PMT16-01291 City of Menifee Permit No.: PMT16-01291
29714 HAUN RD.
ri\CCELA_ MENIFEE, CA 92586 Type: Residential Addition
MENIFEE Date Issued: 04/25/2016
PERMIT
Site Address: 26930 WINTER HARBOR CT, MENIFEE, Parcel Number: 333-471-002
CA 92585 Construction Cost: $4,400.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 1)210 SO FT LATTICE 1)252 SQ FTSOLID ALUMAWOOD PATIO COVER W/ELECTRICAL 1
Work: FAN
Owner Contractor
JENICE ROSE PATIO GUY ALUMAWOOD CONTRACTOR
26930 WINTER HARBOR CT 41197 GOLDEN GATE CIR STE 108
MENIFEE, CA 92585 MURRIETA, CA 92562
Applicant Phone: 9513330056
LOIS MONTINI License Number.872839
PATIO GUY ALUMAWOOD CONTRACTOR
41197 GOLDEN GATE CIR STE 108
MURRIETA, CA 92562
Fee Description ,City Amount 1$1
Receptacle, Switch, Outlet&Fixture 1 116.00
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
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_Blog_Permit_Templale.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION
hereby affirm under penalty or perjury that I am licensed under provisions of ❑ I, as owner of the property an exclusively contracting with licensed
Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044,Business and Professions
Professions Code arld my license is in full fojcg aid fft' Code:The Contractor's License Law does not apply to an owner of a property
License Class License N L. ZS �/ J who builds or improves thereon, and who contracts for the projects with a
Expires Le 6 D ! (Dgnature licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ I am exempt from licensure under the Contractors'State License Law for the
❑ 1 hereby affirm under penalty of perjury one of the following declarations: following reason:
I have and will maintain a certificate of consent of self-insure for workers' By my signature below I acknowledge that,except for my personal residence in
compensation,Issued by the Director of Industrial Relations as provided for by which I must have resided for at least one year prior to completion of
Section 3700 of the Labor Code, for the performance of work for which this improvements covered by this permit. I cannot legally sell a structure that I have
permit is issued.
Policy# built as an owner-building if it has not been constructed in its entirety by licensed
contractors. I understand that a copy of the applicable law, Section 7044 of the
❑ 1 have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is
section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:htto�Nwww lecinfo ca cov/mlaw htm1.
permit is issued.
My workers'compensation insurance carder and policy number are:
Carrier V lif Property Owner orAulhorized Agent Date
Expires l� Policy#
❑ By my Signature below, 1 certify to each of the following: I am the property
Name of Agent Phone# owner or authorized to act on the property owner's behalf. I have read this
(This section need not be completed if the permit is for application and the information I have provided is correct. 1 agree to comply
one-hundred dollars($100)or less) with all applicable city and county ordinances and state laws relating to building
constmction. thorize representatives of this city or county to enter the above-
0 1 certify that In the performance of the work for which this permit is issued,I identif y( r a inspection urposes.
shall not any persons f any manner so to become subject to the
workers'compensation laws of California, and agree that if I should become
subject to the workers'compensation provisions of Ation 3700 of the Labor property Ow er or Authorized Agent Date
Code,I shal forthwi comply with those provisions. t{�-
City Business License# Q�� /c�/. 1
Date: O �Y �v Applicant;
WARNING: FAILURE TO SECURE WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDING
($100,000). IN ADDITION TO THE COST OF COMPENSATION, []YES OCCUPANT HANDLE HAZARDOUS MATERIAL ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS
I hereby affirm that under the penalty of perjury there is a construction lending INFORMATION GUIDE?
agency for the performance of the work which this permit is issued (Section WILL THE INTENDED USE OF THE BUILDING BY THE
3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE
Lender's Name DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION...
Lender's Address �L� ��R91WTHE SOUTH COAST AIR QUALITY MANAGEMENT
TR DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR
GUIDE LINES
OWNER BUILDER DECLARATIONS
I hereby affirm under penally of perjury that I am exempt from the Contractor's PRINT NAME:
License Law for the reason(s)indicated below by the checkmark(s)I have placed []YES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable item(s)(Section 7031.5.Business and Professions Code: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A
Any city or county that requires a permit to construct, alter, improve, demolish, NO�66HOOL?
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
provisions of the Contractor's State License Law (Chapter 9(commencing with I HAVE READ THE HAZARDOUS MATERIAL
Section 7000)of Division 3 of the Business and Professions Code)or that he or ❑YES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from licensure and the basis for the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREMENTS
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to ❑t(I aTHE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than(S500).) CODE, SECTIO 25505 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS M RIAL fiEPOR ING.
compensation, will do( )all of or( )porting of the work,and the structure is PROP R A GE
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 X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
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
purpose of sale).
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE - PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL ^T-RESIDENTIAL O MULTI-FAMILY 0MOBILEHOME O POOL/SPA O SIGN
SUBTYPE: ADDITION C ALTERATION O DEMOLITION '-ELECTRICAL CI MECHANICAL
C' NEW " PLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK A m SOL/b . I5• / G6"
L k77D// ,,^^ o d - �' Iq
PROJECTADDRESS 4D LZIl
ASSESSOR'S PARCEL NUMBER J�?�j LO LOT TRACT
OWNERNAME /
ADDRESS 0,10
PHONE CJs�' ' Q 'SR 9R EMAIL
APPLICANT NAME blS 1q,0AUTWI
ADDRESS
PHONE 9 7l0- EMAIL
CONTRACTOR'S NAME ` OWNER BUILDER? 0 YES C)d
BUSINESS NAME L
ADDRESS14/1977 Q —
PHONE 9Sl- 333 -1)DS4 EMAIL Qj2MQOD r5 . CD
CONTRACTOR'S STATE
,LI/C NUMBER S2ASa9 LICENSE CLASSIFICATION
,7"`-y'VALUATION $ 40Z) SOFT LSQFT L
APPLICANT'S SIGNATURE / DATE L Ot S'
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION 1/.'1 �� CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGIN�EIUNG FIRE I GREEN SMIP
INVOICE 'AlIDPAID AMOUNT C)
AMOUNT CASH -��
CHECK# �)CREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT OCASH %CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
LEDGER &t 1 iiAC
L. SPECTION REQUI Ft�
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L�4Tzof Menifee
Building & Safety Dept.
APR 2 5 2016
_ o , Received
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BUILN�I 'V� g DEPARTMENT
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III PLAN AUVAL
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I 'Approval of these plans shrl!not br cona•• ,ed to h,a pean;t 40. an ��
el approval of,any violation of dr.,c o: o: s, .. ,. to
1 3&ulations and ordinances. ?his se+it 2p;dJ dC 11,05 nnf' . Q i'P:
jobsite until completion.
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