PMT14-02722 1
City of Menifee Permit No.: PMT14-02722
29714 HAUN RD, Type: Residential Addition
<;i'CCCF.L-/k MENIFEE, CA92586
MENIFEE Date Issued: 1 0/0 912 0 1 4
1
i
PERMIT
Site Address: 27918 CACTUS FLOWER DR, MENIFEE, Parcel Number: 333-264-007
CA 92585 Construction Cost: $4,000.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 488 SQ FT SOLID ALUMAWOOD PATIO;2 LIGHTS
Work:
Owner Contractor
ROBERT MADRE PATIO GUY ALUMAWOOD CONTRACTOR
27918 CACTUS FLOWER DRIVE 41197 GOLDEN GATE CIR STE 108
MENIFEE, CA 92585 MURRIETA, CA 92562
Applicant Phone: 9513330056
LOIS MONTINI License Number: 872839
PATIO GUY ALUMAWOOD CONTRACTOR
41197 GOLDEN GATE CIR STE 108
MURRI ETA, CA 92562
Fee Description QQt rr Amount 1$1
Building Permit Issuance 1 27.00
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 building 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
3
City Of Menifee
LICENSED DECLARATION
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,my license is in full force and o fe I. Code:The Contractor's License Law does not apply to an owner of a property
License Class�License No. �v "'� �Y try s with -
� who builds or improves thereon, and who contracts for the projects with a
Expires G' ' D 'fit;-Signature 'Z_,G- �""
-2.��;C .fly2---.. licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ I am exempt from Iicensure under the Contractors'State License Law for the
❑ 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' 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 3 of the Labor Code, for the performance of work for which this improvements covered by this permit, I cannot legally sell a structure that ave
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
❑ I 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:bttp;//www.leoinfo.ca,gov/calaw.html.
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier (AJ`- (El, Property Owner or Authorized Agent Date
//__
Expires LJ '� �/ Policy# ;� OC' Va '/ ��9
Name of Agent Phone# ❑ By my Signature below, I certify to each of the following: I am the property
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 ayfhorize 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 rop r4y 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 fiSetio3700of the Labor
Code, I shall forthwith comply with those pro Property Ow er or Authorized Agent Date
l U C) /// City Business License#
Date; J`' Applicant; ,
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, DYES OCCUPANT HANDLE A HAZARDOUS MATERIAL ORA
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 AYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
Lender's Address FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
❑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 constrict, 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 Iicensure 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($500).) CODE SECTION 25505, 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL REPORTING.
compensation, will do ( )all of or( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not Intended or offered for sale. (Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
CITY OF MENIFEE City of Menifee PLCKNo: Permit No:
29714 Haun Road Building & Safety Del .ate: Date:
Menifee, CA 92586
Phone: (951)672-6777 OCT 0 9 2014 Amours Amount:
Fax:(951)679-3843 Ck#: Ck#:
- Received 23�`
Building Combination Permit �, S
To Be Completed By Applicant
Legal Description: Planning Case: F: L: Rt: R
Property Addres Assessor's Parcel Number:
/9 �buJ = 333- 2(, —r
Project/Tenant Name: UnR#: Floor#*
Name: A �.. n\ �,� hone No. Px No.
Property Address: � Code Y,�
Owner
Email Address:
Name: L. O/S / C r7 its %i//lJ/ ( �� y.. F No.
Applicant Address: Unit Number Zip Code
Endo Address:
If
Na e: - P,l7ojJo_3 bOc Fax No.
U
Contractor Addre s: t It / State Zip Code
L �l DL y Cjf��L " it/ [ �,�
ontractor s City BusinesS License No. Contractor's City Slate of Califosurnia Lic nse No. Classification:
Number of Squares:
Square Footage -
Description of Work: J h / L (J L / /n i-\ Co of Work:$
Applicant's Signature D _',`t .(ILL, 7I „Dst Dale: 7 c�
6 P_X
To Be Completed By City.Staff Only
Indicate As R-Received or NIA-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 cd only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8%x 11)
❑ Foundation Plan ❑ Cross Section El Structural Calculations
❑ Plumbing Plan ❑ Single Line diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan 1 ❑ 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: #Staries: 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 JElec.Vehicle Charger Landmark Seismic Retrofit bpecial case:Bldg.
OffiaalApp.wil
Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing
For Staff Use Only
BuildinglSafet Permit specialist Cily Planning Civil Engineering EPWM-Admen Transportation Myml. Rent Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
City of Menifee
Building & Safety Dept.
EL
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OCT o s Zola O
FCTI N REQUIRED Received ,W
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- c BAILEE
BUiL AND S FE ENT
PLAN APPROVAL Q
�- REVIEWED BY
DATE J
*Approval of these plans shall not be construed be a permit for,or an
approval of,any violation of any provisions of th federal,state or city
regulations and ordinances. This set of approv ans must be kept on the
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