PMT16-00927 City of Menifee Permit No.: PMT16-00927
29714 HAUN RD. Type: Residential Addition
'C;kCCEO MENIFEE,CA 92586
MENIFEE Date Issued:
0312912016
PERMIT
Site Address: 26780 ELK CREEK CT, MENIFEE,CA Parcel Number: 338-343-025
925B6 Construction Cost: $4,200.00
Existing Use: 1 &2 Family Residence Proposed use:
Description of INSTALL 14'x 35'SOLID ALUMAWOOD PATIO COVER WITH 2 FANS, 3 RECESSED LIGHTS,2 POST
Work: LIGHTS, 1 GFI OUTLET
Owner Contractor
JEFFERY ACOSTA CEBALLOS AWNINGS
26780 ELK CREEK COURT 3420 FENSMUIR STREET
MENIFEE,CA 92586 RIVERSIDE,CA 92503
Applicant Phone:7143219411
JEFFERY ACOSTA License Number:949791
26780 ELK CREEK COURT
MENIFEE,CA 92586
Phone:9512467368
Fee Description DQt Amount($i
Receptacle, Switch, Oullet&Fixture 8 151.00
Building Permit Issuance 1 27.00
Deck/Patio, non-standard 1 133.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 1.DO
General Plan Maintenance Fee-Building 1 6.65
$319.65
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 tamed 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_Pennit_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 contractor(s)pursuant to the Contractors State License law).
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from Iicensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class License No. By my signature below I acknowledge that,except for my personal residence
Expires Signature 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.le info.ca. ov calaw.h
this permit is issued. 9-
Policy# Date
❑I have and will maintain workers compensation insurance,as required by PROPER O NER BRED 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 s;issued.My workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
Carrier with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# Expires enter the above Identified pertyi r inspection purposes 9
(This section need not to be completed Is the permit is for one-hundred Date Z/ r&
dollars($100)or less PROPfRWOMERDRAUTHORIZED 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,1 shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date mixture containing a hazardous material equal to or greaterthat the
amounts specified on the Hazardous Materials Information Guide?.
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes O No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE 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(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY ❑Yes ❑No
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 o No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMID
permitting checklist.I understand my requirements under the state of
I hereby affirm under penalty of perjury that I am exempt from the California Health&Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)Indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Oyes ❑No
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED 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(RRP)
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 Iicensure 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 orthrough their
o I,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.epa.eov/lead 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 Firm is required for this project because:
X 1,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/PLAN CHECK •
,Menifee
DATE 7- PERMIT/PLAN CHECK NUMBER
TYPE: []COMMERCIAL RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOUTION []ELECTRICAL [-]MECHANICAL
❑NEW [-]PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK PA7_ --� C� kF_F2 /Y k 3 Z r_Al s
3 P-€C6sSE0 L.iG),73 F Z ?*g- LiLFiiS / 9U7'_Z- `7—
PROJECTADDRESS [o7 8C> e LK C.P-c C K C i tti1 Fn,S'FEE 0,4 g 2S810
ASSESSOR'S PARCEL NUMBER 5M-,'LA'2>-CD3S LOT TRACT
PROPERTY OWNER'S NAME -,fE,GreE'y .4Co57-4
ADDRESS Z(o76o 0c.I.0 CZE6K C__ Fr'iFl` C-4 %7-s-&,_
PHONE ftL/- ZelG. 7gG,g EMAIL E/L1✓J. E- Aeosrzo C'
APPLICANT NAME .J EGG2EY deo57-)A
ADDRESS ZG780 ELL- CIZEE K C--r- n g�,Ep GA- 9 Z Sb
PHONE St1llE EMAIL
CONTRACTOR'S NAME ,91481LTCa J 4,*,6 q(.,E 49R7te 9 l2ocn OWNER BUILDER? YES❑NO
BUSINESSNAME ef1zJZ:AV 011K25A1_R O 11 R2a 5 �ff LF.nv�EG
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE U qy/C NUMBER / qY�' LICENSE CLASSIFICATION
VALUATION$ //Zo0 SQFT ��9d LSQFT
APPLICANT'S SIGNATURE DATE
DEPARTMENF DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT 5 —CASH O CHECKR O CREDIT CARD WWMC
PLAN CHECK FEES PAID AMOUNT OCASH OCHECK# OCREDFFCARD VISAIMC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Naun Rd. Menifee, CA 92585 951-672-6777
www.citvofinenifee.us Inspection Request Line 951-246-6213
O,.
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LEDGER & TRACK V
INSPECTION REQUIRED W
City of Menifee
Building & Safety Dept. U.
MAR 2 9 2016 L ` U.
O
Received
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CITY OF MENIFEE
BUILDING AND SAFETY DEPARTMENT
PLAN APPROVAL
REVIEWED BY II
Dd TE
*Approval of these plans shall not be construed to be a permit for,or a
approval of,any violation of any provisions of the federal,state or city
regulations and ordinances. This set of approved plans must be kept on the
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