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PMT19-00001 City of Menifee Permit No.: PMT19-00001 29714 HAUN RD. MENIFEE, CA 92586 Type: Mobile Home ME14IFEE MENIFEE Date Issued: 01/02/2019 PERMIT Site Address: 25150 BARNES LN, MENIFEE, CA 92584 Parcel Number: 362-020-026 _. Construction Cost: $3,100.00 Existing Use: Proposed Use: Description of ADD PERMANENT FOUNDATION TO EXISTING MANUFACTURED HOME 1440 SQ FT Work: SERIAL#'S AGDSMCA45837583/BGDSM{;A45837583 INSIGNIA#'S 273329A/273330B Owner Contractor SMP REALTY HOLDINGS, INC. PERMA-BRACE CONSTRUCTION 40960 CALIFORNIA OAKS RD#327 21690 VINE ST MENIFEE, CA 9256 WILDOMAR, CA 92595 Applicant IVAN MONTES Phone: 9512459373 PERMA-BRACE CONSTRUCTION License Number:636757 21690 VINE ST WILDOMAR, CA 92595 Fee Qescri tp ion Qty Amour! 5 Manufactured Permanent Foundation 1 Permit Fee 240.72 27.00 .. ... $267.72 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 LICENSED DECLARATION CITY OF MENIFEE Ce 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)Chap ter9(commencing with section 7000)of Division 3 of the Business and pursuant to the Contractors State License Law). Professions Code and my license is in full force and effect. °I am exempt from licensure under the Contractor's State License Law for License Class G' the following reason: License No, +� -- Expires Signature By my signature below I acknowledge that,except for my personal residence in which I must have resided for at least one year priorto completion of WORKER'S COMPEIISATIDN DECLq ftgTfON improvements covered by this permit.I cannot legallysell a structure that I ❑ the following declarations:I have built as an owner-builder if it has not been constructed in its entirety by I hereby affirm undyrpenal[y of perjury one Of follow for worker's licensed contractors.I understand that a copy of the applicable law,Section have and will maintain a certificate of consent of theaff compensation,issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code,for the performance of work for which his a p the Business and Professions Code,is available upon request when this this application is submitted or at the following website: Permit is issued. wtvw.le calaw.htmE. Policy h ❑I have and will maintain worker's compensation insurance,as required by Date section 3700 of the Labor Code,for the performance of the work for which PROPERTY OWNER OR AUTHORIZED AGENT this perm it 0 issued,Labor workers compensation insurance carrier and which °BY my signature below I certify number are: policy owner ar authorized to act on the tp property ownerr's behaifr I have readpthisy Carrier l application and the information I have provided is correct.I agree to tampiy with all applicable city and county ordinances and state laws relating to Policy a Expires p _ _ building construction,I authorize representatives of this city a county to (This section need not to be completed is the permit is for one-hundred enter the above I den tired property for inspection purposes. dollars($I00)or less ❑1 certify that in the performance of the work for which this permit is issued, PROPERTY OWNER OR AUTHORIZED AGENT Date-AGENT ate I shall flat rmP_1ov any persons in any manner so as to become subject to the worker's compensation laws of California,and agree that if I should become CITY BUSINESS LICENSE subject to the workers compensation provisions of Section 3700 of the Labor I t 11� Code,I shall forthvlth comply with those provisions. HA7ARDOLIg MATERIAL pECLARATtON Applicant Will the applicant or future building occupant handle hazardous material or a Date mixture containing a hazardous material equal to or greater that the WARNING FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS amounts specified on the Hazardous Materials Information Guide? UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES °Yes �pla AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Will the intended use of the building Construction the applicant or futurebuilding IN SECTION 37OG OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES occupant reality a permit for the coca( CAQ DJ modification from South Coos[Air Quality Management District(SCAQMD)?See permitting checklist CDNSTRUCTIDN LEIVDfNG AGENCY for guidelf nes I hereby affirm that under the penalt i y of perjury thery is a construction °Yes 640 lending agency for the performance of the work which this permit is issued Will the proposed building or modified facility be within 1000 feet of the {Section 3097 Civil Code) outer boundary of a school? OWNER 6URDE�lTfONS °Yes a 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 items](Section 7031,5 8usiness and Professions Code).Any city or county that requires a permit to hazardous material reporting. °Yes construct,after,improve,demolish or repair any structure,prior to its issuance,also requires the applicant for the Permit to file a signed statement Date that he or she is licensed pursuant to the provisions of the Contractor's State PROPERTY OWNER OR AUTHORIZED AGENT License Law(Chapter 9(commencing with Section 7000]of Division 3 of the EpA RENOVATfON REPRlR AND PAINTING RRP Business and Professions Code)or that he or she is exempt from licensure and the basis for the alleged exemption.Any violation o€Section 7censu a The EPA Renovation,Repair and Paintfng(RRp)Rule requires contractors are Applicant for a permit subjects the applicant la i civff penalty of not more receiving compensation for most work that disturbs paint Ina pre-1978 than($500). residence 0rchildcare facility to be RRP„certified firms and comply with required pr act fces.This includes rental Prop arty owners and property °1,as owner of the property,or my employee with wages as their sole managers who do the paint-disturbing work themselves or through their compensation,will do( ]all of or emPloYees.For more information about EPA's Renovation Program visit: flat intended or ored for sale.(Sectors 7044 g siness and Professions ure is w+! .e a. av lead or contact the National Lead Information Center at Off'? Code;The Contractor's State License Law does not apply to an owner of a 1 800.429•CEAD(5323). 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 sale,If,however,the building or improvement is sold within one year of Certified Firm Name: completion,the Owner-Buffderwill have the burden of proving that it was not built or improved for the purpose of sale, Firm Certification No.: ❑No EPA Lead-Safe Certified Firm is required forthis project because: [r 1,as owner of the properly am exclusively contracting with licensed contractors to construct the proiect(section 7044,Business and Professions Cade: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: �s PERMIT/PLAN CHECK NUMBER r I GRADING/PLANNING CASE NUMBER/OTHER RELATED CASES TYPE: O COMMERCIAL O RESIDENTIAL •i MULTI-FAMILY O MOBILE HOME pOO�gpA SIGN SUBTYPE: •)ADDITION 0 ALTERATION NEW On DEMOLITION O ELECTRICAL O MECHANICAL PLUMBING ()RE-ROOF NUMBER OF SQUARES DESCRIPTION OF WORK �}}D p ) �r iy cWane— OCCUPANCYGROUP CONSTRUCTION TYPE 16Ti N� SPRINKLERS YES �NO PROJECT ADDRESS � �•-� rr 7 �- ZIP 3 ASSESSOR'S PARCEL NUMBER 2 -(j _ 0. r " ? TRACT OWNER NAME 7 IC�� 7 ADDRESS It, C � 3Z� PHONE EMAIL APPLICANT NAME ADDRESS PHONE EMAIL CONTRACTOR'S NAME / ] BUSINESS NAME OWNER BUILDER? YES ❑ G C ADDRESS PHONE 4 • EMAIL ��e . CONTRACTOR'S STA E LIC NUMBER ��s' LICENSE CLASSIFICATION �'- VALUATION$ �f.316O).o- SQ FT �-�� L SQ FT 17 APPLICANT'S SIGNATURE DATE DEPARTMENT DISTRIBUTION BY: CITY OF MENIF E SU INESS CENSE NUMBER BUILDING PLANNING EIVGlAr!7LA7CCEP7TE1D INVOICE TOTAL 7GREEN!OWNER BUILDER VERIFIED YES NO DRIVERS LICEN NOTARIZED LETTER C) YES 0 NO City of Menifee Building &Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777 www.Cityofinenifee.us City of Menifee Building Dept. �ava'a� Received