PMT14-03096 City of Menifee Permit No.: PMT14-03096
29714 HAUN RD. Type: Residential Addition
OW6ML A? MENIFEE, CA 92586
MENIFEE Date Issued: 11/20/2014
PERMIT
Site Address: 28394 TUPELO RD, MENIFEE, CA 92584 Parcel Number: 372-490-008
Construction Cost: $5,130.00
Existing use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 2-163 FT LATTICE& 1-SOLID 204 SO FT ALUMAWOOD PATIO COVERS WITH
Work: ELECTRICAL, 1 FAN
4 LIGHTS
Owner Contractor
WAYNEEWING THE SHADEMAKERS
28394 TUPELO RD 2625 VINE ST
MENIFEE, CA 92584 NORCO, CA 92860
Applicant Phone: 9512800040
TIM A MORAN License Number: 881600
THE SHADEMAKERS
2625 VINE ST
NORCO, CA 92860
Fee Description Guy Amount f$1
Building Permit Issuance 1 27.00
x i
GREEN FEE 1 1.00
$298.00
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 thereunderwhen in violation of the Building Code or of any other
ordinance of City of Menifee. Except as otherwise staled,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_Templatespt 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 ar�d my license is in full force and effect. Code:The Contractor's License Law does not apply to an owner of a property
�License Class c 'M` I License No %t who builds or improves thereon, and who contracts for the projects with a
Expires '40 Signature licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ lam 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
tI 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:htti),//www.leoinfo.ce.ciov/calaw.html.
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier G�[JN \"tE 5-T C,�,TL Property Owner or Authorized Agent Date
Expires '�- '�� ' t � Policy# Off"\"3`i--1Noa
Name of Agent ❑ 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 stale laws relating to building
construction.I authodze representatives of this city or county to enter the above-
0 1 certify that in the performance of the work for which this permit is issued,I identified prop rty for the in action 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 "Olt-
subject to the workers'compensation provisions of Section 3700 of the Labor Property wner or Authorized Agent Date
Code,I shall forthwith comply with those provisi s.! 35
��: ° City Business License# yj �7
Date; \�-2a '�� 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, OYES 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 ONO 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 DYES 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 OYES 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, ONO 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 AYES 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($500).) CODE, SECOUS IONMAT 25505RIAL ffE5533PN�f GD 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole
compensation,will do( )all of or( )porting of the work, and the structure is PROPERTY WNER QR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code; �—�
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
CCITT OF M ENIFE E PLCK No: P
29714 Haun Road
Date: Date:
Menifee, CA 92586
Phone: (951)672-6777 Amount: Amou t: 1 gdp
Fax:(951)679-3843 Ck#: Ck#:
Building Combination Permit cq� I SI
To Be Completed By Applicant
Legal Descl n:` O o V 6 Planning Case: F: IL: Rt R:
Property Address: Assessor's Parcel Number.
,4010 -609
Projectrrenant Name: Unit M Floor#:
tJ�C, - t13U'
Name: Phone No.
g % 3 Fax No.
Property `\�Z.
Address: Unit Number ZipCode
Owner Q-6 Z
Email Address:
Name: Phone No.
Fax No.
Applicant Address: Unit Number Zip Code
Email Address:
Name: Phone No. Fax No.
E IsC6 S >t• 1 -ooy\
Contractor Address: C' St to Zip Code
Was tJ6 S` o o A z wU
ontrac�tor s City ly uostness Contractor's City State of California License No. Classification:�f
�3 1 c-
\O
Number of Squares: y4
Square Footage
Description of Work: r ' t Cost of Work:$
Applicant's 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 oFdocuments 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)
❑El Foundation Plan ❑ Cross Section ❑ Plumbing Plan Structural Calculations
❑ Single Line diagram for slec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration' Addition' MeanslMethods
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.HTz-Zone
At Project Construction Sprinklered that apply: Coastal Zone
PPy
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. I Planning Comm.Zoning Administrator
Fee Exempt: City Project Elec.Vehicle Charger Landmark Seismic Retrofit special case:wag.
OmcialA royal
Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing
For Staff Use Only
Building/Safety I Permit Specialist City Planning I Civd Engineering I EPWM-Admin Transporlation Mqlmt—, l Rent Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
r
LEDG & TRACK
INSPECTIO REQUIRED
Gt Menifee
Sul & Safety Dept
- -� - - - y-
_ hR��ived
cvz)A - `125B - A 2-
CITY OF MENIFEE
BUILDING AND SAFETY DEPARTMEN
PLAN APPROVAL
REVIEWED B DAT
roval of these pl ns shall not be construed to be a permit for,or an
roved plans must be kept on the
approval of,any viol ion of any provisions of the federal,state or city
regulations and ordi ances. lhls set of app
jobsite until completion.
1