PMT18-04885 .v�
City of Menifee Permit No.: PMT18-04885
_ 29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Alteration
MENIFEE MENIFEE Date Issued: 10/05/2018
PERMIT
Site Address: 29374 PEBBLE BEACH DR, MENIFEE, Parcel Number: 338-072-010
CA 92586 Construction Cost: $15.000.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of REMOVE ALL EXISTING LAYERS OF ROOFING MATERIAL AND INSTALL NEW COOL ROOF
Work: SHINGLES
CRRC#0890-0015
REMOVE 1.5 L FT WALL NON LOAD-BEARING, REMODEL EXISTING 5 L FT WALL TO NEW
COUNTERTOP HEIGHT, REPLACE ALL EXISTING WINDOWS LIKE-FOR-LIKE SIZE, MINOR
EXTERIOR SIDING REPAIR,ADDITIONAL REPAIRS PER SCOPE OF WORK
Owner Contractor
WHITEHEAD FAMILY TRUST ,
42407 CHISOLM TRAIL
MURRIETA, CA 92562
Applicant License Number:
WHITEHEAD FAMILY TRUST
42407 CHISOLM TRAIL
MURRIETA, CA 92562
Phone:9512377653
Fee Description QtV Amount 1$1
Building Permit Issuance 1 27.00
Inspections not specified 98 98.00
Inspections not specified 305 305.20
Administrative Fee 98 98.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Building 1 20.16
$549.36
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
with a licensed contractor(s)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 Contractors 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 bythis 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 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 applic on is submittgd or the following website:
by Section 3700 of the Labor Code,for the performance of work for which
this permit is issued. www.le fo. ov c w. /
Policy# 44� Date `f7 SVK
❑I have and will maintain worker's compensation insurance,as required by PRRTY OWNER ORA T RIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which ❑By my signature below I certifyto each of the following: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 with all applicable city and county ordinances and state laws relating to
building construction.1 authorizer resentatives of this city or county to
Policy# Expires enter�denrt fa inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less P RTY OWNER OR ALIT46111ZED AGENT
o I certify that in the performance of the work forwhich 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 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 orgreater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes MO
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 Alp
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) ❑Yes 140
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 Ucense Law forthe reason(s)indicated below by the California Health al Safety Code,Section 25505 and 25534 concerning
hazardous material r parting.
checkmark(s)I have placed next to the applicable items)(Section 7031.5 oyes ❑No q�
Business and Professions Code).Any city or county that requires a permit to Date O
construct,alter,improve,demolish or repalr any structure,prior to its PROPERTY O ER 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,REPAIRAND 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 forthe alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to he 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
❑1,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 doW 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 far 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 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 RAP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION 1, MENIFEE
r
DATE: IDI3 I 1 $ PERMIT/PLAN CHECK NUMBER
PLANNING CASE NUMBER
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME 0 POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES
n
DESCRIPTION OF WORK
ui, 9
2q3 � {�ebblt bt(kC-k Da ZIP q 258 ip
PROJECT ADDRESS 1
ASSESSOR'S PARCEL NUMBER 33$- L
0-12 LOT I-1 a TRACT 4 O
h(hI,-kk mco F&xv I Tv0S4-
OWNER NAME /%� �
ADDRESS L42 4O-' CiIti. W1 I ya-4 I , M U V VI'tfn CA qa5 Lo a-
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PHONE I oZ3-I ' —IU5;S EMAIL C�'IIJLKWIM .Gt��V�Sn • CVY1'�
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APPLICANT NAME
ADDRESS q p_'�11,0-1 VI/vt �✓�I{� �r(�l•t I �r r ` 1�✓�I� .p �" aa519�-
PHONE a 51-'d-3_l - -1 LP5?J EMAIL C btVU(—wll t � `-kXuA ,,/��'"ES
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OWNER BUILDER? ES ONO
CONTRACTOR'S NAME
BUSINESS NAME
Building Dept.
ADDRESS f
EMAIL Orl 0 5 2018
PHONE
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ 4 �I�I,IJIL__ SO FT L SO FT a ce iv e
APPLICANT'S SIGNATURE DATE B Z_.- —
CITY OF MENIFEE BUSINESS LICENSE NUMBER
DEPARTMENT DISTRIBUTION ACCEPTED BY:
BUILDING PLANNING ENGINEERING FIRE
INVOICE TOTAL
GREEN 1- SMIP )(
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE#
NOTARIZED LETTER O YES 0 NO
City of Menifee Building &Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
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