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PMT15-01094 City of Menifee Permit No.: PMT15-01094 _ 29714 HAUN RD, - 49ZC�1,,.�" MENIFEE, CA 92586 Type: Residential Addition MENIFEE Date Issued: 04/28/2015 - PERMIT Site Address: 29176 BOULDER CREST WAY, Parcel Number: 341-210-004 MENIFEE, CA 92584 Construction Cost: $3,000.00 Existing Use: 1 &2 Family Residence Proposed Use: Description of INSTALL 240 SQ FT SOLID ALUMAWOOD PATIO COVER WTIH 1 FAN AND 6 RECESSED LIGHTS Work: Owner Contractor MEGAN BUSCEMI PSLQ INC 29176 BOULDER CREST WAY 28910 RANCHO CALIFORNIA RD MENIFEE, CA 92584 #206 Applicant Phone: 9517954260 LUIS BENTIVENGO License Number: 919885 PSLQ INC DBA GREEN BEE SERVICE 28910 RANCHO CALIFORNIA RD #206 TEMECULA, CA 92590 Fee Description City Amount l$1 ppeC�P�tG,E L Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 $308.00 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 i 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 7,P44. Business and Professions Professions Code ad 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 Licensee No.y G who builds or improves thereon, and who contracts for the projects with a Expires -I- ik, 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 ❑ 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 h this permit, I cannot legally sell a structure that have permit is Issued. P Y P 9 Y Policy# built as an gwner-building if it has not been constructed In Its entirety by licensed contractors(Ipunderstand 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:htto:Uwww leginfo ca aovtcalaw html. permit Is issued.My workers'compensation Insurance carrier and policy number are: Carrier f I ks( r Property Owner or Authorized Agent Date Expires -7- 1 ff7� Policy#_ ) `{ (( 3"t �l El By my Signature below, I certify to each of the following: I am the property Name of Agent 2e;2JP-'> Phone# �0 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 cit county ordinances and state laws relating to building construction. I out rize repres. lalives o 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 proper for the I s ectio V oses. 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 „Z v subject to the workers'compensation provisions of Section 3700 of the Labor Property Owner or Authorized Code,I.shall forthwith comply with those provisions. P Y Agent Date Date; p City Business License# "f Z o - I i 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, ES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE p RE CONTAINING A HAZARDOUS MATERIAL LABOR CODE, INTEREST,AND ATTORNEYS FEES MIXTURE 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 �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 reasons)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, 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 (swE INFORMATION GUIDE AND THE SCAQMD PERMITTING she is exempt from licensors 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 REPORTING. compensation,will do ( ) all of or( ) porting of the work, and the structure is PROPERTY W ORAUTHORIZED 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 I of PERMIT/PLAN CHECK NUMBER - qL.( TYPE: []COMMERCIAL ❑RESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑MECHANICAL ❑NEW []PLUMBING A❑RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK U�' /'J�' S ()L4�dmm d- ak, C +s PROJECTADDRESS ( 6oLd&c cfe-5k LOjCA QOF53 t Menifee Iep ASSESSOR'S PARCEL NUMBER- o��LVH LOT TRACT gulldA P. 2 e OWNER NAME S 1 ((yyam� APR 2 $ ADDRESS I ��b ( Cf2.5� Re PHONE -]�/�-TO�- � EMAIL APPLICANTNAME ( tUZ..i / O //� ADDRESS 'Q .�G( / D iaml PHONE �iJl `7^fV EMAIL WIC CONTRACTOR'S NAME & OWNER BUILDER? ❑YES O BUSINESS NAME ADDRESS to D PHONE ZL 1 EMAIL CONTRACTOR'S STATE LIC NUMBER 89/q�5 LICENSE CLASSIFICATION IQ 40 VALUATION$ 3D� FT L SQ FT APPLICANT'S SIGNATURE DATE i CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE PAID AMOUNT AMOUNT O CASH ✓CHECK# O CREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT CASH -CHECK# -CREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES 0 NO DLNUMBER NOTARIZED LETTER O YES C1 NO City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 Megan Buscemi Plot plan 29176 Boulder crest Way Not to Scale Menifee, Ca. 92584 - 760-707-2226 240 total sq. ft. of Alumawood Solid Patio Cover Attached to the house an(LU to the concrete slab. (1) fan (6) recessed lights U L� LEDGER & TRACK City of Menifee INSPECTION REQUIRED Building & Safety Dem. APR 2 8 2015 Received 13'—► o 0 0 , 291 O 20' O O _A O 12' O O i CITY OF MENIFEE BUILDING AND SAFETY DEPARTMENT PLAN APPROVAL REVIEWED BY DATE *Approval of these Oins shall not be construed to be a permit for,or an approval of,any violation of any provisions of the federal,state or city regulations and ordinances. This set of approved plans must be kept on the jobsite until completion. Driveway Sidewalk Boulder Crest Way