PMT15-01665 City of Menifee Permit No.: PMT15-01665
29714 HAUN RD.
";4CCFi..1�L MENIFEE, CA 92586 Type: Residential Addition
MENIFEE Date Issued: 06/17/2015
PERMIT
Site Address: 26263 DESERT ROSE LN, MENIFEE, CA Parcel Number: 335-520-064
92586 Construction Cost: $8,500.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 368 SO FT SOLID AND LATTICE ALUMAWOOD PATIO COVER WITH 1 FAN, 2 POST
Work: LIGHT, 2 GFI OUTLETS
Owner Contractor
MAURICE MCKEIRNAY HIGHER QUALITY CONSTRUCTION
26263 DESERT ROSE LANE 32833 SAN JOSE COURT
MENIFEE, CA 92586 TEMECULA, CA 92592
Applicant Phone: 9516347776
KEVIN GIGUERE License Number: 929362
HIGHER QUALITY CONSTRUCTION
32833 SAN JOSE COURT
TEMECULA, CA 92592
Fee Description 31 Amount
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
$299.00
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 Code and 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 License No. who builds or improves thereon, and who contracts for the projects with a
Expires Signature licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'( OMPENSATION DECL RATION
❑ 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
permit is iss(u�ed. improvements covered by this permit, I cannot legally sell a structure that I have
Policy# 6 f5 7 !/`'I c�'� 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 submit d or at the following Web site:httw//www.IeoInfo.ca. /1 aw.h I,
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier Pro rty wne or-Authorized Agent D,te
Expires + � � Policy#
By my Signature below, I certify to each of the following: I am the property
Name of Agent Phone# wner 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 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'fied property 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 !^'7
subject to the workers'compensation provisions of Section 3700 of the Labor property Owr r or Authorized Agent D e
Code, I shall forthwith comply with those provisions.
�r Date; Applicant;
City Business License#
� �J
WARNING: FAILURE TO StCURE 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 ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES jij�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 FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
O
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 AYES 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, 'WNO 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 AYES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from Iicensure 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 %CPO UNDER THE STATE OF CAL FORN IA HEALTH AND SAFETY
a civil penalty of not more than ($500).) CODE, SECTION 25505 25533, AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole
HAZARDOUS MATERIAL REPORTING.
compensation, will do( )all of or( ) porting of the work, and the structure is PROP RTY OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale. If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
REF Menifee
DATE �� I5� PERMIT/PLAN CHECK NUMBER
TYPE: 0 COMMERCIAL ><RESIDENTIAL C MULTI-FAMILY <: MOBILE HOME O POOL/SPA CI SIGN
SUBTYPE: O ADDITION Q ALTERATION C DEMOLITION ELECTRICAL :; MECHANICAL
O NEW r' PLUMBING 0 RE-ROOF-NUMBER OF SQUARES--co—M90 Cove
DESCRIPTION OF WORK 0 0 . ' l C c; C D JI+�L BXdgi 8 ifee
AD �� /N� �A7P- Dr- kf-o S
PROJECTADDRESS �a>roI 7 DI SEA-T J-20SE' AJ
ASSESSOR'S PARCEL NUMBER '-/ ,r-('ULt LOT TRACTReceived
OWNER NAME s� L 'vI,CPK-cI f�.ri C!l� (� �+/
ADDRESS /abab3 -D&SL* POSE � MU.7JIfGC 9d-sff,E
PHONE `7S/l 3170 - (9&YO EMAIL
APPLICANT NAME v)A (,- &LJ. - z r
ADDRESS L�'I'DO 6 y DJ4-,°/hnl i 17/L t4 1447-)L 7-19
PHONE / Sl ' _/ro v " EMAIL
CONTRACTOR'S NAME J-ASo %3 sm,H OWNER BUILDER? :;;YES R NO
I
BUSINESS NAME � ,6>+€7L Q�hit-1711l�onlS?R�L7"io,..a
ADDRESS [9433 SA-" Osc GF TCWC"&Yt M . �'iasC7
PHONE 123y-�I�J7(� EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
�j
VALUATION$ SO FT b O L SQ FT
APPLICANT'S SIGNATURE DATE
ndwffiz-� now
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE ^AA _ PAID AMOUNT
AMOUNT QI"�_1 C% CASH `E=CHECK It 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT ;) CASH %CHECK# ?.S CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED YES O NO DL NUMBER NOTARIZED LETTER 0, YES i% 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