PMT15-03141 r
City of Menifee Permit No.: PMT15-03141
29714 HAUN RD.
4ACCEL-% MENIFEE,CA 9258E Type: Residential Addition
c°'"""`"W l MENIFEE Date Issued: 1 0/0 812 01 5
PERMIT
Site Address: 28745 HEATHER GREEN WAY, Parcel Number: 372-231-036
MENIFEE,CA 92584 Construction Cost: $4,950.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 37'x 15.5'SOLID&LATTICE ALUMAWOOD PATIO COVER WITH 1 FAN
Work:
Owner Contractor
SCOTTHAMEN PSLQINC
28745 HEATHER GREEN WAY 28910 RANCHO CALIFORNIA RD
MENIFEE, CA 92584 #206
Applicant Phone:9517954260
LUIS BENTIVENGO License Number.919885
PSLQ INC
28910 RANCHO CALIFORNIA RD
#206
TEMECULA,CA 92590
Fee Description Qtv Amount IEl
— _..._ - - - - -- - __ - - _ - __--
Receptacle, Switch, Outlet&Fixture 1 116.00:
Building Permit Issuance 1 27.00
,Deck/Paflo, non-standard 1 133.00.
pGREEN FEE 1 1.00
iJMLP RES�pE.TIAL _ 1 1.00
General Plan Maintenance Fee-Building 1 6.65
$284.65
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 carded 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 am exempt from Iicensure under the Contractors'State License Law for
I hereby affirm under penalty or perjury that I am licensed under provisions of following reason:
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
Professions Code anZ license is in full force and a which I must have resided for at least one year prior to completion
License Class Lice e s S improvements covered by this permit. I cannot legally sell a structure that I h:
Expires 7- t Signature built as an owner-building if it has not been constructed in its entirety by[[can:
contractors. I understand that a copy of the applicable law, Section 7044 of
WORKERS'COMPENSATION DECLARATVN Business and Professions Code,is available upon request when this applicatioi
submitted or at the following Web site:
❑ 1 hereby affirm under penalty of perjury one of the following declarations: htto:!/www.leainfo.p.aov/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
ZPoli d
# By my Signature below, I certify to each of the following: I am the propr
have and will maintain workers compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read
section 3700 of the Labor Code, for the performance of the work for which this application and the information I have provided is correct. I agree to cotr
permit is issued.My workers'compensation Insurance carrier and policy number are: with all applicable city and county ordinances and state laws relating to builc
((��e- construction.I authoriz re enlatives of this city or county to enter the abc
Carder ,1 i.A.cr identified property for e i 'on purposes. _
Policy# ` W Expires - — i U Date
Property Owner or Authorized Agent
(This section need not be completed if the permit is for City Business License#
one-hundred dollars($100)or less)
�1 certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not enrol ov any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material o
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 specified on the Hazardous Materials Information Guide?
Code,I shall forthwi comply with those provisions. ❑YES j2fNO
ApplicanC1_
Date; ti'� ` �� - t ) Will the intended 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(SCAOMD)?See permitting check)
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES IND
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 ou
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of a school?
LABOR CODE,INTEREST,AND ATTORNEYS FEES DYES i(NO
CONSTRUCTION LENDING AGENCY I have read 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) hazardous material repo 'A .
OWNER BUILDER DECLARATIONS YES ❑NO
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
Date
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OWNER OR AUT RED AGENT
next to the applicable hem(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 contractor
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 firths and comply with
she is exempt from licensors 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:
❑ I, as owner of the property, www.epa.gov/lead or contact the National Lead Information Center at
p perty, 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 proje:
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).
❑ 1, as owner of the property an exclusively contracting with licensed ❑No EPA Lead-Safe Certified Finn 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.
e
DATE I Q PERMIT/PLAN CHECK NUMBER - o-3 Lek
TYPE: ❑COMMERCIAL ❑RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA it StZmenife
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑MECHANICALg a Y ept.
❑NEW ❑PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK SO �• r IN P.r
Yl t4h n _ ecesve
PROJECTADDRESS ` l
ASSESSOR'S PARCEL NUMBER 'Jj - 22�- LOT TRACT
PROPERTY OWNER'S NAME e
ADDRESS
PHONE (� EMAIL
APPLICANT NAME i 1 t
ADDRESS $q11�O no (�`,T l �Ag25
PHONE qV 1- 4 3� EMAIL L ,S fC'.-2Y1 YWX.
CONTRACTOR'S NAME OWNERBUILDER? DYESIONO
BUSINESS NAME ^
ADDRESS F/ ' I I 1p, 1& CA Q
PHONE Gs-� D �d) / EMAIL
CONTRACTOR'S STATE LIC NUMBER gl LICENSE CLASSIFICATION
VALUATION $ H q 50 'o,,�, SQ FT 5fo 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
AMOUNTU0
PAID AMOUNT •�� CASH O CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 4CHECK# 0CREDITCARD VISA/Mc
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Hour;Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
Scott Hamen
Plot plan 28745 Heather Green Way
Not to Scale Menifee, Ca. 92584
951-237-9975 _�
540 sq ft. Solid 1 Lattice Combo Alumawood Patio Covers Attached to
the house and to the concrete slab. Set at 9' high
Installing (1) fan
2
city o enifee
Building & Safety DeAL
L RACK OCT 0 8 2015 0
SPECTION REQUIRED IF ceived
1 '
3T
12' I 0 0 0 23'
155
Driveway CITY OF MENIFEE
BUILDING AND SAFFTY DIPARTMENT
PLAN APPROVAL
Sidewalk
DATE
Heather Green Way *Approval of these plans shall not be construed to be a permit for,or an
approval of,any violation of any provisions of the federal,g2te 9F city
regulations and ordinances. This set of approved plans must be kept on the
jobsite until completion.