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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 U 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 Lbk ? �� 4 V C � N zw _ << vZ' t3 O rr1SS ncis. c i CITY OF MENIFEE . 4 �� BUILDING AND SAFETY EPARTMENT m PLAN APPROVAL J >7 CJ- rr7 CD x 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.