PMT15-02173 City of Menifee Permit No.: PMT15-02173
�^''' 29714 HAUN RD. Type: Residential Addition
`�`^lCl.,A1' MENIFEE, CA 92586
s sn sm�.�M MENIFEE Date Issued: 0 712 9/2 0 1 5
PERMIT
Site Address: 29111 BLACK MEADOW CT, MENIFEE, Parcel Number: 333-421-010
CA 92585 Construction Cost: $3,700.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 360 SO FT SOLID ALUMAWOOD PATIO COVER W/ELECTRICAL 2 FANS 1 OUTLET
Work:
Owner Contractor
RYAN WEISBROUD PATIO GUY ALUMAWOOD CONTRACTOR
29111 BLACK MEADOW CT 41197 GOLDEN GATE CIR STE 108
MENIFEE, CA 92585 MURRIETA, CA92562
Applicant Phone: 9513330056
LOIS MONTINI License Number: 872839
PATIO GUY ALUMAWOOD CONTRACTOR
41197 GOLDEN GATE CIR STE 108
MURRIETA, CA 92562
Fee Description Otz Amount
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
I
$288.00
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 an effect�7 Code:The Contractor's License Law does not apply to an owner of a property
License Class__6 License N 7a O % 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'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-building if it has not been constructed In its entirety by licensed
Policy# 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'//www.1eQInfo.ca.gov/caIaw.htmI.
permit is issued.My workers'compensation insurance carrier and policy number are:
Property Owner or Authorized Agent Date
Carrier
L!!- 1fv
Expires Policy# r �� it
❑ 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 relatra to building
constructiory hauthorize representatives of this city or county to enter the ab,..
❑ I certify that in the performance of the work for which this permit is issued,I identified p o le y for the inspection}purposes.
shall not employ any persons in any manner so as to become subject to the /C
workers' compensation laws of California, and agree that if I should become �y�(',,.� _ _ /`� 9 6
subject to the workers'compensation provisions�o/f-Section 3700 of the Labor Property Owner or Au horized Agent -^� Date
Code, shall forthwith comply with those pro 'sioy�sj ®� 1 W
7 0� ! [C,��7M z.7 City Business License# �'�"
Date; .� 7 Applicant 0'-
WARNING: FAILURE TO SECURE WORKS S' 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 HANDLEA HAZARDOUS MATERIAL ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES ICI -- 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) APPLICA T-OR FUTURE BUILDING OCCUPANT REQUIRE
Lender's Name ❑YS WIT FOR THE CONSTRUCTION OR MODIFICATION
ROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address EINC 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 []YE
S WI Lr7HE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable item(s)(Section 7031.5. Business and Professions Code: / WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A
Any city or county that requires a permit to construct, alter, improve, demolish, il 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 IN
..ORMATION 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 ❑ C UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) HAOZDAdD0U3TM RIA�REPORTING D 25534 CONCERNING
El 1, as owner of the property, or my employees with wages as their sole t
compensation, will do ( )all of or( ) porting of the work, and the structure is PROPS Y 4� ER,O UTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale. If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
& SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE 7- 13D - 15 PERMIT/PLAN CHECK NUMBER
TYPE: 0 COMMERCIAL &-<§IDENTIAL :; MULTI-FAMILY C MOBILE HOME <> POOL/SPA C%SIGN
SUBTYPE: '%ADDITION 0 ALTERATION `.i DEMOLITION 7 ELECTRICAL 0 MECHANICAL
0•krW 0 PLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
UT
PROJECTADDRESS C101111 LAW- - q
ASSESSOR'S PARCEL NUMBER 333 —y-ate-oi 0 LOT rj(p - TRACT J, 1 15-0)
OWNER NAME
ADDRESS %Cl [—
PHONE ID 19 - 51 I- (fig D k EMAIL
APPLICANT NAME
ADDRESS C.
PHONE 9s1—„��y � EMAIL
CONTRACTOR'S NAME j�� r • � S OWNERBUILDER? C%YE51r.N6
BUSINESS NAME (fir L)
ADDRESS q1l QI„� = e „ E
PHONE 9s/- 3 33- U' DS (e0 EMAIL L
CONTRACTOR'S STATE LIC NUMBER '39 AG'3 9 LICENSE CLASSIFICATION m
VALUATION$ SQ FT 3 to D L SQ FT
APPLICANT'S SIGNATURE DATE 7-,OTY STAFF USE 94KL�
DEPARTMENT DISTRIBUTION I .l1 CITY OFpyE;IF I NS�p S ENUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP UU ffJJ��`� 6(
INVOICE w PAID AMOUNT
AMOUNT O CASH •`.:CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT CASH :%'CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED EYES C% NO DLNUMBER NOTARIZED LETTER C% YES G' NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.Lis Inspection Request Line 951-246-6213
LEDGER & TR K
/ S Q 1b INSPECTION RE0 IRED 1
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Nunne City of Menifee
Building & Safety Dept.
GMT 8 "bl AbDQ'� G11L 2 9 2115 .
'Received
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1avow
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BUI DING AND SAFETY DEPARTMENT I
PLA Y APPROVAL �
REWM6 By_,
DATE
'Apprc al of these plans sha construed to be a permit for,or an
apPra Vf,anyviolationofar. isionsof the federal,state orcity
jobsite until co ��
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