PMT16-00894 City of Menifee Permit No.: PMT16-00894
29714 HAUN RD. Type: Residential Addition
'ACCELA? MENIFEE, CA 92586
MENIFEE Date Issued:
03/28/2016
PERMIT
Site Address: 29855 CALLE SAN MARTINE, MENIFEE, Parcel Number: 340-083-005
CA 92584 Construction Cost: $2,420.00
Existing use: 1 &2 Family Residence Proposed use:
Description of INSTALL 162 SO FT SOLID ALUMAWOOD PATIO COVER W/ELECTRICAL 1 FAN
Work:
Owner Contractor
ANTOVAN YOUKHANA BUILT RIGHT PATIOS
29855 CALLE SAN MARTINE 3410 LA SIERRA AVE#F456
MENIFEE,CA 92584 RIVERSIDE, CA 92503
Applicant Phone: 9514427025
KEES DE GROOT License Number.996516
BUILT RIGHT PATIOS
3410 LA SIERRA AVE#F456
RIVERSIDE, CA92503
Fee Description Qtv Amount($)
Receptacle, Switch, Outlet&Fixture 1 116.00
Building Permit Issuance 1 27.00
DeddPatio, 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 5.80
$290.45
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
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractors)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contractor's State License Law for
Professions Code an/d�m/y lyicense is in full force and effect the following reason:
License Class q"tpO'J I License No. By my signature below I acknowledge that,except for my personal residence
Expires q-'bO- 1tL Signature h/ in which l must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
❑I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section
have and will maintain a certificate of consent of self-insure for workers 7044 of the Business and Professions Code,is available upon request when
compensation,issued by the Director of Industrial Relations as provided for this application is submitted or at the following website:
by Section 3700 of the Labor Code,for the performance of work for which www.leeinfo.ca.eov/calaw.html.
this permit is issued.
Policy#
Date
*1 have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which ❑By my signature below I certify to each of the following:I am the property
this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this
number are: 2 application and the information I have provided is correct I agree to comply
Carrier 5 f r C f nu A with ail applicable city and county ordinances and state laws relating to
� f building construction.I authorize representatives of this city or county to
Policy# q f N�5r669 Expires. Y') ✓r/� enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for once-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
❑I certify that in the performance of the work for which this permit is issued,
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shall forth wit omply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date 3 a S 16 mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide.
WARNING: AIL ETO SECURE WORKER'S COMPENSATION COVERAGE 15 Oyes 00
UNLAWFUL,AND S14ALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air quality Management District(SCAOMD)7 See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guide Ines
CONSTRUCTION LENDING AGENCY O Yes
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) ❑Yes 'PP4Jo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
California Health&Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)Indicated below by the
hazardous mate reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 d
Business and Professions Code).Any city or county that requires a permit to
D No Date i (_1_I 6
S
construct,alter,Improve,demolish or repair any structure,prior to its pROPF' TW NER OR A THORIZED AGENT
issuance,also requires the applicant for the permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRPI
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)or that he or she is exempt from licensure receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with
an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
Dl,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.eoa.eovAead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code,The Contractors State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Finn is required for this project because:
❑I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLANAPPLICATION
u+ 1nFSJi
1 K, i:,
&�",Menifee
DATE PERMIT/PLAN CHECK NUMBERW�IYJ<
TYPE: O COMMERCIAL X ESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
>(NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORKIQ 5� SoldAbAwMet
e
PROJECTADDRESS g.J� C.C{, JG{PI L�,f fJl^^vp v` O
ASSESSOR'S PARCEL NUMBER 3LIO -109S -EX:?S` LOT '� TRACT
OWNER NAME m vo,0 � {I Cl j
ADDRESS ,J CU 11 f S( V' k ►'IL I4\� (F � D
ll
PHONE SIR- ? 5 1/4� EMAIL N
APPLICANT NAME 6 60� /
ADDRESS -j qlZZ4
�J/Q 6 b I' r f vj?
rj
PHONE �tjj _ � /' Va � EMAIL
CONTRACTOR'S NAME M9,444 ht�o S OWNER BUILDER? O YES )�O
BUSINESS NAME 416
I /� S (x
ADDRESS :/ 4i(,/�f 1 t
PHONE -/ r i - 4�I pI ' �/a. 7//J EMAIL N
CONTRACTOR'S STATE LIICC NUMBER -/`Z b LICENSE CLASSIFICATION
VALUATION$ q a ✓ SO FT L SO FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION , CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN ( SMIP
INVOICE �i�
AMOUNT O. 1 PAIDAMOUNT OCASH '✓'CHECK# 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
519,clas-8 5-76 b1c gg65(6
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S I TE PLAN
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SITE ADDRES I//e S ofnackbi eo V`'t/I�Q
ASSESSORS PARCEL NUMBER .'iiy of Menitee
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Provide North Arrow REAR PROPERTY-L I NE .
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these plans shall not be construed to be a permit for,or a•eau JV3i ur,any violation of any provisions of the federal,stakekoft PROPERTY L 1 NE
regulations and ordinances. This set of approved plans must be kept on the
jobsite until completion.
284-199 (Rev. 06/2009)