PMT14-02352 City of Menifee Permit No.: PMT14-02352
29714 HAUN RD, Type: Residential Addition
'SCCIEO MENIFEE, CA 92586
cwm..: lsmkr N MENIFEE Date Issued: 0 9/0 312 01 4
PERMIT
Site Address: 29103 OFFSHORE CT, MENIFEE, CA Parcel Number: 333-381-013
92585 Construction Cost: $3,500.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL SOLID ALUMAWOOD PATIO COVER WITH 2 FANS, AND A FREESTANDING 8'x 12'SOLID
Work: ALUMAWOOD COVER/GAZEBO WITH 1 FAN
Owner Contractor
SAMANTHA FLORES PRO INSTALLATION
29103 OFFSHORE COURT 43043 CAMINO CARUNA
MENIFEE, CA 92585 TEMECULA, CA 92592
Applicant Phone: 7142348652
TOM MOORE License Number: 895950
PRO INSTALLATION
43043 CAMINO CARUNA
TEMECULA, CA 92592
Fee Description City Amount 1$1
€Rees fa"cld Swlfc Outlet&Fi U'e a �'� '; k ""
Building Permit Issuance 1 27.00
Deck/ alto non-sfan and t .; � 1 � {9 33 063
GREEN FEE 1 1.00
$288.00
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_Permit_Templatexpt 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 C I'Ifgense is in full for+ nd effect. Code:The Contractor's License Law does not apply to an owner of a property
License Class icense 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).
WORKERS'COMPEN TION 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. 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
" have and will maintain workers' compensation insurance, as required 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:http'//www.leginfo.ca.ciov/calaw.html.
permit Is issued.My workers'compgnsation insurance carrier and policy number are:
Carrier_
tj-y\J,�(L�1e—'JJ�- �C- JJ��A ' Property Owner or Aut orized Agent Date
� 1 1 c ✓/ �—y
Expires 5�51 11rJ Policy# C2LV4 �W�"/0Z'L
By my Signature below, I certify to each of the following: I am the property
Name of Agent Phone# ow r 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 ap Iicable city and county ordinances and state laws relating to building
constr ion authorize re res of this city or county to to ent
certify that in the performance of the work for which this permit is issued, I id ified p Party
forth sp ction ction pur purposes.
DAK 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 'Y- [
subject to the workers' compensation provision f Section 3700 of the Labor Property Owner or Authorized Agent Date
Code,I shall'orth,. ilh comply with those pro ' io s.
City Business License# 3_ �J
Date; Applican
WARNIN FAILUR TO SECURE WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVER GE 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 [I 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 ❑YES 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 reason(s)indicated below by the checkmark(s)I have placed ❑YES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable items) (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 OYES 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, SECTOUS ION 505AL 1�5533EPO�ff AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole
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 MENIF�., �, Ity of Menifee
�(1htling & Safety Dept. PLCKNO: P rmltNO:
29714 Haun Road SEP 0 3 2014 Date: Dale: -
Menifee, CA 92586 ,1 13 I
Phone: (951)672-6777 moon Dort:
Fax:(951)679-3843 Received CkM: Clot:
Building Combination Permit
To Completed By Applicant
Legal esmp on: Vent , , arming Casey L: Rt R
ProplxlY 7563 t�3-A PG� � Assessor's Parcel Number,
ro c en l.- qre: Unit N: Flow tl:
Namo: l O i ' 1 - o e y P e Nc. ,, Fax No.
ProOwV �drese7 p(6 ��0 ' 1� ,r ,S+`/\, Unit Number try Z 5
mail Address: 1-SC1'f�%-.
Narrl`-�l 6^^` ,to , .3 n P on� ?41 Z � o.Fax N
Applicant Addms yV rr. 15�q ( �t➢Q, Unit Number
z° t3t 7
Email 'J�
1N
Fax No.
Contractor Ad r 45
o e� ®�-y- D S _ Z aQb G zJ(+
s y s ns
on rac area o. Contractor's 1 f ali LeeLicense No. C7astiMa C.11
Number of Squares:
Square Footage
Description of r _ M ,\ �,a t� Cost of VOTH 7cm,
plicanf lure 'if W V ll`l T�-4-� Data •-J
To Be Completed By City Staff only
lndi aIe As R.Received or N!A-Not Appl¢eble
5 Completes sets of fully dimenmoned.drawn to sale plans wb¢h iMIude. 1 set Of documents whim induce
❑ TiNe Sheet ❑ Elevations ❑ Electrical Plan ❑ Geo Tech/Soils Report(on ed only)
❑ Plot/Site Plan ❑ Root Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8'/,x 11)
❑ Foundation Plan ❑ Structural Calculations
❑ Cross Section ❑ Plumbing Plan ❑ Single Line diagram for efec.services over 400 AMP
❑ Floor Plan ❑ Structural Fm ilvlg Plan&DelaO ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteratlon' Addifion• MeanslMethods
Work Type. Repair• Rehofit' Revidon to Emlim PtxnlA' Required? YES NO
Proposed Building Use(s): Existing Building Uso(s):
p Buildings. 5 Units: N Stories: Will me Building Have a Basement?
V ai N
Bldg.Code Occupancy Group Indicate Indicate it Indicate all Ceo-tech.Haz Zone
At Project Sormkimed YES or NO
Completion: Construction that apply: Coastal Z-Me
TYpe(s): C rlf O YLS or NO Norse Zone
Required? Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commis Arch.Review Boartl Landmark Comm. I Planning Comm.Zoning Administrator
Fee Exempt: City Projacl Elec.Vehkle Charger Landmark Seismic Retrofit ese g
OfA word:
Expedite Projecl(s): Child Care City Rojlrct Green Building [Landmarki I Affordable Housing
For Staff Use Only
BuIldinglSalety I einnat pecialrsl I Uty,Planning I Gv,1F,,g::�ameermg I E min I ransponalson mi eru Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
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