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PMT18-05922 City of Menifee Permit No.: PMT18-05922 29714 HAUN RD. Type: Residential Alteration MENIFEE, CA 92586 MENIFEE MENIFEE Date Issued: 01/02/2019 PERMIT Site Address: 27964 MEAD CT, MENIFEE, CA 92585 Parcel Number: 333-741-021 Construction Cost: $2,500.00 Existing Use: 1 &2 Family Residence Proposed Use: Description of ALTERATION TO PORTION OF EXISTING GARAGE, CONVERT TO ART ROOM, Work: 100 SQ FT Owner Contractor PAUL&JULIE KILER 27964 MEAD CT MENIFEE, CA 92585 Applicant License Number: PAUL&JULIE KILER 27964 MEAD CT MENIFEE, CA 92585 Phone: 714-809-5369 Fee Description gty Amount 1$1 Receptacle, Switch, Outlet&Fixture 3 126.00 Fire-New Res&Accessory Structure Review 1 147.00 Building Permit Issuance 1 27.00 Inspections not specified 305 305.20 Additional Plan Review Building 171 171.14 GREEN FEE 1 1.00 SMIP RESIDENTIAL 1 1.00 New Construction Permit Fee 1 11.50 General Plan Maintenance Fee-New 1 0.58 Construction $790.42 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 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 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 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 this permit is issued. WLAm eeirrfa.ca. ov Calaw.htm. Policy# Date ❑I 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 p 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 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.I authorize representatives of this city or county to Policy# Expires enterth ove id ntified P.o rty for inspection purposes. (This section need not to be completed is the permit is for one ,�'J/IVIQ`-� I dollars($100)or less — — _Date_ 1 C� 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 Labor Code,I shall forthwith comply with those provisions. Will the applicant or future pp u e building occupant handle hazardous material or a Applicant_.._ Date mixture containing a hazardous material equal to or greater that the - amounts specified on the Hazardous Materials Information Guide? WARNING.:_FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes t;(,No UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN Will the intended use of the building the applicant or future building ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction ruction modification from South IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)D)?See permitting checklist for guidelines CONSTRUCTION LENDING AGENCY ❑Yes 0No 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 m(No OWNER BUILDER _OECLARATIONS 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 Contractor's 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 report g. Business and Professions Code).Any city or county that requires a permit to 04es ii No )lz, /_�y` construct,alter,improve,demolish or repair any structure,prior to its Date issuance,also requires the applicant for the permit to file a signed statement PROPERTY WNER OR AUTHORIZED AGENT that he or she is licensed pursuant to the provisions of the Contractor's State E PA-RENOVATI00N Rf_PAIR AND PAINTING(RR PI 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 EPA Renovation,Repair and Painting(RRP)Rule requires contractors and the basis for the alleged exemption.Any violation of Section 7031.5 by receiving compensation for most work that disturbs paint in a pre-1978 an Applicant for a permit subjects the applicant to a civil penalty of not more residence or childcare facility to be RRP-certified firms and comply with than($500). required practices.This includes rental property owners and property managers who do the paint-disturbing work themselves or through their tp4-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.eva.poy/Jead 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 property who,through employees'or personal effort,builds or improves the 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 completion,the Owner-Builder will have the burden of proving that it was Firm Certification No.: not built or improved for the purpose of sale. N 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 �� /S Code:The Contractor's State License Law does not apply to an owner of a If your project does not com Ith EPA RRP rule please fill out the RRP Acknowledgement. BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE DATE: lZ ) Z lg PERMIT/PLAN CHECK NUMBER GRADING/PLANNING CASE NUMBER/OTHER RELATED CASES TYPE: COMMERCIAL RESIDENTIAL MULTI-FAMILY 0 MOBILE HOME POOL/SPA - SIGN SUBTYPE: ADDITION /\ALTERATION C)DEMOLITION C::: ELECTRICAL MECHANICAL NEW PLUMBING RE-ROOF NUMBER OF SQUARES DESCRIPTION OF WORK o[_ y,�or f 4 0 C3 ,al v yv� OCCUPANCY GROUP CONSTRUCTION TYPE tZQ, SPRINKLERS :. YES NO PROJECT ADDRESS Z ]q aL �� Yr� l ZIP ASSESSOR'S PARCEL NUMBER 3 +-, LOT TRACT -�j OWNER NAME C�✓� � �L/I I� �) ADDRESS 0,71 6 PHONE 7N �O S-1-W EMAIL , )-"aI rI�CLYv", APPLICANT NAME -SApyl- ADDRESS PHONE EMAIL CONTRACTOR'S NAME 1::�7A y'L9- OWNER BUILDER? YES NO BUSINESS NAME ADDRESS PHONE EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION$ Z�� SQ FT f C2 C' L SQ FT APPLICANT'S SIGNATURE DATE -z-bz1a 71TY STAFF USE ONLY DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE INVOICE TOTAL -Q GREEN Ir SMIP lop— OWNER BUILDER VERIFIED YES t:.% NO DRIVERS LICENSE# NOTARIZED LETTER :: YES NO City of Menifee Building &Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777 City Of Menifee www.cityofinenifee.us Building Dept. DEC 12 2018 Received ��3