PMT15-00518 II
City of Menifee Permit No.: PMT15-00618
29714 HAUN RD. Type: Residential Addition
MENIFEE, CA92586
MENIFEE Date Issued: 03/27/2015
PERMIT
Site Address: 25659 BETH DR, MENIFEE, CA 92584 Parcel Number: 358-232-007
Construction Cost: $20,000.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of CONSTRUCT 800 SQ FT ENGINEERED SOLID PATIO COVER
Work:
Owner Contractor
BRANDON BURROWS A VALENZUELA CONSTRUCTION
25659 BETH DR P 0 BOX 78421
MENIFEE, CA 92584 CORONA, CA 92882
Applicant Phone: 9512647095
ANDREW VALENZUELA License Number: 849291
A VALENZUELA CONSTRUCTION -
P O BOX 78421
CORONA, CA 92882
Fee Description Oft Amount
Building Permit Issua ce 1 27 00*
Deck/Patio, non-standard 1 133.00
Inspections not sped ed 258 258:14;
Additional Plan Review Building 240 240.00
GREEN FEE » '_ u_ '1' 1 00
SMIP RESIDENTIAL 1 3.00
New Corisfructlon Permit Fee 1 92 00
$754.14
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_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 nd my license is in full fo�rc�e a�ndqeffect. Code:The Contractor's License Law does not apply to an owner of a property
License Class License No.JQ who builds or improves thereon, and who contracts for the projects with a
Expires // 2D( ignatu licensed contractor(s)pursuant to the Contractors State License Law).
ORKERS'COMPENSATI0 DECLARATION
l� la mpt from tic ure under the tractors'State License Law for the
❑ 1 hereby affirm under penalty of perjury one of the following declarations: (/following reas
I have and will maintain a certificate of consent of self-insure for workers' By my signature below wledge that,except for my personal residence in
compensation,issued by the Director of Industrial Relations as provided for by which I must have resided o 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 t legally sell a structure that I have
permit is issued.
built as an owner-b " if it has not been con ted in its entirety by licensed
Policy# contractors. I ers nd that a copy of the applicable Section 7044 of the
❑ I have and will maintain workers' compensation insurance, as required by Business Pro ions Code,is available upon request whe 's application is
section 3700 of the Labor Code, for the performance of the work for which this subm I#ng Web site:http,//www.leginfo.m. ov/cala I.
permit is issued.My workers'compensation insurance carrier and policy number are:
r party Owner or u oriz d Agent Date
Carrier
Expires Policy#
❑ 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 t be c m less) with all applicable cit county ordinances and state laws relating to building
construction.I a ri representatives of this city or county to enter the above-
certify that in the performance of the work for which this permit is issued,I identified pr t e Action purposes.
hall not employ any persons in any manner so as to ome subject to the
\workers' compensation laws of California, and agre a if I should becomegj�Z7 �S~
Subject to the workers'compensation provisions Sec" n 3700 of the Labor Arty Owner or Authorized Agent Date
r Code,I shall forthwith comply with those provisi s.
�7 /,,c�---- City Business License#
Date; 5Applicant;
WARNING: FAILURE O 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 OR A
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 OYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
Lender's Address ❑NO FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
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 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, ❑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 (Chapter9 (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($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL( EPORI'ING.
compensation, will do( ) all of or( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not Intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
Menifee
DATE PERMIT/PLAN CHECK NUMBER I5' W5 2
TYPE: 0 COMMERCIAL '/RESIDENTIAL O MULTI-FAMILY % MOBILE HOME 0 POOL/SPA " SIGN
SUBTYPE: ADDITION 0 ALTERATION 0 DEMOLITION f) ELECTRICAL C MECHANICAL
NEW <' PLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
PROJECT ADDRESS
ASSESSOR'S PARCEL NUMBER LOT _ TRACT '!3 CO
OWNER NAME
ADDRESSZtSZC,�
PHONE EMAIL
APPLICANT NAME
ADDRESS
PHONE GI.�(�- Zle '7/01� EMAIL �'�q�2u.Z�t�/ �vc✓Lt.� �eMJ�
CONTRACTOR'S NAME _ // z(f" - OWNER BUILDER? 0 YES 0 O
BUSINESS NAME
ADDRESS l � Z
PHONE G/�/2(py 7,?) EMAIL gdale-lzl �.[p /�eG7t�CD �•f •�L --
CONTRACTOR'S STATE LIC NUMBER ov LICENSE CLASSIFICATION
VALUATION$ v � 111f SOFT LSQFT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION aG O� CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN ' SMIP 3
INVOICE 00II:PAID AMOUNT
AMOUNT ' �� CASH `L%CHECK# !.i CREDITCARD VISA/MC
PLANCHECKFEES PAIDAMOUNT ;)CASH 'CHECK# GCREDITCARD VISA/MC
OWNER BUILDER VERIFIED `)YES NO DL NUMBER NOTARIZED LETTER YES 'i NO
City of Menifee Building& Sofety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
[DO NOT PAY— THIS IS NOT AN INVOICE]
VALUATION AND PLAN CHECK FEE
JURISDICTION: MENIFEE PLAN CHECK NO.: PMT15-00518
PREPARED BY: ALI SADRE, S.E. DATE: MARCH 18, 2015
BUILDING ADDRESS: 25659 BETH DRIVE
BUILDING OCCUPANCY: R3/U; V-B
BUILDING AREA Valuation Reg. VALUE ($)
PORTION ( Sq. Ft.) Multiplier Mod.
PATIO COVER 800
Air Conditioning
Fire Sprinklers
TOTAL VALUE
Jurisdiction Code MNF Manual Input
Bldg. Permit Fee by Ordinance J
Plan Check Fee by Ordinance _ W�
Type of Review: ❑ Complete Review ❑ Structural Only
•
ElRepetitive Fee El Other
I
Repeats Hourly 2 Hrs. @
EsGil Fee $120.00 $240.00
Based on hourly rate
Comments: Sheet 1 of 1
macvalue,doc+