PMT18-05383 City of Menifee Permit No.: PMT18-05383
29714 HAUN RD.
o MENIFEE, CA 92586 Type: Residential Electrical
MENIFEE MENIFEE Date Issued: 11/08/2018
PERMIT
Site Address: 29333 CORAL ISLAND CT, MENIFEE, CA Parcel Number: 333-481-032
92585 Construction Cost: $250.00
Existing Use: Proposed Use:
Description of INSTALL NEW NEMA 14-50 OUTLET IN GARAGE
Work:
Owner Contractor
JEREMY KOVAL
29333 CORAL ISLAND COURT
MENIFEE, CA 92585
Applicant License Number:
JEREMY KOVAL
29333 CORAL ISLAND COURT
MENIFEE, CA 92585
Phone:6193631352
Fee Description Qty Amount 1$1
Receptacle, Switch,Outlet&Fixture 1 116.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Electrical 1 5.80
$149.80
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 Law).
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 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 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 this application is submitted or at the following website:
by Section 3700 of the Labor Code,for the performance of work for which
www.leEinfo.ca.gov/calaw.html.
this permit is issued.
Policy# Date
PROPERTY OWNER OR AUTHORIZED AGENT
❑I have and will maintain worker's compensation insurance,as required by
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: application and the information I have provided is correct.I agree to comply
with all applicable city and county ordinances and state laws relating to
Carrier building construction.I authorize representatives of this city or county to
Policy# Expires enter the abo dentified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred ` / 0 /
Date ! le5
dollars($100)or less PROP OWNER OR AUTHORIZED AGENT
❑I certify that in the performance of the work for which this permit is issued,
1 shall not employ any persons in any manner so as to become subject to the CI BUSINESS LICENSE#
worker's 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
mixture containing a hazardous material equal to or greater that the
Applicant Date amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes KNo
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 "' o
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 ANo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the California Health&Safety Code,Section 2550S and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oyeslo
Business and Professions Code).Any city or county that requires a permit to Date Gl
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY=TION,
R 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 RENDREPAIR AND PAINTING RRP
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt from licensure The EPk Renovation,Repair and Painting(RRP)Rule requires contractors
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
than
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( )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 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
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE
DATE: 4, PERMIT/PLAN CHECK NUMBER �Q�
GRADING/PLANNING CASE NUMBER/OTHER RELATED CASES
TYPE: COMMERCIAL * RESIDENTIAL MULTI-FAMILY MOBILE HOME POOL/SPA SIGN
SUBTYPE: ADDITION ALTERATION : DEMOLITION 0 ELECTRICAL MECHANIC* of Menifee
NEW PLUMBING RE-ROOF NUMBER OF SQUARES Building Dept.
DESCRIPTION OF WORK �+ I � '�� dl)� '
OCCUPANCY GROUP CONSTRUCTION TYPE SPRINKLERS E e:G+I v e
PROJECT ADDRESS ZIP a
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME 166VI(L, �
ADDRESS �j� lh� J�\v-"� L� "�"l�l��• "i �7 (3�
PHONE 6- l 3 EMAIL DC-Sk-„
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME ++ OWNER BUILDER? YES NO
BUSINESS NAME
ADDRESS 1v Lf- A, 0 -ff, !� q
PHONE �s(' "O) OiI V EMAIL U4Vgj2 LE 66('fTj cl:::�iLU�L� lq��
CONTRACTOR'S STATE LIC NUMBER ��Ui L LICENSE CLASSIFICATION
VALUATION$ cp�50 SQ F L SQ FT
APPLICANT'S SIGNATURE DATE // O
OTYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: Q�� CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE W�.�
INVOICE TOTAL ' GREEN SMIP
OWNER BUILDER VERIFIED YES C NO DRIVERS LICENSE# NOTARIZED LETTER YES NO
City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
www.cityofinenifee.us
ENIFE
Show all Property Lines SAMPLE PLOT/SITE PLAN Provide location, height and lineal
and indicate any slopes footage of all proposed block or wood
on the property fences and block retaining walls
------------------------------------
10 --
Distance 5'-0" Min. i City of Menifee
Pools only, all other ; Building Dept.
structures-es-Mi . Distance 10'-0" Min
Distance 10'-0"
( 4 Dimension j NOV 0 8 2018
Dist a 5'
Show proposed and/or tonce 5'- " Min Received
existing additions and Dista I
a 5'-0" I
I
identify use, ie... Room
Addition, Patio Cover,
Balcony, etc... Include o 1 Show proposed and or ■
location, dimensions and if) i existing Detached
setb `�
CITY OF E Accessory Structure(s),
H I nd identify use, ie... M
BUILDING AN SA ; Garage, Workshop, Pool �1�
PLAN APPR L i or Spa. Include location, COD
dimensions and setbacks -73
I
Distance 5 0" Min
REVIEWED E
DATE
I
Distance 5'-0" Min
'Approval of these pl ;hall not b consil"w .J be a permit for,or an
approval of,any vial: )f any prc iisions of the federal, 61*G D LLING
regulations and ordiir This se of approved plans must be kept on the
jobsite until comple;
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CITY STREET
Requirements:
• Plans and notes shall be legible.Each plan shall fill a minimum 81/2"x 11"sheet of paper.Include homeowners name and property
address
• Show all property lines and the distances of all structures to the property lines.Show all buildings and/or structures on the property,
existing and proposed and the distances between those buildings and/or structures
• Three(3)copies of the plot plan are required.Some projects may require approval from the Planning Department prior to permit
issuance.Please contact the Planning Department to verify minimum setbacks requirements.
• Show a North Arrow on the Plot/Site Plan
• For proposed Gas,Electrical and/or Plumbing improvements,show meter locations,conduit size,and number of wires,breaker and
wire sizes,linear square footage and their respective locations for each of the trades.
City of Menifee Building&Safety Department 29714 Haun Rd.Menifee,CA 92586 951-677-672-677 wwwcityofinenifee.us