
Received
PROIECTADDRESS �2�/5' AP,' ZIP -2 V
ASSESSOR'S PARCEL NUMBER ,'�(,`- �Q"j� ��a LOT TRACT
OWNERNAME p�„i Q2`C wt, C•--+
ADDRESS F
0 . 6
PHONE G2 _3 I d79 EMAIL
APPLICANT NAME
ADDRESS <9&Q cL v-n,u /J C.
PHONE �/��'�.�� S_�J�/? EMAIL
CONTRACTOR'S NAME OWNER BUILDER? O YESkNO
BUSINESS NAME
ADDRESS �U' Cr4 a--.� Ia G� a,')C
PHONE !?Q,? EMAIL
CONTRACTOR'S STATE LIC NUMBER �(J-� 7 / LICENSE CLASSIFICATION
VALUATION$ SQ FT SO FT
APPLICANT'S SIGNATURE DATEVf;�STAFF USE ONLY
o�O�
,
DEPARTMENT DISTRIBUTION ACCEPTED BY: �Q.� CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE 1 b
INVOICE TOTAL GREEN SMIP
OWNER BUILDER VERIFIED O YES 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
www.cityofinenifee.us4� .
ENIFB �
5 �
City of Menifee
Building Dept.
CITY OF MENIFEE P,t.U,1�', 2 3 2018
BUILDING AND SAFETY DEPARTMENT
PLAN APPROVAL Received
` `
REVIEWED BY LP 1 �Ic�JI� Tn
DATE ' n
'ApproAl of these plans shall not be construed to be a permit for,or an
approval of,any violation of any provbions of the federal,state or city M
regulations and ordinances. This set of approved plans must be kept on the
jobsite until completion,
r
O
r
27 //S- Sca7f 2d
N .
South Coast Air Quality Management District Notification Number
21865 Copley Drive,Diamond Bar,CA 91765-4182
Phone: (909)396-2336 524529
www.agmd.gov
City of Menifee
de 1403 Notification of Routine Demolition Building Dept.
ise maintain a copy of this Notification at the job site,either electronic or paper. AUG 2 3 2018
IS
,oject Type
ojectType Demolition Project Urgency Routine Received
)mpleted By Harry Graun Phone Number (909) 239-3574
)ntractor Information
)mpany Name PACIFIC DEMOLITION, H F G PAC Address 28690 CAPANO BAY CT
EXCAVATION
ty MENIFEE State CA
P 92584
3LB License# 902479 OSHA REG #
ipervisor#1 Harry Graun Phone (909) 239-3574
to Information O
to Name 27115 Scott Rd Menifee Project# 1
to Street# 27115 Street Name Scott Rd
oss Street Site County Riverside
ty Menifee State CA
p 92584
Intact Name John Werthwein Contact Phone (626)233-4179
to Owner John Werthwein Owner Address PO Box 910
ty Sierra Madre State CA
p 91025
oject Start Date 8/20/2018 Project End Date 8/27/2018
oject Work Shift(s) Day Building Size in Sq.ft 1169
ember of Floors 1 Building Age(years) 79
ember of Building/Dwelling Units 1 Building Prior Use House
;bestos Survey Yes Asbestos Found No
:bestos Removed NA Building to be Demolished Yes
!scribe Work Demolish house Describe Work Location 27115 Scott Rd Menifee
oject Information
molition Information
ksbestos containing materials must be removed prior to any demolition activity
.e of Demolition Project in sq.ft 1169 Work Practices at Demolition Site Spray Water,Tarp Trucks/Bins
ntingency Demolition plan Stop Work,Isolate Work Area,Notify
Owner,Stabilize,Secure,Characterize
D
'aste Information
'aste Transporter Pacific Demolition
idress 28690 Capano Bay Ct city Menifee
.ate CA Zip 92584
indfill El Sobrante
idress 10910 Dawson Canyon Rd city Corona
:ate CA Zip 92883
:e Payment
>_e of Demolition Project in sq.R 1169
acking Number 3327439
oject Size Fee 192.40
Iditional Fee 0
ital Fee $ 192.40
iyment Made $ 192.40
ilance Due $0
clicking the Sign&Submit button,I certify that an individual trained in
provisions of SCAQMD Rule 1403 and the Asbestos NESHAP(CFR
e 40, Part 61,Subpart M)will be onsite during the demolition or
ovation and evidence that the required training has been accomplished
this person will be available for inspection during normal business
ms.In addition,I certify that all of the information contained herein
I information submitted with this Notification is true and correct.
ENVIROCARE CONSULTING, INC. 16155 Cousins Circle. Riverside, 9mg
pt
Phone (909)772-6541. Fax(951)687-3502
AUG 23 2018
PRE-DEMOLITION ASBESTOS SURVEY REPORT
Single-Family Home Receive
L, i(
s
-
Sr. N�
.. ... �. .,_._. ire
IY4&h xN:+eax.a+l nnr_e•,..•aneux Y �
SERVICES
ASBESTOS
ASBESTOS TESTING
�. ASBESTOS INSPECTION
ASBESTOS CONSULTING
PLM-PCM-TEM ANALYSIS I ss r ;� v ti' 'r . del '-
ASBESTOS AIR MONITORING
ASBESTOS FINAL CLEARANCEo
ASBESTOS SURVEY SAMPLING
... _. ...._�. .i _n.... ._ . _ .
LEAD-BASED PAINT
SOIL ANALYSIS 27115 Scott Road. O
XRF-PAINT CHIPS
LEAD SOIL SAMPLING Menlfee, California 92584
LEAD PAINT TESTING
LEAD WIPE SAMPLING
LEAD FINAL CLEARANCE
MOLD Prepared for:
MOLD TESTING
MOLD ANALYSIS s John Werthwein
MOLD PROTOCOL
MOLD INSPECTION Worth Engineering
VIABLE MOLD ANALYSIS
NON-VIABLE MOLD ANALYSIS ` P. O. Box 910
BACTERIA d
BACTERIA TESTING
BACTERIA SAMPLING Sierra Madre, California 91025
BACTERIA INSPECTION '
SEWER WATER ANALYSIS f Prepared by:
SMOKE & SOOT ASSESSMENT
TRAUMA SCENE & BIOHAZARD Envirocare Consulting Services, Inc.
INDUSTRIAL HYGIENE ASSESSMENT
INDOOR AIR QUALITY
VOLATILE ORGANIC COMPOUNDS q
(VOC's)
HAZ-MAT SURVEY Sam S. Lutchmiah. CIHM. CAC. CDPH
s CONTACT US Columbia State University
4 (909) 772-6547 Certified Industrial Hygiene Manager
g State of California
Certified Asbestos Consultant No. 93-1152