PMT15-01324 i
City of Menifee Permit No.: PMT15-01324
29714 HAUN RD. Type: Residential Addition
CCCCt~i..�' MENIFEE, CA 92586
MENIFEE Date Issued: 05/18/2015
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PERMIT
Site Address: 26065 SIERRA SKY ST, MENIFEE, CA Parcel Number: 360-530-007
92584 Construction Cost: $3,900.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 375 SO FT SOLID ALUMAWOOD PATIO COVER WITH ELECTRICAL 2 FANS, 2 LIGHTS
Work:
Owner Contractor
DAN SISSON PATIO GUY ALUMAWOOD CONTRACTOR
26065 SIERRA SKY ST 41197 GOLDEN GATE CIR STE 108
MENIFEE, CA 92584 MURRIETA, CA 92562
Applicant Phone: 9513330056
LOIS MONTINI License Number: 872839
PATIO GUY ALUMAWOOD CONTRACTOR
41197 GOLDEN GATE CIR STE 108
MURRIETA, CA 92562
Fee Description QQtr Amount
Building Permit Issuance 1 27.00
Dec l�q�` d ta'h��r � �ty� > w,� � > , :•, u� a- ,.. ,.33"t)0
GREEN FEE 1 1.00
S'.•4I�,-.`F2,�S�; E�TIAL � .mac `t. 4 � ,' a £��. aairs'.re:�: awc'
$293.00
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 license is in full force and ef(ecj, Code:The Contractor's License Law does not apply to an owner of a property
License Class��i License N js J who builds or improves thereon, and who contracts for the projects with a
Expires(p 32)l.raignature licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ I am exempt from licensure under the Contractors'Stale 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.
Policy# built as an owner-building if it has not been constructed in its entirety by licensed
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:http'/Iwww lepinfo ca pov/calaw html.
permit is issued.My workers'compensation��i�nns��//rra\ance carver and policy number are:
Carrier �,) &,/ A4 I //,^, // Property Owner or Authorized Agent Date
Expires '! Policy# 142)u)C�/� )/7
❑ 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
with
one-hundred dollars($100)or less) all applicable city and county ordinances and state laws relating to building
conslructi 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 iden ife party for th insp tion 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 C3
subject to the workers'compensation provisions of S ct n 3700 of the Labor property Owner or Authorized Agent Date
Code,I shall forthwith comply with those provisi S. O A —7`4 !
City Business License# /� "�
Date; Applicant;
_ /A"��*
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 ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE TURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES D+41 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 _.PERMIT FOR THE CONSTRUCTION OR MODIFICATION
Lender's Address ❑ O/FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
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: B HIN 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 EjYES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from licensure and the basis for the alleged exemption. Any _CH-ECKLIST. I UNDERSTAND MY REQUIREMENTS
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to BAe— UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE, SECTION 5505 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MA IAL ffEPOR1�ING.
compensation,will do( )all of or( )porting of the work, and the structure is PROPE OR AUT RIZED
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).
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
AMenifee
DATE - ^J -/S PERMIT/PLAN CHECK NUMBER p ls- 13
TYPE: O COMMERCIAL *<E'SIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME C5 POOLI SPA U SIGN
SUBTYPE: 0 ADDITION 0 ALTERATION 0 DEMOLITION 0 ELECTRICAL O MECHANICAL
Wlq'EW O PLUMBING '.'. RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK L D
J
PROJECTADDRESS 4 . /rEWIP49I�
3Q ASSESSOR'S PARCEL NUMBER -S 2
30 ^001 LOT J(Q TRACT
OWNER NAME S ISS
ADDRESS EN/FEE
PHONE Z lb • 1• $aD 9 EMAIL
APPLICANT NAME
ADDRESS C
PHONE I — � L4-17 16-!5 EMAIL
CONTRACTOR'S NAME OWNER BUILDER? 0 YES *-116
BUSINESS NAME ADDRESS II b �34745
C Aj4ejffljE7WCo4
PHONE i �/_ �3 •DD5,(� EMAIL 9a
CONTRACTOR'S STATE LIIC�NUMBER 9101 R 3D LICENSE CLASSIFICATION
VALUATION$ �/D 03 SO FT a 7 5 L SO FT
APPLICANT'S SIGNATURE DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION w� CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I SMIP
INVOICE n PAID AMOUNT
AMOUNT Q( ::CASH OCHECK# 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT <<CASH f%CHECK# O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED C%YES NO DLNUMBER NOTARIZED LETTER <) YES i% NO
City of Menifee Building &Safety Department29714 Haun Rd. Menifee, CA 92586951-672-6777
www.cityofinenifee.us Inspection Request Line 951-245-6213
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INSPECTION REQUIRE
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CITY OF MENIFEE
BUILDING AND SAFETY DEPARTMENT
PLAN APPROVAL
5 REVIEWED B ! �S
L DAT
L A�pp ov§of these plansshall not be constru
approval of,any violation of any provisions of ihe federal,state or city V
L11q s7DN 9 regulations and ordinances. This set of apprc ed plans must be kept on t
jobsite until completion. J
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