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PMT15-03988 City of Menifee Permit No.: PMT15-03988 29714 HAUN RD. Type: Residential Addition �A_CCEL/_> MENIFEE,CA 92586 Gmm�tS,Mixe MENIFEE Date Issued: 12I28/2015 PERMIT Site Address: 28197 INSPIRATION LAKE DR, Parcel Number: 364-064-004 MENIFEE,CA 92584 Construction Cost: $3,000.00 Existing Use: 1 &2 Family Residence Proposed Use: Description of INSTALL 276 SO FT SOLID ALUMAWOOD PATIO COVER, NO ELECTRICAL Work: Owner Contractor STEVE&SALINA SIMMONS CALIFORNIA SHOWCASE CONSTRUCTION 28197 INSPIJRA16N LXKFDR'� 1507 MARLBOROUGH AVE MENIFEE, CA 925b4' RIVERSIDE, CA 92507 Applicant Phone:9516820208 ANGELA GOODMAN License Number.912352 CALIFORNIA SHOWCASE CONSTRUCTION 1507 MARLBOROUGH AVE RIVERSIDE,CA 92507 Fee Description g,yt Amount I$ 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 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 - ED DEC ARATION ❑ I am exempt from licensure under the Contractors'State License Law forth 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 I Professions Code and my license is in full force and effect. which I must have resided for at least one year prior to completion i License Class License No. Improvements covered by this permit, I cannot legally sell a structure that I hav Expires Signature built as an owner-building If it has not been constructed in its entirely by license contractors. I understand that a copy of the applicable law, Section 7044 of th WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application submitted or at the following Web site: ❑ I hereby affirm under penalty of perjury one of the following declarations: http-//www.leginfo.ca.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 Policy# ❑ By my Signature below, I certify to each of the following: I am the proper ❑ 1 have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owners behalf. I have read th 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 comp permit is issued.My workers'compensation insurance carrier and policy number are: with all applicable city and county ordinances and state laws relating to buildir q _ construction.I authorize representatives of this city or county to enter the above Carver(S��-C 17C Ca M -F+� -tea IL7 IIW I �� identified property for the Inspection purposes. Policy#-tV Z�.`i Z( Expires (O ' J 1 ' Date Property Owner or Authorized Agent (This section need not be completed If the permit is for City Business License# V-d✓�I one-hundred dollars($100)or less) HAZARDOUS MATERIAL DECLARATION y67 I car*that in the performance of the work for which this permit is issued,I shall not emol any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or. 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 forthwith comply with those provisions. DYES XNO Applica� Date; of '1 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: FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checkliE COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES m 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 outs DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of a school? LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES j!iNO 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 reporting. 1 OWNER BUILDER DECLARATIONS ES NO v Date (d-.d&- (5 I 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 PROP RTY 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 fines 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 Elproperty, I, as owner of the ro err , or m employees with wages as their sole www.epa.gov/lead or contact the National Lead Information Center at compensation,will do( )all of or( ) portin of the work, and the structure is 1-800-024-LEAD(5323). 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). ❑ 1, 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 BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION - Menifee DATE PERMIT/PLAN CHECK NUMBER �� TYPE: ❑COMMERCIAL RESIDENTIAL MULTI-FAMILY ❑MOBILEHOME POOL/SP7[ISIGN SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑MECHAN ❑NEW [I PLUMBING ❑RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK PROJECTADDRESS IV ASSESSOR'S PARCEL NUMBER LOT �� TRACT ' PROPERTY OWNER'S NAME h �� ADDRESS PHONE EMAIL APPLICANTNAME Rez- CZDO mcc(l e z ADDRESS PHONE 0� � S(o� '� —7 3 —7 EMAIL CONTRACTOR'S NAME OWNERBUILDER? ❑YES❑NO BUSINESS NAME ( e Shy ADDRESS p PHONE C p ��0,4 EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION (�(' .�6 SOFT ` LSQFT APPLICANT'S SIGNATURE lYl0--- DATE i l' .� DEPARTMENT DISTRIBUTION CITY OF MENIF US NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN ' SMIP l ��! INVOICE PAIDAMOUNT AMOUNT {(yo O CASH O CHECK# O CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT 0 CASH O CHECK.# O CREDIT CARD VISA/MC OWNER BUILDERVERIFIED O YES 0 NO DL NUMBER NOTARIZED LETTER 40 YES O NO City Of Wnifee Building& safety Department 29714 HDun Rd. Menifee,CA 92585951-572-5777 Wvv .citvOfinenifee.us Inspection Request Line 951-225-5213 � M t�- � � & TRACK ,P,FCTiON REQ iy " Building & Sa ty Dept. DEC 2 2015 '- J "ei ed so L- II � , 7jri • TY DEPARTMENT . j OVAL RF41AV -By AT Or __ ^ R i oa permit or,or AA.... t a ;a,, ,i,a viola ion of any provision' ofthe ie era;s a ael Y. -' regu!.vtions an ordinances. . - tom.Irept an the �� letion :. ,�