PMT15-02179 City of Menifee Permit No.: PMT15-02179
29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Addition
MENIFEE Date Issued: 07/29/2015 I'
PERMIT
Site Address: 25562 PELION RD, MENIFEE, CA 92584 Parcel Number: 339-284-027
Construction Cost: $6,900.00
Existing Use: 1 &2 Family Residence Proposed Use: '..
Description of INSTALL 2 SOLID ALUMAWOOD PATIO COVERS 14'X 16' EACH W/ELECTRICAL 1 FAN, 2 OUTLETS
Work:
Owner Contractor
GERALD SMITH AMERICAN HOME REMODELING INC
25562 PELION RD 4375 PRADO RD SUITE 108
MENIFEE, CA 92584 . CORONA, CA 92880
Applicant Phone: 9515200654
DAN STINSON License Number: 807029
AMERICAN HOME REMODELING INC
4375 PRADO RD SUITE 108
CORONA, CA 92880
Fee Description Qtv Amount f$1
Rece acle, wi c e ° ti 2 '
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
$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,mt 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 Co nd 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. c who builds or improves thereon, and who contracts for the projects with a
Expires3-3/—/4, 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
airs 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 Ieginfo ca gov/calaw html.
permit is issued.My workers'
compensation insurance carrier and policy number are:
Carrier� y '�+�l�7 yl' o_ k roperty Owneror ut orized Agent Date
Expires Policy#CAST 45_00 6!92,
❑ By my Signature below, I certify to each of the f�nnwing: I am the property
Name of Agent Phone# owner or authorized to act on the property owner's behalf. I have
(This section need not be completed if the permit is for application and the information I have provided is correct. I an— ,omply
one-hundred dollars($100)or less) with all applicable city and county ordinances and state laws relating to building
construction. I uthorize r presentatives 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 identified pr for it ins fiction purposes.
shall not employ any persons in any manner so as to become subject to the
workers'compensation laws of California, and agree at if I should become
subject to the workers'compensation provisions of ion 3700 f the Labor Props Owner or Authorized Agent Date
Code, I shall forthwith comply with those provision . y� (,.�-
City Business License# y� 1 97
Date; �"�4'6� 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, QyES 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 g0v0 EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS
INFORMATION GUIDE?
I hereby affirm that under the penalty of perjury there is a construction lending
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
yam' FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address 10 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: y BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A
Any city or county that requires a permit to construct, alter, improve, demolish. 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 (Chapter9 (commencing with 1 HAVE READ THE HAZARDOUS MATERIAL
Section 7000)of Division 3 of the Business and Professions.Code)or that he or ❑YES 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 UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE
SECDOUS MATERIAL 505f�E5533,AND 25534 CONCERNING
El 1, as owner of the property, or my employees with wages as their sole
compensation,will do( )all of or( )porting of the work, and the structure is PROPER W ER O UTRORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X/ / / ,(
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
I
I
C Ity& SAFETY PERMIT/PLAN CHECK APPLICATION
Of Menifeee .,Menifee
ning & Safety Dept.
DATE jUL 2 9 2015 PERMIT/PLAN CHECK NUMBER V ` q
TYPE: C) CO��+M+ MERCI L ,<RESIDENTIAL O MULTI-FAMILY C) MOBILE HOME O POOL/SPA C) SIGN
U PE: l:)ADDITION C)ALTERATION O DEMOLITION G ELECTRICAL C MECHANICAL
O NEW " PLUMBING C) RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK //
!PC /7cz� /? C' Je/ ! 6 i!1�P I I5
PROJECTADDRESS ./L�rS .9_
ASSESSOR'S PARCEL NUMBER '33jj&V02;4-q LOT TRACT
OWNER NAME ey' yyj, p
ADDRESS
PHONE ��� (p`�'�—�'� EMAIL
APPLICANT NAME1
ADDRESS e o�
PHONE lyC _ EMAIL
CONTRACTOR'S NAME fir/ e o�,e�s WNER BUILDER? 0YES,>60
BUSINESS NAME GCfJ(It'gS T:�Oil
ADDRESS 075 �cial'n
PHONE lyS� Z7^['��,j� EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION I
VALUATION$ SQ L SQ FT
APPLICANT'S SIGNATURE DATE
CITYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION OV CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I SMIP
INVOICE 'u�7/�� PAIDAMOUNT
AMOUNT �"v 'J CASH C)CHECK# "CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT l) CASH 0 CHECK# 'CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES C) NO DL NUMBER NOTARIZED LETTER 0 YES 0 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