PMT15-03142 City of Menifee Permit No.: PMT15-03142
29714 HAUN RD. Type: Residential Addition
/9-\CCEL/t�i. MENIFEE, CA 92586
cam.FSMt..,.e MENIFEE Date Issued: 1 010 812 01 5
PERMIT
Site Address: 28420 SUNGLOW RUN LN, MENIFEE, CA Parcel Number: 372-512-032
92584 Construction Cost: $5,225.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 14'x 37'SOLID ALUMAWOOD PATIO COVER WITH 2 FANS, 3 LIGHTS
Work:
Owner Contractor
ROLAND HOUSEHOLDER PSLQ INC
28420 SUNGLOW RUN LANE 28910 RANCHO CALIFORNIA RD
MENIFEE,CA 92584 #206
Applicant Phone: 9517954260
LUIS BENTIVENGO License Number.919885
PSLQ INC
28910 RANCHO CALIFORNIA RD
#206
TEMECULA, CA 92590
Fee Description -qti Amount($
Receptacle,Switch,OuUet&&Fixture 5 _T 136.00)
Building Permit Issuance 1 2Z00
Deck/Patio, non-standard -_ _ _ ____ _ 1 133.00
GREEN FEE 1 1.00
— — —— ------ - --
tSMIPRESIDENTIAL _ 1 _ 1.00--
�
General Plan Maintenance Fee-Building 1 6.65
$304.65
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 carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise staled,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_Pe"it_Templatexpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ lam exempt from licensure under the Contractors'State License Law for the
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 in
Professions Code an license is in full force and a which I must have resided for at least one year prior to completion of
License Class� Lice S improvements covered by this permit,I cannot legally sell a structure that I have
Expires "7— I �., Signature e 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 DECIARA N Business and Professions Code,is.available upon request when this application is
submitted or at the following Web site:
w❑ I hereby ill under penalty of perjury one the following declarations: htto://www.leciinfo.ca.ciov/mlaw.html.
I have and will maintain a certificate of consentt 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
Polio # M 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 Lobar Code, for the perormance of the work for which this application and the information I have provided is correct. I agree to comply
permit is issued.My workers'compensafion insurance carder and policy number are: with all applicable city and county ordinances and state laws relating to building
����� construction.I authorize re entatives of this city or county to enter the above-
Carder .1 1 1 identified property for to i lion purposes.
Policy# 1 -i .J� Expires —7— 1 b Date
Property Owner or Authorized Agent
'�
(This section need not be completed if the permit is for City Business License# b.7�`-f��
one-hundred dollars($100)or less)
s ] certify that In the performanceperformanceof the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not employ 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 specified on the Hazardous Materials Information Guide?
Code,I shall forthwl comply with those provisions. DYES y�N0
Applican ; Date; t — o — t 1 WIII 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(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES EfNO
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 boundary of a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES 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 'm .
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 IZED 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(RRPI
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 Iicensure 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 roe www.epa.gov/lead or contact the National Lead Information Center at
, as owner of the property,rty, 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 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.
r,
t,ity Menitee
o II mg n��
OCT 0 8 2015
DATE (0 ' PERMIT/PLAN CHECK NUMBER gT'�
TYPE: ❑COMMERCIAL RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION [—]ELECTRICAL ❑MECHANICAL
❑NEW�x1❑PLUMBING ❑RE—RRO,O,,F-NU-1MBEROFSQUARES o�h I
DESCRIPTION OF WORK 5I v Sd E A 1 O 1 04`
& 2)ins "0
PROIECTADDRESS tine Men��e-
ASSESSOR'S PARCEL NUMBER 1-5;L LOT TRACT
PROPERTY OWNER'S NAME b
ADDRESSQ LA
U ' I51 _ n `ou,-) n En
PHONE \�1�-I�-�`�"�[� � 1 EMAIL
APPLICANT NAME "�I ,pyy7
ADDRESS ?) `[I ]() c) yI,S
PHONE 9 b 1- `/- I l EMAIL
CONTRACTOR'S NAME OWNER BUILDER? ❑YESNNO
BUSINESS NAME II o
ADDRESS UFI '
PHONE G8I-1 G & �00 /EMAIL
CONTRACTOR'S STATE LIC NUMBER 15 C// ( LICENSE CLASSIFICATION
VALUATION$ V I SQ FT I L SQ FT
APPLICANT'S SIGNATURE DATE )0
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CnY OF MENIFEE BUSINESS UCENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREENINVOICE
I SMIP
AMOUNT . US PAID AMOUNT 2
O CASH C CHECK# C CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDITCARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER C YE5 C NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92585 951-672-6777
www.cltyofinenifee.us Inspection Request Line 951-246-5213
Plot plan Roland Householder
Not to Scale 28420 Sunglow Run Ln.
Menifee, Ca. 92584 951-712-6469
518 sq. ft. Solid Alumawood Patio Covers. Attached to the house and concrete
slab.
(2) fans and (3) lights
Uj
airy of Menifee
Building $ Safety Dept..
INSPECTION REQUIRED OCT 0 8 2015 LL
Received
80'
1171
10, ❑ ❑ ❑ ❑ ❑ 4
74'
CITY OF MENIFEE
BUILDING P NRiWjyTY
PLAN APPROVAL
REVIEWED 1Y W, ko
DATE
Sidewalk 'Approval of t ese p ans shall not be construed .
approval of,any violation of any provisions of the federal,state or city
Sunglow Run Ln. regulations and ordinances. This set o approved plans mu
st Se Kept on
jobsite until completion.