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PMT14-03072 City of Menifee Permit No.: PMT14-03072 29714 HAUN RD. iCC✓-tl-A?` MENIFEE, CA 92586 Type: Residential Addition MENIFEE Date Issued: 11/19/2014 PERMIT Site Address: 28978 GOLDEN DAWN DR, MENIFEE, Parcel Number: 372-352-025 CA 92585 Construction Cost: $5,500.00 Existing Use: 1 &2 Family Residence Proposed Use: Description of INSTALL 13'x 50' SOLID ALUMAWOOD PATIO COVER WITH 3 FANS Work: Owner Contractor JOSE RODRIGUEZ KYLE KELLY 28978 GOLDEN DAWN DRIVE 35406 REDBERRY PALMS COURT MENIFEE, CA 92585 LAKE ELSINORE, CA 92532 Applicant Phone: 9512960908 KYLE KELLY License Number: 948536 KYLE KELLY 35406 REDBERRY PALMS COURT LAKE ELSINORE, CA 92532 Fee Description O�1 Amount ece•t e' S Ich, a ure11 23: 2600 Building Permit Issuance 1 27.00 -. 00 GREEN FEE 1 1.00 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 slated,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_Bidg_Permlt_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_A my license is in full for a and effec2t. Code:The Contractor's License Law does not apply to an owner of a property License Class License No. 1 (j 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). s-- WORKERS C-6i�fiENSfkFION-DECLRRATION— ❑ I am exempt from licensure under the Contractors'State License Law for the ❑ I hereby affirm under penally 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 ProfessiGas.0ode,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 We alwww.le mfo.ca. ovj/Ga/law.html. permit is issued.My workers'compensation insurance carrier and policy number are: ---� 16 roperty Owner or uthorized Agen Date Carrier --- Expires licy ❑ 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 cif accounty to enter the above- [I I certify that in the performance of the work forwhich this permit is issued,I identifie operiy-Mthe inspection ction purposes. shall not ample any persons in any manner so as to become subject to the _ ___ workers' compensation laws of California, and agree that if I should beco ems._.._.._ subject to the workers'compensation provisions of Section 3700 of tin abor proms Owner or Authorize 7cgent---e_ Date Code,I shall forthwith comply with those provisions. ^�---- -- City Business License# Date; Applicant; WARNING: FAILURE TO SECURE W__ ORKER HAZARDOUS MATERIAL DECLARATION COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUS A DOLCA S WILL THE APPLICANT OR FUTURE BUILDING ($100,000), IN ADDITION TO THE COST O MPENSATION, ❑YES OCCUPANT HANDLE 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 INFORMATION GUIDE? I hereby affirm that under the penalty of perjury there is a construction lending 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 PRINT NAME: I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the reasons)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 I HAVE READ THE HAZARDOUS MATERIAL provisions of the Contractor's State License Law(Chapter 9 (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or ❑YES INFORMATION GUIDE AND TI_I-E-SGAQMD PERMITTING she is exempt from licensure and the basis for the alleged exemption. Any CHECKLIST. ,_LUN©ERSTAND MY REQUIREMENTS violation of Section 7031.5 by any Applicant for a permit subjects the applicant to [I NO UNDER-TFfE STATE OF CALIFORNIA HEALTH AND SAFETY a civil penalty of not more than($500).) HOD SECNDOUS ION 5505AL ffE 533�ff AND 25534 CONCERNING ❑ 1, as owner of the property, or my employees with wages as their sole /// compensation, will do ( ) all of or( ) porting of the work, and the structure is / PROPERTY OWNER OR AUTHORIZED AGENT not intended or offered for sale.(Section 7044, Business and Professions The Contractor's State License Law does not apply to an owner of a property k who, through employees' or personal effort, builds or improves the property, --��`�Ay provided that the improvements are not intended or offered for sale. If,however, the building or improvement is sold within one year of completion, the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). BUILDING & SAFETY PERMIT/.PERMIT/PLAN CHECK APPLICATION yA�.6� 5 Menifee DATE PERMIT/PLAN CHECK NUMBER TYPE: O COMMERCIAL * RESIDENTIAL O MULTI-FAMILY 1:1" MOBILE HOME i;i POOL/SPA <?SIGN SUBTYPE: ""ADDITION ALTERATION O DEMOLITION * ELECTRICAL O MECHANICAL NEW Jp -% PLUMBING ,:;CARE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK Q w L P Building & Safety D pt. PROJECTADDRESS e' G0/,/P/l d,7 NOV 19 201 ASSESSOR'S PARCEL NUMBER 3�a,.� ? -CQ5 LOT TRACT OWNER NAME c/�jSQ ADDRESS p PHONE qS'/� -2 C/6 - �?S ?2 EMAIL APPLICANT NAME 10 6 ADDRESS PHONE mK `0L5/�y EMAIL CONTRACTOR'S NAME''-- < OWNER BUILDER? Ci YES `, NO BUSINESS NAME yp ADDRESS PHONE EMAIL CONTRACTOR'S STATE LIC NUMBER 3(5C LICENSE CLASSIFICATION VALUATION$ O(% SQ FT L SO FT APPLICANT'S SIGN T CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP 1 C23:2 INVOICE AMOUNT PAID AMOUNT CASH .:)CHECK# OCREDITCARD VISA/MC PLAN CHECK FEES PAID AMOUNT iCASH <%CHECK It `+CREDITCARD VISA/MC OWNER BUILDER VERIFIED YES 2 NO DL NUMBER NOTARIZED LETTER % YES 0 NO City of Menifee Building& Safety Department 29714 Haun Rd. Menifee, CA 92585 951-672-6777 www.cityo(menifee.us Inspection Request Line 951-246-6213 � A f jUC / PP. �� City of Menifee 0 Building & Safety Dept. U 7 NOV 19 ,2014 L Received IL O LEDGER & TRACK INSPECTION REQUIRED i CITY OF MENIFEE BUILDING AND SAFETY DEPARTMENT PLAN APPROVAL REVIEWED BY 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.