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PMT14-02305 City of Menifee Permit No.: PMT14-02305 29714 HAUN RD. Type: Residential Addition c�A_> MENIFEE, CA 92586 MENIFEE Date Issued: 08/28/2014 PERMIT Site Address: 30983 LA JOE ST, MENIFEE, CA 92584 Parcel Number: 360-465-009 Construction Cost: $4,950.00 Existing Use: 1 &2 Family Residence Proposed Use: Description of INSTALL 560'SOLID ALUMAWOOD PATIO COVER WITH ELECTRICAL 4 LIGHTS,2 FANS Work: Owner Contractor KEVIN NGUYEN KYLE KELLY 30983 LA JOE ST 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 Fee Description ON Amount f$1 Receptacle, Switch Outlet&Fixture 6 141.00 - Building Permit Issuance 1 27,00 Deck/Patio, non-standard 1 -.,133.00 GREEN FEE 1 1.00 SMIP RESIDENTIAL ? 1.00A $303.00 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. A,A_Bldg_Permit Template.rpt 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 an y license is in full force and eff ct. Code:The Contractor's License Law does not apply to an owner of a property License Cal-asses License No. �tj who builds or improves thereon, and who contracts for the projects with a Expires LDS Signature � licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATION DECLARATION ❑ 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. Policy# built as an owner-building if it has not been constructed in its entirety by licensed 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 Code,is available 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 Web site:htt"//www.leginfo.ca.aov/calaw.html. permit is issued.My workers'compensation insu ance carrier and policy number are: — p CarrierP erty Owner or Authorized A Date Expires 5 -�- —S Policy# ❑ By my Signature below, I certify to each of the following: I am the property Name of Agent Phone# owner or authorized to act on the property owner's behalf. I have read this (This section need not be completed if the permit is for application and the information I have provided is correct. I agree to comply one-hundred dollars($100)or less) with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to enter the above- El I certify that in the performance of the work for which this permit is issued, I identified property for the inspection purposes. shall not emolov any persons in any manner so as to become subject to the workers'compensation laws of California, and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor pro Date Code,I shall forthwith comply with those provisions. /� i y usiness License# Date; GApplicant; 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, ❑YES 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 El 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 AYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION FROM THE SOUTH COAST AIR QUALITY MANAGEMENT Lender's Address ❑NO DISTRICT(SCAQMD) SEE PERMITTING CHECKLIST FOR OWNER BUILDER DECLARATIONS GUIDE LINES I hereby affirm under penalty of perjury that I am exempt from the Contractor's PRINT NAME: License Law for the reason(s)indicated below by the checkmark(s)I have placed []YES 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 ❑YES 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($500).) CODE SECTION E s ION 25505RIAL tE5533POR­l,AND 25534 CONCERNING ❑ I, as owner of the property, or my employees with wages as their sole G. compensation,will do ( )all of or( )porting of the work,and the structure is PROPERTY OWNER OR AUTHORIZED AGENT not intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's State License Law does not apply to an owner of a property X who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale.If,however, the building or improvement is sold within one year of completion, the Owner- - Builder will have the burden of proving that it was not built or improved for the purpose of sale). CITY OF ME IIFEE PLCK No: 29714 Haun Road Date: Date: Menifee, CA 92586 g Phone: (951)672-6777 Amount: Amount; Fax:(951)679-3843 Ck#: Ck#: Building Combination Permit To Be Completed By Applicant Legal Description: 16X3S i U wC P nning Case: F: L: Rt: R Properly Address: „ 16 C `ry "? 14 Assessor's Parcel Number: ly ProjectlTenant Name: Unit#: Floor#: Name: Phone N Fax No, Property Address: Unit Number Zip Code Owner Email Address: Name: Phone No. Fax No. Applicant Address: Unit Number Zip Co ' +C J ! Email Address: Name: �� Phone No. Fax No. Contractor Address: City Sta a Zip o 5.S Y (/O' .2 ref S,, ?`rtl C l( /� • ,5 ontractor s us ness tense 15,S 0 Tractors Clty-State of Callt iskicgnse No. Classification: Number of Squares: Qom^ Square Footage Gd Description of Work: _a S` [1 , Cost of Work:$ Applicant's Signature ------ Date: Ifh1 aff On yi.. 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 ❑ Goo Tech/Soils Report(on cd only) ❑ Plot!Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8%x 11) ❑ ❑ Structural Calculations Foundation Plan ❑ Cross Section El Plan ❑ Single Line diagram for elec.services over 400 AMP ❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan ❑ Sound Report-Residential Class Code: Indicate New Construction Alteration' Addition' Means/Methods Work Type: Repair' Retrofit' Revision to Existing Permit' Required? 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 YES or NO Indicate all Geo-tech.Haz.Zone At Project Construction Sprinklered that apply: Coastal Zone Completion: Type($): C Of O Noise Zone Required? YES or NO 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 Chargerl Landmark Seismic Retrofit Specjai Case.Sid g. OReaIA ro.Si Expedite Projecl(s): Child Care City Project I Green Building Landmark I Affordable Housing For Staff Use Only auildin Salety I Permit Specialist I City Planning ICivil Engineering EPWM-Admin I mnsponabon Mgmt. Rent Control THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY 1hlin /16� uyEN 30983 Ga �'oe S�, /�l eat%ape C',g 9o2S8 y `'a 6 7 - 9 ya a 'NS C/01V TRACK BuilCi' RofS enifee U afety Deft. d S�OG 2 8 10o ReCe1Ved �- e200 0 —7 3 -CITY 0 MFfu�rrrl 1c� BUILDING AND SAFETY DEPARTMENT 2 / \ PLAN APPROVAL REVIEWED B DATE *Approval of these plans shall not be construed to be a permit for,or an 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.