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PMT15-01587 I I City of Menifee Permit No.: PMT15-01687 29714 HAUN RD. 4� MENIFEE, CA 92586 Type: Residential Addition s smM,�e MENIFEE Date Issued: 0 6/1112 01 5 i PERMIT Site Address: 27862 LAKES LANDING DR, MENIFEE, Parcel Number: 333-361-019 CA 92585 Construction Cost: $4,500.00 Existing Use: 1 &2 Family Residence Proposed Use: , Description of INSTALL 13'x 28' SOLID ALUMAWOOD PATIO COVER WITH 2 FANS Work: Owner Contractor JEFFERY KENNEDY OMEGA BUILDERS 27862 LAKES LANDING DRIVE 29980 MOONDANCE WAY MENIFEE, CA 92585 MENIFEE, CA 92586 Applicant Phone: 7142635575 SHANE TULLOS License Number: 963275 OMEGA BUILDERS 29980 MOONDANCE WAY MENIFEE, CA 92586 Fee Description City Amount Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 1 E $283.00 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 building 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 Cod an n y license Is in full f rce and effe5 Code:The Contractor's License Law does not apply to an owner of a property License CI ss F`'rd =License who builds or improves thereon, and who contracts for the projects with a Expires r—_ Signature_�) �"�'- 1� licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATION DECLARATION am exempt from licensure under the Cotractors'State License Law for the El hereby affirm under penalty of perjury one of the following declarations: ( wing reason: ,/'�f QM 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, cannot legally sell a structure that Ihave - permit is issued. built as an owner-building if It has not been constructed in Its entirety by licensed Policy# contractor un erstand that a copy of the applicable law, Section 7044 of the ❑ 1 have and will maintain workers' compensation insurance, as required by Business n ofessions 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 the Poll tag-Web site:http://www.leginfo.c ov calaw m permit Is issued.My workers'compensation insurance carrier and policy number are: Carrier r ert wner orA oozed 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 cons truc .I authorize representatives of this city or county to enter the above- >eI certify that In the performance of the work for which this permit is issued, I identif`J' any 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 I should become subject to the workers`compensation provisions of Section 3700 of the Labor Pro rty Owner or Authorized Agent Date Code,1 shall forthwith comply with those provi ns. _ Date; (' (1y' d hc Applicant; City Business License# 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, ❑YES OCCUPANT HANDLE A HAZARDOUS MATERIAL ORA 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 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 reason(s)indicated below by the checkmark(s)I have placed AYESWILL 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, 0 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 yff-sr 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 HAZAR O S MATERIAL t';EPORYING. compensation, will do ( ) all of or( ) porting of the work, and the structure is PROP RT WNER OR AUTHOR ED-AGENT not intended or offered for sale.(Section 7044,Business and Professions Code; ✓.,(''ti�"`" 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, a 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 Et't Menifee DATE PERMIT/PLAN CHECK NUMBER TYPE: COMMERCIAL ESIDENTIAL 0 MULTI-FAMILY '0 MOBILE HOME C} POOL/SPA C,SIGN SUBTYPE: 'ADDITION o ALTERATION 0 DEMOLITION 0 ELECTRICAL 0 MECHANICADity Of Menif,to > NEW "' PLUMBING 0 RE-ROOF-NUMBER OF SQUARES Building & Safety Dept. DESCRIPTION OF WORK (/ a- JUN 1 1 2115 d PROJECTADDRESS (, ( 2,_ LA ASSESSOR'S PARCEL NUMBER �:/'3- 3te I - CjCt LOT TRACT OWNER NAME ADDRESS t�2 $-7(p Z to- Von' &, a �,,,J PHONE ICp O - gI LI '�j 3 I EMAIL APPLICANT NAME V ADDRESS '2 $O 87 (,j cA I f�eQ 1 Z '-7 �j PHONE I (4- 2 `j c- -5J -n- EMAIL Z`'LQ GZ S' '� Q \O . Cp" CONTRACTOR'S NAME OWNER BUILDER? 0 YES ""' NO BUSINESS NAME E (LQ 7 ADDRESS C— `3 1" cl Ili �Q/Q� / PHONE '7(tl1 2(63-rs-7r— EMAIL U\A mC.(S", r o) CONTRACTOR'S STATE LIC NUMBER q(0 3 )L7 I d pp LICENSE CLASSIFICATION .3 VALUATION $ SOFT 36 y L SQ FT APPLICANT'S SIGNATURE DATE CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE ^� PAID AMOUNT /� AMOUNT �J '3 CASH }CHECK 6CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT ;CASH <}CHECK# 0 CREDIT CARD VISA/MC OWNER BUILDER VERIFIED ("YES NO DL NUMBER NOTARIZED LETTER YES '=} 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 x d CL LEUQER & TRACK U WSPECTAQN REQUIRED u V. �1 City of t e Building & Safeafety Dept. I� w JUN 1 1 2015 Received lip _ N � o W CITY OF MENIFEE C� BUILDING AND SAF DEPARTM NT dN b� PLAN APPROVALGN REVIEWED BY 111 &ATE *Approval of these plans shall not be construed to be a permit for,or an > 'Ilk approval of,any violation of any provisions of the federal,state or city C' regulations and ordinances. This set of approved plans must be kept on the jobsite until completion.