PMT15-02700 i
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1
City of Menifee Permit No.: PMT16-02700
1
29714 HAUN RD. Type: Residential Alteration
d9 CCEL.. c" MENIFEE, CA 92586
MENIFEE Date Issued: 0 8131/2 01 5
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i
PERMIT
Site Address: 29902 EVANS RD, MENIFEE, CA 92586 Parcel Number: 338-111-026
Construction Cost: $2,723.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of EXISTING DINING ROOM WINDOW TO BE CUT DOWN FOR INSTALLATION OF 5'X 6' PATIO
Work: SLIDING GLASS DOOR, REPLACING 1 LAUNDRY RM WINDOW W/RETRO FIT 2.5'X 4'
Owner Contractor
JOANNE MARES WIN-DOR INC
29902 EVANS RD 450 DELTA AVE
MENIFEE, CA 92586 BREA, CA92821
Applicant Phone: 7143851202
DAN STINSON License Number: 545553
WIN-DOR INC
450 DELTA AVE
BREA, CA 92821
Fee Description O_yt Amount
Inspections not specified 258 258.14
E x ._
SMIP RESIDENTIAL 1 1.00
$287.14
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifcations 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 ❑ lam exempt from licensure under the Contractors'State License Law for the
following reason:
I hereby affirm under penalty or perjury that I am licensed under provisions of
Chapter 9(commencing with section 7000)of Division 3 of the Business and By my signature below I acknowledge that, except for my personal residence in
Professions Co and my license is in full force and effect which I must have resided for at least one year prior to completion of
License Class License No. _ 5,5 improvements covered by this permit, I cannot legally sell a structure that I have
Expires 2'z 17 Signature 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
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application is
submitted or at the following Web site:
❑ 1 hereby affirm under penalty of perjury one of the following declarations: htti),//www.leginfo.ca.gov/calaw.html.
I have and will maintain a certificate of consent of self-insure for workers'
compensation,issued by the Director of Industrial Relations as provided for by Date
Section 3700 of the Labor Code, for the performance of work for which this
permit is issued. Property Owner or Authorized Agent
Policy# �1-7 391I f /-7 tYe�( ci`/ ❑ By my Signature below, I certify to each of the following: I am the property
❑ have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read this
section 3700 of the Labor Code, for the performance of the work for which this application and the information have provided is correct. I agree to comply
permit is iss d, ly worigrs'compensation insurance carrier and policy number are: with all app'cable city and county ordinances and state laws relating to building
J � L1 -terr construc' .I authori representatives of this city or county to enter the above-
Carrier ��t-(I L cy-I fG� _F-//7identifi ropert to e ns�ction purposes.
Policy# Expires Date 3/
Prop Owner or Authorized Agent
(This section need not be completed if the permit is for City Business License#
one-hundred dollars($100)or less)
HAZARDOUS MATERIAL DECLARATION
❑ 1 certify that in the performance of the work for which this permit is issued,I
shall not emolov any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or a
workers'compensation laws of California, and agree that if I should become mixture containing a hazardous material equal to or greater that the
subject to the workers'compensation provisions of Section 3700 of the Labor amounts s ecifed on the Hazardous Materials Information Guide?
Code,I shall fort ith co ply with those provisions. [I YES NO
Applican lf1( e; �/ // 5 intended
Will the nt"````ended use of the building by the applicant or future building
occupant require a permit for the construction or modification from South
WARNING: FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guideli as
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES NO
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundEd
f a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES ❑YESNO
CONSTRUCTION LENDING AGENCY I have the Hazardous Material Information Guide and the SCAQMD
I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist. I understand my requirements under the State of
agency for the performance of the work which this permit is issued (Section California Health&Safety Code,Section 25505 and 25534 concerning
3097 Civil Code) hazardou!INO
erial re or ring.
OWNER BUILDER DECLARATIONS 11
❑YE
I hereby affirm under penally of perjury that I am exempt from the Contractor's =
_YL%.L Date
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OWNER OR AUTHORIZED AGENT
next to the applicable item(s)(Section 7031.5. Business and Professions Code:
Any city or county that requires a permit to construct, alter, improve, demolish, EPA RENOVATION REPAIR AND PAINTING(RRP)
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 The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
provisions of the Contractor's State License Law(Chapter 9 (commencing with receiving compensation for most work that disturbs paint in a pre-1978
Section 7000)of Division 3 of the Business and Professions Code)or that he or residence or childcare facility to be RRP-certified firms and comply with
she is exempt from licensure and the basis for the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than($500).) employees.For more information about EPA's Renovation Program visit:
www.epa.gov/lead or contact the National Lead Information Center at
❑ I, as owner of the property, or my employees with wages as their sole 1-800-424-LEAD(5323).
compensation, will do ( )all of or( ) porting of the work, and the structure is
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 ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however, Certified Firm Name:
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 Firm Certification No.:
purpose of sale).
❑ I, as owner of the property an exclusively contracting with licensed El No EPA Lead-Safe Certified Firm is required for this project because:
contractors to construct the project(Section 7044, Business and Professions
Code:The Contractor's License Law does not apply to an owner of a property
who builds or improves thereon, and who contracts for the projects with a
licensed contractor(s)pursuant to the Contractors State License Law). If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
LICATION
BUILDING & SAFETY PERMIT/.PERMIT/PLAN CHECK A.j•
2'Y .i
Menifee
DATE p 3/ /S PERMIT/PLAN CHECK NUMBER
TYPE: ❑COMM ERCIALZRESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA []SIGN
SUBTYPE: [-]ADDITION ❑ALTERATION []DEMOLITION ❑ELECTRICAL ❑MECHANICAL
❑NEW [-]PLUMBING ❑RE-ROOF-NUMBER OF SQUARES _
D RIPTIO�v OF WORK �o (; - !t? /,r/r /� p t �/�(✓C 9
iS7r�
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER (1�� Qh�7 54 ( 1O TRACT I�1O(0' '
PROPERTY OWNER'S NAME
ADDRESS
PHONE IT,J�/ /��{�j` -�jL�,z EMAIL
APPLICANT NAME
ADDRESS
PHONE /1rj' ��2��Z�-�j EMAIL
CONTRACTOR'S NAME OWNER BUILDER? ❑Y 0
BUSINESS NAME
ADDRESS
PHONE 7/� �/�y EMAIL
CONTRACTOR'S STATE LIC NUMBER �J'7-� � LICENSE CLASSIFICATION
VALUATION$ o?-7,2-3` S FT L SQ FT
APPLICANT'S SIGNATURE l� DATE C3/
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OFMENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN 00 SMIP
CREDITCARD V
INVOICE (�^. I�f, PAIDAMOUNT
AMOUNT o I "� `--"CASH %CHECK# '% ISA/MC
PLAN CHECK FEES PAID AMOUNT % CASH '.%CHECK# %CREDITCARD VISA/MC
OWNER BUILDER VERIFIED "YES 0 NO DL NUMBER NOTARIZED LETTER YES ' NO
City of Menifee Building&Safety Department 2971.4 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
Customer Name: Jmmk 'MoorQ�
Phone: R5k- 0if)-SA12
Custom Window / Door Lay-Out Form or
House Lay-Out Form
city of Menifee
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CITY OF MENIF
BUILDING ANC
PAN APPROVI
Coo� REVIEWED
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Uvm" ) R4x'"/' `A provalof these plans sl
ap)roval of,any violation c
rej ulations and ordinances
jo ite until completion.
2`190'L EvffinS ireIf&-e ca 025-S(n —�
( OUTSIDE / STREET )
Please circle one
Note: Please be informed that all drawings are from outside of the home looking in. We, Win-Dor, Inc. will tF
manufacture the window(s)ldoor(s) according to the specifications as stated above. �6
Customer Signature:__ Date:
Salesperson Signature: _.._ ___._ Date:
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