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PMT15-00944 i City of Menifee Permit No.: PMT16-00944 29714 HAUN RD. MENIFEE, CA 92586 Type: Residential Addition MENIFEE Date Issued: 04/15/2015 i PERMIT Site Address: 27739 AVENIDA HALAGO, MENIFEE, CA Parcel Number: 333-274-024 92585 Construction Cost: $3,500.00 Existing Use: 1 &2 Family Residence Proposed Use: Description of INSTALL 1 V x 32' SOLID ALUMAWOOD PATIO COVER Work: Owner Contractor JOHN ANDREWS ANTHONY COCILOVA 27739 AVENIDA HALAGO 31321 PALOMAR ROAD MENIFEE, CA 92585 MENIFEE, CA 92584 Applicant Phone: 9513146910 ANTHONY COCILOVA License Number: 962132 ANTHONY COCILOVA 31321 PALOMAR ROAD MENIFEE, CA 92584 Fee Description Qtv Amount l$1 Deck/Patio, non-standard 1 133.00 SMIP RESIDENTIAL 1 1.00 $162.00 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,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 Cc ark 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? L Licens lo. ��i, - 3 who builds or improves thereon, and who contracts for the projects with a Expires L-3 ) 6 Signature licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATION DECLARATION ❑ I am exempt from licensure under the Contractors'State license Law for the I hereby affirm under penalty of perjury one of the following declarations: following reason: �( 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 lssuegj. _ `-Policy#� —'t� �� 7 built as an owner-building if has not been constructed in its entirety by licensed rr 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:http,//www.leginfo.ca.00v/calaw.html. permit is issued.My workers'compensation insurance carrier and policy number are: Carrier gq✓� Property Owner or Authorized Agent Date Expires / "� Policy# 6U'6_Q ^�- — � I d e El 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 city or county to enter the above- ❑ I certify that in the performance of the work for which this permit is issued, I identified property for the inspection purposes. shall not employ 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 of Section 3700 of the Labor Property Owner or Authorized Agent Date Code, I shall forthwith comply with those prov' 'ons- i tq _t J _ 1 f;_ s City Business License# Date; ! Applicant; �� i WARNING: FAILURE TO SlibURE 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, AYES 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 IVNO 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 Lender's Address L9'�0 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 DYES 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, 2/N0 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 Stale 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 S 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 ❑ 1, as owner of the property, or my employees with wages as their sole HAZAADOUS MATERIAL AEPORffING. compensation, will do ( )all of or( ) porting of the work, and the structure is PROPER YY�ER OR ORIZ 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). APPLICATION& SAFETY PERMIT/PLAN CHECK Menifee DATE PERMIT/PLAN CHECK NUMBER TYPE: C COMMERCIAL A RESIDENTIAL ca MULTI-FAMILY C> MOBILE HOME '% POOL/SPA C3.SIGN SUBTYPE: -"> ADDITION 0 ALTERATION ) DEMOLITION 0 ELECTRICAL O MECHANICAL NEW " PLUMBING ORE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK a t Sal l U 6 I y Ot Menifee PROJECT ADDRESS �j }� & Safety Dept. ASSESSOR'S PARCEL NUMBER '� L{— CS" LOT TRACT qp OWNER NAME -2 eceive ADDRESS �� � A y' a PHONE EMAIL APPLICANTNAME �ho)J v 66 vcG_ ADDRESS PHONE / ,j / 6�j/(7 EMAIL on a j CONTRACTOR'S NAMEII-- t n OWNER BUILDER? O YESXO BUSINESS NAME �"fri GT �OGo� -- C f vi ADDRESS G/t, PHONE 95 1 31 L(— 6Ile EMAIL �/d lfG� � � � � (yl CONTRACTOR'S STATE LIC NUMBER �' �22 13 O' LICENSE CLASSIFICATION VALUATION $ 3 6 SO,FT LSO FT 11 APPLICANT'S SIGNATURE 1 - DATE CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE PAID AMOUNT AMOUNT .)CASH "CHECKN OCREDITCARD VISA/MC PLAN CHECK FEES PAID AMOUNT ",CASH G CHECK N %CREDIT CARD VISA/MC OWNER BUILDER VERIFIED ':'YES " NO DLNUMBER NOTARIZED LETTER C' YES Q., NO City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-5213 City of Menifee Building & Safety Dept. Gl w APR 15 2015 Received U LU U LEDGER & TRACK NSPECTION REQUIRED O 1 Z O r[c',q e � �w � ,�} Sal ► � � ! al AM40ad -Flo GviefZ plrri() Posf Tv 1-c-,icy e Jp Fe- � 7 FU DING AND SAFETY DEPARTMENT`" L,kok �r9 PL. N APPROVAL EWWED BY sa DATE fppr�al9these r[ans shall not be construed to be a permit for,or an d%roval c§Wy violation of any provisions of the federal,state or city regul 'ions a`adi ordinances. This set of approved plans must be kept on the jobsit until completion.