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PMT15-01092 I I City of Menifee Permit No.: PMTIS-01092 MENIFEE, EE, C 92 Type: Residential Addition MENIFEE, CA 92586 MENIFEE Date Issued: 04/28/2015 PERMIT Site Address: 30283 MOON STAR CIR, MENIFEE, CA Parcel Number: 360-640-039 92584 Construction Cost: $3,900.00 Existing Use: 1 &2 Family Residence Proposed Use: Description of INSTALL 401 SQ FT SOLID ALUMAWOOD PATIO COVER WITH 1 FAN Work: Owner Contractor DEBBIE SIDEBOTHAM SO CAL PATIO COVERS 30283 MOON STAR CIR 36206 PURSH DRIVE MENIFEE, CA 92584 LAKE ELSINORE, CA 92532 Applicant Phone: 9518050263 JEFF JAIME License Number: 848033 SO CAL PATIO COVERS 36206 PURSH DRIVE LAKE ELSINORE, CA 92532 Fee Description Qtv Amount zReceptatle, Switch OufletSGplxture � ;s i�, """"1�" �� x Building Permit Issuance 1 27.00 wvtahaw.m,r SnM u2a5:SW 1...idd'me€I`uFrw..ax.Ya.3R1.1.rN.u.��...�'..u.me�dda:3Ca LYm'S. n4wes GREEN FEE 1 1.00 $278.00 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 Code and onlicense is in full force and effect. Code:The Contractor's License Law does not apply to an owner of a property License Class \Op3 DUI Licensq No Bg6033 who builds or improves thereon, and who contracts for the projects with a Expires Lo \b 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: 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 ❑ 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 Cade, for the performance of the work for which this submitted or at the following Web site:htti)�//www.leginfo.ca.aov/calaw.htmi. permit is issued.My workers'compensation insurance carrier and policy number are: Carrier Property caner or Authorized 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 autho� a 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 iden�iied property fo he inspection purposes. shall not employ any persons in any manner so as to become subject to the 1 workers' compensation laws of California, and agree that if I should become 1_ W 2 \J— subject to the workers'compensation provisions of Section 3700 of the Labor �P pert Owner or Authorized Agent Date Code, I shall forthwith comply with those provisions. City Business License# 114 ,->✓77%L 5. Date; (IN .� 157 Applicant; )C-t.'t= �W- 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, 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 ) NO 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 ❑YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION FROM THE SOUTH COAST AIR QUALITY MANAGEMENT Lender's Address \0 DISTRICT(SCAQMD) SEE PERMITTING CHECKLIST FOR X� 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 DYES 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, '_Gk�'Q 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 14ES 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 ($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING ❑ 1, as owner of the property, or my employees with wages as their sole HAZA OUS MATERIAL f�EPOR�ING. compensation, will do ( )all of or ( ) porting of the work, and the structure is PROP TY OWNE O AUTHORIZED AGENT not intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's State License Law does not apply to an owner of a property X who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale. If,however, the building or improvement is sold within one year of completion, the Owner- Builder will have the burden of proving that 1t was not built or improved for the purpose of sale). SAFETY •ERM IT/PLAN CHECK APPLICATION 11';ti Menifee DATE Y'� ERMI /PLAN CHECK NUMBER TYPE: 0 COMMERCIAL : RESIDENTIAL Ci MULTI-FAMILY I' MOBILE HOME ': POOL/SPA )SIGN SUBTYPE: V, ADDITION Q ALTERATION f) DEMOLITION 0 ELECTRICAL O MECHANICAL O NEW'' \\ 11 O PLU11IMBING () RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK V IQ Db PROJECTADDRESSSoDZ3 MOON LS CI, R- .n ASSESSOR'S PARCEL NUMBER 3(��_(o�IO— (U3�1 LOT 5 `p 'RAND _ � `` 1111 Building & a ety ept. OWNER NAME '- l� `-\ H ADDRESS 3 cU SrtAIZ �(Z APR 2 8 2015 PHONE qS, l '2_�) :2 EMAIL Rp APPLICANT NAME C e. ADDRESS V,7 \'U {�S' ) ��• 1.-.A�.c ICI k 'c l�`� �2� �. PHONE �J �Qrj\\ - ��`7� EMAIL S (�'�.}'cT U Q1^S C1� -1/�'IJ�( L-' /J/r•1 CONTRACTOR'S NAME _J a OWNER BUILDER? D YES 4, 0 BUSINESS NAME S o C " \ CJ v e f ADDRESS b20(o DOLS� 9r U),t= r \tV� 1- Z PHONE Q`Sj EMAIL CONTRACTOR'S STATE LIC NUMBER g y 2) O 3 3rr ,, LICENSE CLASSIFICATION Cb\ 6() VALUATION$ Qj' SO FT LA O, L SQ FT APPLICANT'S SIGNATURE DATE Zu CITYSTAFF USE ONLY DEPA TMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BZNG PLANNING ENGINEERING FIRE GREEN / SMIP -e.SS INVOICE 11 PAIDAMOUNT Q AMOUNT � ,�,/ 0CASH C%CHECK# C.%CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT 0 Z�IC ;;) CASH "CHECK# C='CREDITCARD VISA/MC _4e,�S . L . OWNER BUILDER VERIFIED OYES C3 NO DLNUMBER NOTARIZED LETTER 0 YES `-) NO City of Menifee Building& Safety Department 29714 Haun Rd. Menifee, CA 92585 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 30283 MOorl .S}�1'r C � So Cal Pafio Cow "One call and you're couerecr I G 951-805-0262 socalpatiocoversinc*gmett.com .s;tk,MWOW- saTes/d} ign{.instanabaft I repairs C.TG '848933` Re�,t2 PRc9P�V �Nt .. 22 l 13 12 -3' � � t ro spa g Cove 2q3 sQ�+ toe Fi S D S IOF MENI BE U LDING AN[ gFETY FL N APPROV WED BY i flrlqt City of S tety DOPt. 'Appro Iofthese plans se const approva f�anwiolation rovisions a ZQ15 regulati d ordinances, is set of appi APR jobsite ut til completion. ,eCeived VAWATWtA3SM.-60 uTLEDGER & TRACK SQ q(OI INSPECTION REQUIRE®