PMT14-02052 i
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City of Menifee Permit No.: PMT14-02062
29714 HAUN RD.<A76CIEgil MENIFEE, CA 92586 Type: Residential Addition
MENIFEE Date Issued: 08/07/2014
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PERMIT
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Site Address: 27834 BLUFF VISTA WAY, MENIFEE, CA Parcel Number: 340-430-023
92584 Construction Cost: $3,200.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL SOLID ALUMAWOOD PATIO COVER WITH 2 FANS, 3 LIGHTS
Work:
Owner Contractor
SAL GOMEZ KYLE KELLY
27834 BLUFF VISTA WAY 35406 REDBERRY PALMS COURT
MENIFEE, CA 92584 LAKE ELSINORE, CA 92532
Applicant Phone: 9512960908
KYLE KELLY License Number: 948536
KYLE KELLY
35406 REDBERRY PALMS COURT
LAKE ELSINORE, CA 92532
Phone: 9098161288
Fee Description ,Oty Amount l$1
Building Permit Issuance 1 27.00
ark/flat °"�a°�
noft st� 1a_ 1, "33 00
GREEN FEE 1 1.00
$298.00
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_Permil_Template.rpl Page 1 of 1
City Of Menifee
LICENSED DECLARATION
I hereby affirm under penalty or perjury that I am licensed under provisions of ❑ I, as owner of the property an exclusively contracting with licensed
Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professions
Professions Code and y license is in full4- l8 and 1c Code:The Contractor's License Law does not apply to an owner of a property
License Claass J/ Licen�"-No. who builds or improves thereon, and who contracts for the projects with a
Expires ( Signature) -'�_—� licensed contractor(s)pursuant to the Contractors State License Law).
_77
"C ENSCIODECLARATIONWORKERS' "- --
❑ I am exempt from licensure under the Contractors'State License Law for the
❑ 1 hereby affirm under penalty of perjury one of the following declarations: following reason:
I have and will maintain a certificate of consent of self-insure for workers' By my signature below I acknowledge that, except for my personal residence in
compensation,issued by the Director of Industrial Relations as provided for by which I must have resided for at least one year prior to completion of
Section 3700 of the Labor Code, for the performance of work for which this improvements covered by this permit, I cannot legally sell a structure that I have
permit is issued. built as an owner-building if it has not been constructed in its entirety by licensed
Policy# contractors,I understand that a copy of the applicable law, Section 7044 of the
❑ 1 have and will maintain workers' compensation insurance, as required by Business and Professions-eode,-i-aavailable upon request when this application is
section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following W- site:htt alwww.le info.ca.cc tCM w.html.
permit is issued.My wo kers'compensation insurance carrier and policy number are: u.
P[opertv-OWnero�tldhcxlzed.Agent-- ---- Date
Carrier l
Expires s -- Policy#
s ❑ By my Signature below, certify to each of the,following: am the property
Name of Agent Phone# owner or authorized to act on the property owners,behalf. I have read this
(This section need not be completed if the permit is for application and the information I have provided is cdrract. I agree to comply
one-hundred dollars($100)or less) with all applicable city and county ordinances and stale Ows relating to building
construction. I authorize representatives of this city or county to enter the above-
'' ❑ I certify that in the performance of the work for which this permit is issued,I identified-property for the ins etionpurposes._.._, --
shall not employ any persons in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become ✓� -- C ^6
subject to the workers'compensation provisions of Section 3700 of the Labor -"- ---e-d Agent Date
Code, I shall forthwith comply with those provisions. Property Owner or Authorizgent""-"'-"---"
-> City Business License#
Date; Apph ant----
WARNING: FAILURE TO SECURE WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDING
($100,000), IN ADDITION TO THE COST OF COMPENSATION, OYES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES ❑NO EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS
I hereby affirm that under the penalty of perjury there is a construction lending
INFORMATION GUIDE?
agency for the performance of the work which this permit is issued (Section WILL THE INTENDED USE OF THE BUILDING BY THE
3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE
Lender's Name DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address ❑NO DISTRICT (SCAQMD) SEE PERMITTING CHECKLIST FOR
GUIDE LINES
OWNER BUILDER DECLARATIONS
I hereby affirm under penalty of perjury that I am exempt from the Contractor's PRINT NAME:
License Law for the resson(s)indicated below by the checkmark(s)I have placed OYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable item(s) (Section 7031.5. Business and Professions Code: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A
Any city or county that requires a permit to construct, alter, improve, demolish, ❑NO SCHOOL?
or repair any structure, prior to its 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 License Law (Chapter 9 (commencing with I HAVE READ THE HAZARDOUS MATERIAL
Section 7000)of Division 3 of the Business and Professions Code)or that he or DYES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from licensure and the basis for the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREMENTS
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL f EPORI ING.
compensation, will do ( )all of or( ) porting of the work, and the structure is ,PROPERTY OWNER.OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code; --�'-'
The Contractor's State License Law does not apply to an owner of a property �X 7
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
CITY OF MIENIFEE
City of Menifee PLCK No: Permit No:
29714 Haun Road Building & Safety Dept. —i
Date: Date
Menifee, CA 92586 AUG 0 7 ,air
Phone: (951)672-6777 Amount: Amount:
Fax:(951)679-3843
Building Combination Permit
To Be Completed By Applicant
Legal Description: Planning Case: F:
Property Address: ", _ r Assessor's Parcel Number. 1 ^
7 l� �i✓l( Lfr -`-C
Projectlfenant Name: Unit#: Floor#:
Name: S Phone No.
�.- 6,p y Fax No.
Property Address:
Owner ) t�3 c �w �•�Q (_ Unit Number Zip Cgde
Email Address:
Name: // Phone
`�O� �6-/ZS8 Fax No.
Applicant Address: �� Unit Number Zip Code
Email Address:
Name: Phon
Fax No.
Contractor Address: yO� /J Ci State Zlp 3
pos
Contractor's city Business ontractor's tense o. /-C City.5late of Califomf License No. Classification: 9
Number of Squares:
Square Footage a
Description of Work: �J' 5 , Cost of��¢¢rk:$
Applicant's Signature y�y �joZ UG
` 3 Ilk Date: _O
-W a omp eted By,CityStaff Only
Indicate As R-Received or N/A-Not Applicable
5 Completes sets of fully dimensioned,drawn to sale plans which include: 1 set of documents which include
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Geo Tech/Soils Report(on ed only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8%x 11)
❑ Foundation Plan ❑ Cross Section ❑ Structural Calculations
❑ Plumbing Plan ❑ Single Line diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan&Detalis ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration` Addition' Means/Methods
Work Type: Repair' Retrofit` Revision to Existing Permit' Required4 YES NO
Proposed Building Use(s): Existing Building Use(s):
#Buildings: #Units: #Stories: Will the Building Have a Basement?
Y of N
Bldg.Code Occupancy Group Indicate Indicate if Indicate all Geo-tech.Haz.Zone
At Project Spdnkleretl YES or NO
Completion: Construction that apply: Coastal Zone
Type(s): C Of O YES NO Noise Zone
Required? Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board Landmark Comm. Planning Comm.Zoning Administrator
Fee Exempt: City Project Elec.Vehicle Charger Landmark Seismic Retrofit Op.rralA Casa:buirr
Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing
For Staff Use Only
Building/Safely Permil Specialist I City Planning I Civil Engineering I EPWM-Admin ITransportation Mgml, Rent Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
City of Menifee
Suilding & Safety Dept.
LEDGER & TRACK AUG 0 7 2014
INSPECTION REQUIRED - ived
daSe n
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CITY OF MENIFEE
BUILDING AND SAFETY DEPARTMENT
PLAN APPROVAL Q
r `
REVIEWED BY S _ T
ATE =wow
*Approval of these plans shall nc'tip construed to be a permit for,o an
approval of,any violation of any provisions of the federal,state or ci
regulations and ordinances, This set of approved plans must be kept on the
jobsite until completion.
IS G-v%n e Z
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