pmt17-04462 City of Menifee Permit No.: PMT17-04462
29714 HAUN RD. Type: Residential Alteration
'5-�CCELA? MENIFEE, CA 92586
MENIFEE Date Issued:
12/1812017
PERMIT
Site Address: 30114 NIGHT PASSAGE, MENIFEE, CA Parcel Number: 358-500-007
92584 Construction Cost: $800.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of UNDERGROUND GAS AND ELECTRIC TO FUTURE BBQ&CURRENT FIRE PIT.80 L FT 3/4 GAS
Work: LINE, 15 L FT 3/4 ELECTRIC
Owner Contractor
JODI LATHAM BILL&DAVITS LANDSCAPE MAINTENANCE INC
30114 NIGHT PASSAGE 1153 HARLEY KNOX BLVD
MENIFEE, CA 92584 PERRIS, CA 92571
Applicant Phone:9519436455
MENIFEE, CA License Number.751707
Phone:9513298405
Fee Description Qtv Amount i61
Receptacle, Switch,Outlet&Fixture 1 116.00
Plumbing Fixtures and Vents, fixtures 1 116.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 1.00
General Plan Maintenance Fee-Plumbing 1 5.80
General Plan Maintenance Fee-Electrical 1 5.80
$246.60
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 D I am exempt from licensure under the Contractor's State License Law for
Professions Cade nd,{r1sy license is in full force and effe—ct.7 the following reason:
License Class o L17se�7No. ` S 26 By my signature below I acknowledge that,except for my personal residence
Expires •7J I ' Signature /'"�=J'� 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
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.leainfoca.gov/calaw.html.
this permit is issued.
Policy# 2!,C 04 l pia 16-r 17 r Date
�ave 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 D By my signature below I certify to each of the following:I am the property
this permit Is issued.My workers compensation insurance carrier and policy owner or authorized to act an the property owner's behalf.I have read this
number are- 1 application and the information I have provided is correct.I agree to comply
VV A � N h with all applicable city and county ordinances and state laws relating to
Carrier ` V ��`J 1 building construction.I authorize representatives of this city or county to
Policy#7 G6 6 C] //i Z,�- 1(d i )E:(pires .S L enter the above Identified property for inspection purposes.
(This section need not to be completed is the permit is for one/ Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
D 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 became 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,Isha hwit comply with those provisions. Will the applicant or future building occupant handle hazardous material or
mixture containing a hazardous material equal to or greater that the
Applicant l �� Date .�—S(� amounts s °cified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS Dyes �6No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building bythe 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 forguidelines
CONSTRUCTION LENDING AGENCY oyes "a
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) D Yes 00
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perJurythatlam 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 75534 concerning
hazardou3�naterial reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Dyes�b No ,�� 1 1 Business and Professions Code).Any city or county that requires a permit to ' Date
construct alter,improve,demolish or repair any structure,prior to its ftO15ERTY OWN ER 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 Contractor's State EPA RENOVATION,REPAIR AND PAINTING IRRPJ
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 for the alleged exemption.Any violation of Section 7031.5 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 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 do( )all of or( I portion of the work,and the structure Is www.epa.Rov/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 D 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 of Menitee Certified Firm Name:
sale.If,however,the building or improvement is sold within one yePi'tN &Safety Deft- Firm Certification No.:
completion,the Owner-Builder will have the burden of provin phoag
not built or improved for the purpose of sale. ��ee � o a loll No EPA Lead-Safe Certified Firm is required for this project because:
❑1,as owner of the property am exclusively contracting with licensedmA
contractors to construct the project(Section 7044,Business and Professions �p
Code:The Contactors State License Law does not apply to an own a 8'6ur project does not comply with EPA RRP rule please fill out the RRP
IKKL„.flu'6r Acknowledgement.
• t
Menifee
DATE: a- 0% 7 PERMIT/PLAN CHECK NUMBERFMr — 0
TYPE: O COMMERCIAL P-gSIDENTIAL 0 MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION .6lILECTRICAL O MECHANICAL
O NEW/ 8-PLUMBING O tRE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK
PROJECTADDRESS (")�` )G�Q• JY�J y�,� Pn SS,A y - 9 V
ASSESSOR'S PARCEL NUMBER , Cn• LOT TRACT
OWNER NAME LA
( /n� �c e.ADDRESSL r A S)IA -
4 `
PHONE lS r 2 � tD 6� V�1 EMAIL,, \
APPLICANT NAM``E P'1v 16 c ' LZA_S '-'
ADDRESS \ l`' S_�, r, \� n< /
(',
PHONE 7J I � z S EMAIL
CONTRACTOR'S NAME ��/' ' A\YC 5 OWNER BUILDER? O YES BiQO
BUSINESS NAME (" 1p 1 1�,, A\/ -C S
ADDRESS I 1 S IC- 4 C IV-0 - (�
PHONE �51 'i .3 -6 ysr EMAIL Cj � ,� UC3
CONTRACT TATE LIC NUMB LICENSE CLASSIFICATION ^
VALUATION$ D O j Q FT L SQ FT
2 (� C
APPLICANT'S SIGNATURE DATE I O l (J
CITYSTAFFU�Y-.
DEPARTMENT DISTRIBUTION CITY MENIFEE US ESS LICENSE NUMBER
BUILDING PLANNING ENG EEft/NG FIRE ACCEPTED BY:
PERMIT FEE p� ,l.!/ SMIP GREEN •`
PLAN CHECK FEE INVOICE TOTAL
OWNER BUILDER VERIFIED OYES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES NO
City of Menifee
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
DEC 18 2017 www.citycfinenifee.us
Received
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- LDING AND SAFETY DEPARTM (.
��� M,S PLAN APPROVAL �V ��� �
REVIEWED BY
DATE
'Approval of these plans shall not be construed to be a permit for,or an t
I approval of,any violation of any provisions of the federal,state or city !
regulations and ordinances. This set of approved plans must be kept on the
jobsite until-completion.
4 1
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B (ding Dept. W i DCAI
DC182017Z)a�vt�
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i Received i I i