PMT14-02410 City of Menifee Permit No.: PMT14-02410
_ 29714 HAUN RD.
4,^�L MENIFEE, CA 92586 Type: Residential Addition
SA., MENIFEE Date Issued: 09/08/2014
PERMIT
Site Address: 25295 LONE ACRES RD, MENIFEE, CA Parcel Number: 358-421-009
92584 Constructlon Cost: $2,900.00
Existing Use: 1 &2 Family Residence Proposed use:
Description of INSTALL SOLID ALUMAWOOD PATIO COVER WITH 2 FANS
Work:
Owner Contractor
PRISCILLA HEADRICK PSLQ INC
25295 LONE ACRES ROAD 28910 RANCHO CALIFORNIA RD
MENIFEE, CA 92584 #206
Applicant Phone: 9517954260
LUIS BENTIVENIGO License Number: 919885
PSLQ INC DBA GREEN BEE
28910 RANCHO CALIFORNIA RD
#206
TEMECULA, CA92590
Fee Description Qtv Amount I$1
c IYC , tl � � - ii • �,.
Building Permit Issuance 1 27.00
t
GREEN FEE 1 1.00
$283.00
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,orwhere 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
I hereby affirm under penalty or perjury that I am licensed under provisions of ❑ [, as owner of the property an exclusively contracting with ]loans
Chapter 9 (commencing with section 7000),.of Division 3 of the Business and
Professions Code my my license is in f to a n, efjest. contractors to construct the project(Section 7044, Business and Professio
License Class-�License c �`(,�j Code:The Contractor's License Law does not apply to an owner of a prope
Ex ires � _�� � who builds or improves thereon, and who contracts for the projects with
P —�L`Y Signatur licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ I am exempt from Iicensure under the Contractors'Slate License Law for it
❑ I 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'
compensation,issued by the Director of Industrial Relations as provided for by By my signature below I acknowledge that, except for my personal residence
Section 3700 of the Labor Code, for the performance of work for which this which I must have resided for at least one year prior to completion
permit is issued. improvements covered by this permit, I cannot legally sell a structure that I ha,
Poll # built as an owner-building if it has not been constructed in its entirety by license
contractors. I understand that a copy of the applicable law, Section 7044 of 9
have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application
section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:http�11www lepinfo ca eov/calaw html,
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier_ a p (2 Property Owner or Authorize Agent
Date
Expires '1 1 j Policy#
Name of Agent t 0_1_� Phone# ❑ By my Signature below, I certify to each of the following: I am the proper
owner or authorized to act on the property owner's behalf. I have read th,
(This section need not be completed if the permit is for application and the information I have provided is correct. I agree to comp)
one-hundred dollars($100)or less) with all applicable city and county ordinances and stale laws relating to buildin
consI certify that in the performance of the work for which this permit is issued,I identifedlproperty for authorize representatives of this city or county to enter the above
shall not emolov any persons in any manner so as to become subject to the P purposes.
workers' compensation laws of California, and agree that if I should become O subject to the workers'compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those p isio Property Owner or Authorize ant l.� Date
Date; /� 7 Applicant; City Business License#
WARNING: FAILURE TO SECURE WORKERS'
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL HAZARDOUS MATERIAL DECLARATION
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, WILL THE APPLICANT OR FUTURE BUILDING
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE DYES OCCUPANT HANDLE A HAZARDOUS MATERIAL ORA
LABOR CODE, INTEREST,AND ATTORNEYS FEES / MIXTURE CONTAINING A HAZARDOUS MATERIAL
CONSTRUCTION LENDING AGENCY (❑NO EQUAL TO OR GREATER THAN THE AMOUNTS
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
3097 Civil Code) WILL THE INTENDED USE OF THE BUILDING BY THE
Lender's Name APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE
DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
Lender's Address FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
/D 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
DYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable item(s) (Section 7031.5. Business and Professions Code;
Any city or county that requires a permit to construct, alter, improve, demolish, BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A
or repair any structure, prior to its issuance �NO, also requires the applicant for the SCHOOL?
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 t UNDERSTAND MY REQUIREMENTS
violation
exempt from Iicensure and the basis for the alleged exemption. Any CHECKLIST.on of Section 7031.5 by any Applicant for a permit subjects the applicant to
a civil penalty of not more than($500).) D NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
❑ I, as owner of the property, or my employees with wages as their sole CODE, SECTION 25505, 25533 AND 25534 CONCERNING
HAZARDOUS MATERIAL REPORT ING.
compensation, will do ( ) all of or ( ) porting of the work, and the structure is
not intended or offered for sale, (Section 7044,Business and Professions Code; PTr�=
ENT
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
CITY O ME wl IFL' E PLCK No: Permit No:
City of Menifee
29714 Haun Road 8WIding & Safety Dept. Date Date:
Menifee, CA 92586 6l lis
Phone: (951)672-6777 SEP 0 8 2014 Amount: Amount
Fax:(951)679-3843 Ck#: Ck#:
Building Combination Permit
To Be Completed By Applicant
Legal Description: Planning Case: F: L: Rt. R
Property Address:Zr 2 o S Assessor's Parcel Number:
J 1 n-L �C. r.¢.S ZO,
Project(fenant Name: SG; Unit#: Floor#:
Name: Ph ne No. o Fax No,
Fr 1 5C Ll,c� 1�c �J r, �L` `�rl - z
Property Address: Unit Number Zip Code
Owner Z g'Z (�,�e roc f�s �2c� 9 z rS l
Email Address:
Name: V i S �g.�-4-uJ�^ v Phone No.9 y 1-937-b Fax No.
Applicant Address: Unit Number Zip Code
Email Address: '
l✓.� t5� —E� �rS�JLJ(�-�, C
Name: j Phone No. , Fax No.
J
Contractor Address: ,99910 �F��O i City Stat Zip l:,pgg _, D
Contractor's it j ss,LOiceSe o. Contractor's City r Cj§1c egia License No. Classification: 11>
tApplicant's
quares: `'"I ZJ L7
ge 3� —a
of Work: �2 �Z b S`\.r� ��ur✓-u-�'�"� Cost of Work:$
Signature Date:
_ To Be Completed By City:Staff 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)
❑ Structural Calculations
❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Single Line diagram for elec,services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan I ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration' Addition' MeanslMethcds
Work Type: Repair' 77Retrofit* 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(s): 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 I Elec.Vehicle Charger Landmark Seismic Retrofit special ase.atlg.
Official Approval
Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing
For Staff Use Only
Buildmg/Safet Permit Specialist Cily Planning I Civil Engineering EPWM-Admen Transportation Mgmt. Rent Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
Priscilla Headrick (`
Plot plan 25295 Lone Acres Rd.
Not to Scale Menifee, Ca. 92584 LL
951-246-9857 Cl
336 sq. ft. of Alumawood Solid Patio Cover Attached to the house and to LL
the concrete slab. (2) ceiling fans. Color to match the house C-
( Latte and Desert Sand ) set at 9'
City of Menifee
Building & Safety Dept
SEP 0 8 2014
16' Received
32' o 0 0 o g1-.
CITY OF MENIFEE
BUILDING AND SAFETY DEPARTMEN
Driveway --WAM PPROUAL
REVIE ED BY >, R lit
-'� DATE
'Approval of these plans shall not be construed to be a permit for,or an
approval of ay violation of any provisens ef the federal,state or city
Sidewalk regulations and ordinances, This set of approved plans must be kept on the
job5ite until completion.
Lone Acres