PMT15-01192 City of Menifee Permit No.: PMT15-01192
29714 HAUN RD,
MENIFEE, CA 92586 Type: Residential Addition
MENIFEE Date Issued: 05/07/2015
S
PERMIT
Site Address: 30259 MOON STAR CIR, MENIFEE, CA Parcel Number: 360-640-042 i
92584 Construction Cost: $1,900.00
Existing use: 1 &2 Family Residence Proposed use:
Description of INSTALL 324 SO FT SOLID ALUMAWOOD PATIO COVER WITH ELECTRICAL 4 POST LIGHTS, 1
Work: FAN
Owner Contractor
KAREN ROBINSON THE GRAND CANYON PATIO'S
30259 MOON STAR CIR P O BOX 71190
MENIFEE, CA 92584 RIVERSIDE, CA 92503
Applicant Phone: 9515790369
IVONEE COLORADO License Number: 991633
THE GRAND CANYON PATIO'S
P0 BOX 71190
RIVERSIDE, CA 92503
Fee Description Qtv Amount
Building Permit Issuance 1 27.00
GREEN FEE - 1 1.00
$298.00
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 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 C�05 License No. (lv who builds or improves thereon, and who contracts for the projects with a
Expires 3-3k-I G Signatures 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 by this permit, I cannot legally sell a structure that I have
permit is issued.
built as an owner-bulldin if it has not been constructed in its entirety by licensed
Policy# contractors. I under., nd hat a copy of the applicable law, Section 7044 of the
❑ I have and will maintain workers' compensation insurance, as required by Business and Profession Code,is available upon request when this application is
section 3700 of the Labor Code, for the performance of the work for which this submi d or at th o to i Web site:htt ://www.le info.ca. ov/cal W.ht I
permit is issued.My workers'compensation insurance carrier and policy number are: 4
Carrier Property ner uthorized 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 cjt a county ordinances and state laws relating to building
_ .I aytlionze presentatives of this city or county to enter the above-
constructionRl certify that in the performance of the work for which this permit is issued iden fled property f -t spection purposes.
shall not employ any persons in any manner so as to become subject tqqi ` ��a
workers' compensation laws of California, and agree that if I should bgUs W % (/-�"
subject to the workers'compensation provisions of Section 3700 of the lebo Property Owner or Authorized Agent Dat
Code, I shall forthwith comply with those provisions.
City Business License#
Date; 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, [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 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
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address ❑NO 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 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, ❑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(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 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 I)EPORtING.
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).
APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK
Menifee
DATE _ PERMIT/PLAN CHECK NUMBER PM lti p(
TYPE: 0 COMMERCIAL ' RESIDENTIAL ; MULTI-FAMILY 0 MOBILE HOME POOL/SPA %SIGN
SUBTYPE: %ADDITION 0 ALTERATION <%DEMOLITION �? ELECTRICAL :> MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK a�uy-" A wood pov7uD C_0\4 2Y
PROJECTADDRESS �,S Q-n S :c &4 2
O
ASSESSOR'S PARCEL NUMBER SOW - t04o-� LOT L � TRACT aQ?Ro-1
OWNER NAME (k-rL,V ) b1,1130,)q Cop,
ADDRESS 3 Q 2E 9 (/ t ` S� ZkD^ C I r �'l Qy-L j -e-2 Co /.2 S
PHONE (15/) 20 7 '7 ,�j 31 EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME q/O'11*kI fl- Old 0)-^d_0 OWNER BUILDER? O YES 8 NO
BUSINESS NAME. YAI-id C. CL+j 03
ADDRESS 2 1`:Q-'Y'Y`o� ICY 1'�I..2-'V S 2-
PHONE ( 9, / 233gb2:�e EMAIL 1 �"Y � � k'IAI' � C-O 'vC
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION Q
VALUATION $ 1900 SO FT 3 Z L SQ FF/T��
APPLICANT'S SIGNATURE DATE
OTYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION GO O.� CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I SMIP
INVOICE PAID AMOUNT
AMOUNT �rG. IV CASH %CHECK# vCREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT CSCASH :.%CHECK# C%CREDITCARD VISA/MC
OWNER BUILDER VERIFIED ("YES O NO DL NUMBER NOTARIZED LETTER YES 0 NO
City of Menifee Building &Safety Department 29714 Houn Rd. Menifee, CA 92546 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-5213
LEDGER & TRACK
INSPECTION REQUIRED
/0 ❑ 0 City of Menlfee ❑ ��
Building & Safety Dept.
MAY 0 7 2015
Received
()
TL esl o iV L�
- 3� ZS�`'1 ltilab�S�ar C��
CITY OF NMI �
BUILDING ARID SXATY DEPARTMENT ' S �
PLAN APPROVAL
REVIEWED
DATE
'Approval of these plans 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 1
jobsite until completion.
rz:vim Wr�.r/
CGV�2
a