PMT15-03773 City Of Menifee Permit No.: PMT15-03773
_ 29714 HAUN RD. Type: Residential Addition
It �CCIELA? MENIFEE, CA 92586
MENIFEE Date Issued: 12/08/2015
PERMIT
Site Address: 26956 HANFORD ST, MENIFEE, CA Parcel Number: 360-411-021
92584 Construction Cost: $6,260.00
Existing use: 1 &2 Family Residence Proposed use:
Description of REPLACE EXISTING 658 SO FT WOOD LATTICE COVER W/658 SO FT ALUMAWOOD LATTICE
Work: COVER
Owner Contractor
JERALD MEDVIN S A E BUILDERS
26956 HANFORD ST 28810 BROKEN ARROW CIRCLE
MENIFEE,CA 92584 MENIFEE,CA 92584
Applicant Phone: 9516585807
SCOTT EGBERT License Number.625328
S A E BUILDERS
28810 BROKEN ARROW CIRCLE
MENIFEE,CA 92584
Fee Description O_yt Amount 151
Building Permit Issuance 1 27.00
Deck/Patio, non-standard 1 133.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 1.00
General Plan Maintenance Fee-Building 1 6.65
$168.65
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 building 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_Pemiit_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ lam exempt from Iicensure 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 and m license is in full force and eff ct._ which I must have resided for at least one year prior to completion of
License Class License N improvements covered by this permit, I cannot legally sell a structure that I have
Expires .3 /7 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'COMPENSATI RATION Business and Professions Code,is available upon request when this application is
submitted or at the following Web site:
❑ I hereby affirm under penalty of perjury one the following declarations: hfto://www.leginfo.m.goy/cala%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
Pol
icy# ❑ By my Signature below, I certify to each of the following: I am the property
,u I 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 I have provided is correct. I agree to comply
permit is issued.Myworkem'compensation insurance carrier and policy number are: with all applicable city and county ordinances and state laws relating to building
construction.I authorize representatives of this city or county to enter the above-
Carrier 5rw,,� identified property for the inspection purposes.
Policy# Expires 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 emolov any persons in any manner so as to became 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 a cified on the Hazardous Materials Information Guide?
Code,I shall forthwi ly with those provisions. ❑YES A NO
Applicant; Date; �� Will the intended use of the building by the applicant or future building
occupant require a permit for the construction or modification from South
WAR FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist
6-0—MISENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND OYES ❑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 boundary of a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES ❑YES/El 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 R Safety Code,Section 25505 and 25534 concerning
3097 Civil Code) hazardous aterisl-rq orting.
OWNER BUILDER DECLARATIONS ❑YES 0
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date/�C_w
License Law for the reason(s)indicated below by the checkmark(s)I have placed PR P OWNER OR AUTHORIZED AGENT
next to the applicable item(s)(Section 7031.5.Business and Professions Code: EPA RENOVATION.REPAIR AND PAINTING(RRP)
.Any city or county that requires a permit to construct, alter, improve, demolish,
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
❑ 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-
Bulkier will have the burden of proving that it was not built or improved for the Finn Certification No.:
purpose of sale).
❑ I, 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 Stale License Law). If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
I• ' i 11
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE 12/08/2015 PERMIT/PLAN CHECK NUMBER
TYPE: ❑COMMERCIAL ❑✓ RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOUSPA ❑SIGN
SUBTYPE: ❑✓ ADDITION [—]ALTERATION [-]DEMOLITION ❑ELECTRICAL ❑MECHANICAL
❑NEW ❑PLUMBING [I RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Replace existing 658 SF wood lattice cover with 658 SF Alumawood lattice cover
PROJECTADDRESS 26956 Hanford Street,Menifee,CA 92584
ASSESSOR'S PARCEL NUMBER 360-411-021 LOT 21 TRACT T28303
OWNERNAME JeraldMedvin
ADDRESS 26956 Hanford Street,Menifee,CA 92584
PHONE (951)672-7608 EMAIL jerrylive365@yahoo.com
APPLICANT NAME Scott Egbert
ADDRESS 28810 Broken Arrow Circle, Menifee,CA 92584
PHONE (760)567-0709 EMAIL soott@saebuilders.com
CONTRACTOR'S NAME Scott Egbert dba SAE Builders OWNER BUILDER? ❑YES❑✓NO
BUSINESS NAME SAE Builders
ADDRESS 28810 Broken Arrow Circle,Menifee,CA 92584
PHONE (951)658-5807 EMAIL soott@saebuilders.com
CONTRACTOR'S STATE LIC NUMBER 625328 LICENSE CLASSIFICATION B
VALUATION$ $6,260.00 SQ FT 658 L SQ FT
APPLICANT'S SIGNATURE DATE 12/08/2015
DEPARTMENT DISTRIBUTION �{1 CITY OF MENIFEE BUUSSIINESS U NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN V- SMIP O-J53
INVOICE Lb(9 RAIDAMOUNT
AMOUNT { bb 0 CASH O CHECK# O CREDIT CARD VISAIMC
PLAN CHECK FEES PAID AMOUNT 0CASH 0CHECK# 0CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES C NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
Carl Putnam P.E.
3441 Ivyllnk Place
Lynchburg,VA 24503
Carl Putnam, P.E.
June 4, 2015
Heath Morgan
Amerimax Exterior Home Products
28921 US Hwy 74
Romoland, CA 92585
Dear Heath:
My California PE registration was renewed in June 2015 and is currently valid u til 2017. All
previous documentation (plans, letters, calculations,etc.)that I approved Conti ue to be
valid under the conditions specified in those documents.
If you require further information please contact me at(434) 384-2514 or at
car!outnam5comcastnet
Sincerely,
Carl Putnam, P.E. Eli�/N
PU7 4F1
60139
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City
of Menifee
& Safety Deft
Building
DEC 0 8 2015
Received
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