PMT16-01190 City of Menifee Permit No.: PMT16-01190
29714 HAUN RD. Type: Residential Alteration
�/-►CCEL/47. MENIFEE,CA 92586
MENIFEE Date Issued: 0 4/1 912 01 6
PERMIT
Site Address: 28144 CANNON DR, MENIFEE, CA 92585 Parcel Number: 336-360-002
Construction Cost: $23,000.00
Existing Use: 1 &2 Family Residence Proposed use:
Description of INSTALL 12'x 24'PATIO ENCLOSURE WITH 13'x 26'ROOF AND 4 OUTLETS,3 PORCH LIGHTS,2
Work: FANS
Owner Contractor
THOMAS SINGLETON TRADER DAN'S INC
28144 CANNON DRIVE 840 S ROCHESTER AVE STE C
MENIFEE, CA 92585 ONTARIO, CA 91761
Applicant Phone:9093900555
DON DAUGHENBAUGH License Number: 517575
TRADER DAN'S INC DBA ROOMS N'COVERS
840 S ROCHESTER AVE STE C
ONTARIO, CA 91761
Fee Description Qtv Amount
Receptacle, Switch, Outlet&Fixture 9 156.00
Building Permit Issuance 1 27.00
Inspections not specified 258 258.14
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 3.00
General Plan Maintenance Fee-Building 1 12.91
$458.05
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 slated,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 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 Codagd my license is in full force and effect. y� the following reason:
License Qass 71J! UMCAe Na / By my signature below I acknowledge that,except for my personal residence
Expires 3o Signature in which l must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I an not legally sell a structure that I
have built as an owner-builder if it has not been constructed in its entirety by
O 1 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 worker's 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 ,Nlny.leeinfo.ca.eov/mlaw.ntml.
this permit is issued.
Poll Date
❑I have and will maintain worker's 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 worker's 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
s' .f with all applicable city and county ordinances and state laws relating to
Gamier building construction.I authorize representatives of this city or county to
Policy#L nA-50003n6y t Expires enter the above identified property for inspection purposes.
(This section need not to be completedis the permit is for one-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 fyGp 'th wkh those provisions. / Will the applicant or future building occupant handle hazardous material or a
Applicant \ Date ( mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAI RE TO SEC 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 forguldelines
CONSTRUCTION LENDING AGENCY ❑Yes uNo
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 SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
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,priorto 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 exemptfrom 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
❑I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program vise
compensation,will do( )all of or( )portion of the work,and the structure is www.eoa.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 Finn is required for this project bemuse:
❑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/PLAN r r •
Menifee
DATE 7 1 / /b PERMIT/PLAN CHECK NUMBER
TYPE: O COMMER✓CIAL "ESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: -ADDITION O ALTERATION -DEMOLITION ,e-rLEcTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES �'
DESCRIPTION OF WORK Z X f?C/0_f0I'P- W / �L� �/'00 , City of Menife
ept.
oa-H e4 S 3 arc�fl,' h�s' ���S
APR i PROJECTADDRESS 0 1�I y �!�✓1�1.8�'1 D/� F�rj 61
ASSESSOR'S PARCEL NUMBER 3 S- 3Lf0- �aM LOT
_ TRACT poi , �v d
OWNER NAME Q1/I�6✓1'1/�) 11� 7 h /' '/��' 6 �; zJrS J�
ADDRESS 2/Jp �7 t� t q"Pk07 4
PHONE ✓ /-d ��-3 3O/ EMAIL
APPLICANT NAME A.) �7" 4t4q
ADDRESS f?5'tCVa-V-
PHONE �"EMOOAIL
CONTRACTOR'S NAME �OD✓I'IS ✓� CO�I'-S OWNER BUILDER? OYES e O
BUSINESS NAME �p
ADDRESS B�.O o7�• hocbiieSS)L-er_4j/C, ot44-eY liO Cl- -1I1 J
PHONE q 09^3 /0 _a✓" " EMAIL
CONTRACTOR'S STATE LIC NUMBER S/-1535- LICENSE CLASSIFICATION
VALUATION$ 23 , D'M QFT 33 LSQFT p1 /
APPLICANT'S SIGNATURE DATE
CITYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP 3
INVOICE PAID AMOUNT U
AMOUNT Ltag•� 1� C51 0CASH 0CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Deportment 29 714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
OWNER
ADDRESS g C �-
CITY / ZIP9 -PHONE// �� 0
LOT NO. TRACT APN (L
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CONTRACTOR
LC
ROOMS N' COVERS PROPOSED ADDITION(S) Q
840 S ROCHESTER AVE#C i/
ONTARIO, CA 91761 A-L`X 9z alL-kok 9176'1051,14 t
LIC. B-517575
909-390-0555 � ��i `X�r t City of Menifee
WORK COMP s / building& Safety Dept.
ICW GROUP LC�Gr = ��Gc Y �C � /z�s PR 19 2016
WSA5000386-07
EXP6/14/2016 C �
Received
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CITY OF MENIFEE . 4 ��
BUILDING AND SAFETY EPARTMENT m
PLAN APPROVAL J >7
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REVIEWED BY q 1
DATE DO
`Approval of these plans shall not be con rued t be a permit for,or an In
approval of,any violation of any provisions o e federal,state or a T
regulations and ordinances. This set of approved plans must be kepti E ET C77
jobsite until completion.