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PMT15-01086 City of Menifee Permit No.: PMT16-01086 29714 HAUN RD. Type: Residential Addition A MENIFEE, CA 92586 cw solm�a MENIFEE Date Issued: 0 412 812 01 5 PERMIT Site Address: 28220 WINDSOR DR, MENIFEE, CA Parcel Number: 337-174-007 92586 Construction Cost: $3,200.00 Existing Use: 1 &.2 Family Residence Proposed Use: Description of INSTALL 12X12 FREESTANDING LATTICE PATIO COVER Work: Owner Contractor HECKTOR HERNANDEZ MADE IN THE SHADE PATIO COVERS INC 28220 WINDSOR DRIVE 25075 GELDING COURT MENIFEE, CA 92586 WILDOMAR, CA 92595 Applicant Phone: 9516757998 TOD KLEHR License Number: 734463 MADE IN THE SHADE PATIO COVERS INC 25075 GELDING COURT WILDOMAR, CA 92595 Fee Description Oty, Amount($1 ButldlnP:eyml�lssuance 1 27'O6" Deck/Patio, non-standard 1 133.00 j::�>00 w" .W. 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 Bidg_Permit_Template.rpt Page 1 of 1 City Of Menifee LICENSED DECLARATION I hereby affirm under penalty or perjury that 1 am licensed under provisions of ❑ I, as owner of the property an exclusively contracting with licensed Chapter 9(commencing with section 70 0)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professions Professions Code and my license i� �I f r a ff ct. Code:The Contractor's License Law does not apply to an owner of a property License Class _ License who builds or improves thereon, and who contracts for the projects with a Expires�D 3� j Signatur �^ licensed contractors)pursuant to the Contractors State License Law). WORKERS'COMPENSATION DECLARATION ❑ I am exempt from licensors 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. 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 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:htto�tiwww.teginfo.ca.00v/calaw.html. permit is issued.My workers'compensation insurance carrier and policy number are: Carrier roperty Owner or Aut orized Agent Date 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($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,1 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 should become subject to the workers'compensation provisions gf Section 3700 of the Labor Property Owner or Authorized Agent Date Code, she l forth�ith comply with those provi,Ci2sf. / ^ City Business License# Date; Applical _ WARNI G: 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 OR A DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL LABOR CODE, INTEREST,AND ATTORNEYS FEES N,9NO EQUAL TO OR GREATER THAN THE AMOUNTS CONSTRUCTION LENDINGAGENCY / 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 FROM THE SOUTH COAST AIR QUALITY MANAGEMENT Lender's Address --FANO 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 reasons)indicated below by the checkmark(s)I have placed AYES 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, _-h1O 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 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($500).) CODE, SECTIO r 25505 25533 AND 25534 CONCERNING ❑ 1, as owner of the property, or my employees with wages as their sole HAZARDOUS M ERIAL IEPORTING. compensation, will do ( )all of or( ) porting of the work, and the structure is PROPERTY N ORAU ORIZEDAGENT not intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's State License Law does not apply to an owner of a property X who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale. If,however, the building or improvement is sold within one year of completion, the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). I i =2ardmakilwo GINA 11:11 W-101 I Lei /I'len'fee Op I DATE a PERMIT/PLAN CHECK NUMBER i TYPE: :%CO MEERCICIAL % RESIDENTIAL O MULTI-FAMILY C) MOBILE HOME POOL/SPA C SIGN SUBTYPE: -ADDITION C?ALTERATION O DEMOLITION ) ELECTRICAL ".'7 MECHANICAL U NEW C) PLUMBING 0 RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK JGt ) PROJECTADDRESS ASSESSOR'S PARCEL NUMBER ( -7 LI _ ne)"7 LOT 7 TRACT 3 "Z'j OWNER NAME ` 9��` �.. ti fc :,^ Ciry Of Menifee 7-�C� w( ti_� tvz ul .u lg a e y ep . ADDRESS �J PHONE 45(-r�C)(- 153 H'�j EMAIL APR O15 APPLICANT NNA/MrE-�,-7 1LU�k/2 Ran— ADDRESS PHONE �� 21 Z'''�2j��Cr-"CJ EMAIL CONTRACTOR'S NAME L/ t-+--"�-�1/t'�- OWNER BUILDER? C YES : O BUSINESS NAME ADDRESS ` ��j vj I PHONE ��I2��7 7(oQ " / EMAIL CONTRACTO STATE LIC NUMBE 7 �(0� LICENSE CLAS11FICATION VALUATION$ Z b S T L SQ,,..//FT APPLICANT'S SIGNAT lfU r DATE `T I CITY STAFF USE ONLY DE�PAAHI M))EN I DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER B49I ; G PLANNING ENGINEERING FIRE I GREEN �� SMIP � o $-z( 6- INVOICE ///�� PAID AMOUNT "f AMOUNT LLl ( 0CASH `.3CHECK# 0CREDIT CARD VIS MC PLAN CHECK FEES PAID AMOUNT `...CASH <iCHECK# CiCREDITCARD VISA/MC OWNER BUILDER VERIFIED D YES O NO DL NUMBER NOTARIZED LETTER (", YES 0 NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 ffC�Kral ,�$�2e wJw�se2 'D2 M�t�C4 City of Menifee Building & Safety Dept. l�vt�tUSoy2� --- �t Received CITY OF A ENIFEE BUILDINC AND SAFETY PLAN API ROYAL REVIEWE BY "Approval of tht se plans shall not be cot approval of,any iolation of any provisio regulations and rdinances, This set of a jobsite until co letion. ty r3 f PL I/