PMT15-03556 City of Menifee Permit No.: PMT15-03556
29714 HAUN RD.
�CCEL/_> MENIFEE, CA 92586 Type: Residential Addition
MENIFEE Date Issued: 1111212015
PERMIT
Site Address: 25426 GANT DR, MENIFEE, CA 92584 Parcel Number: 358-022-024
Construction Cost: $3,000.00
Existing Use: 1 &2 Family Residence Proposed use:
Description of ALUMAWOOD SOLID PATIO COVER 25'X14'
Work: 1-FAN,2-LIGHTS
Owner Contractor
CATHY ZIEMIENSKI SOLID ROCK LANDSCAPE CONSTRUCTION
25426 GANT DR 32760 SHEILA LANE
MENIFEE,CA 92584 WILDOMAR, CA 92595
Applicant Phone: 9517575743
SOLID ROCK LANDSCAPE CONSTRUCTION License Number.753301
32760 SHEILA LANE
WILDOMAR,CA 92595
Fee Description gyt Amount 151
Receptacle, Switch,Outlet&Fixture 3 126.00
Building Permit Issuance 1 27.00
DedUPatio, non-standard 1 133.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 1.00
General Plan Maintenance Fee-Building 1 6.65
General Plan Maintenance Fee-Electrical 1 6.30
$300.95
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.
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City Of Menifee
LICENSED DECLARATION ❑ lam exempt from licensure under the Contractors'State License Law forth
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 y my signature below I acknowledge that, except for my personal residence 1
Professions Code and my license is in full fort nd effect. which I must have resided for at least one year prior to completion c
License Class tr'—Q-7 Licar Improvements covered by this permit, I cannot legally sell a structure that I hav
Expires a.D I Signature built as an owner-building if it has not been constructed in its entirety by license
contractors. I understand that a copy of the applicable law, Section 7044 of th
WORKERS'COMPENSATION DECLA14ATION Business and Professions Code,Is available upon request when this application I
submitted or at the following Web site:
❑ 1 hereby affirm under penalty of perjury one of the following declarations: htto:LA ww.leainfo ca.cov/calaw.html.
1 have and will maintain a certificate of consent of self4nsure 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 my Signature below, I certify to each of the following: I am the propert
❑ 1 have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owners behalf. I have read thi
section 3700 of the Labor Code, for the performance of the work for which this lion and the information I have provided is correct. I agree to comp)
permit is issued.My workers'compensation insurance carder and policy number are: with al ppllcabie city and county ordinances and state laws relating to buildin
censtru 'on.1 uthorize repres laces of this city or county to enter the above
Carrier identified rop'it foJ the i ecdon purposes.
Policy# Expires Date
Pr ' e Own Authorized Agent
(This section need not be completed if the permit is for n
City Business License
one-hundred dollars($100)or less)
certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not emolDv 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 r11111
hwlth comply with those provisions. DYES;O'110
AppIi nt; Date; /t '12 f I S 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: F ILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklisl
COMPENSAT OVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES P"
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 Y""
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) hazardp4T ma rial reporting.
OWNER BUILDER DECLARATIONS ❑Y
1 hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the reason(s)indicated below by the checkmark(s)I have placed PR P TY OWNER 0 THORIZED AGENT
next to the applicable Rem(s)(Section 7031.5. Business and Professions Code:
Any city or county that requires a permit to construct, alter, improve, demolish, EPA RENOVATION. EPAIR AND PAINTING(RRP)
or repair any structure, prior to its issuance, also requires the applicant for the
permit to rile 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 firths 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 vm Certification No.:
purpose of sale).
❑ 1, as owner of the property an exclusively contracting with licensed o 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.
1 ./
SAFETY PERMIT/PLAN APPLICATION
'wMenifee
DATE f/ / PERMIT/PLAN CHECK NUMBER •
I
TYPE: --COMMERCIAL 4ESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK u„yq. L`
PROJECTADDRESS aS Q.fa
ASSESSOR'S PARCEL NUMBER 3jr0• ^L�Zz -bz' LOT 'Z— TRACT 3�3
OWNER NAME Z
ADDRESS pry■ ,
PHONE (9SI) LLyy- A0,2S EMAIL ?
APPLICANT NAME
ADDRESS allo a l..o
PHONE 1 '75 '�— $'j ,3 EMAIL C-a
CONTRACTOR'S NAME OWNER BUILDER? OYES 0
BUSINESS NAME $ C
ADDRESS .-A,�bo J (, Z-rj . �Llja
PHONE (9s1 757 -57413 EMAIL /at
T
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION .St
VALUATION$ L SO FT 11� -2 c
APPLICANT'S SIGNATURE I J. DATE s-
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT OCASH OCHECKN CREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O 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
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