PMT16-01310 City of Menifee Permit No.: PMT16-01310
29714 HAUN RD.
�ACCELj�>. MENIFEE, CA 92586 Type: Residential Addition
finemM;&4Mxe MENIFEE Date Issued:
04/26/2016
PERMIT
Site Address: 31869 ROUGE LN, MENIFEE, CA 92584 Parcel Number: 372-500-001
Construction Cost: $4,050.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL SOLID 300 SQ FT ALUMAWOOD PATIO COVER W/ELECTRICAL 1 FAN
Work:
Owner Contractor
MIGUEL BUSTOS TRADER DAN'S INC
31869 ROUGE LN 840 S ROCHESTER AVE STE C
MENIFEE, CA 92584 ONTARIO, CA 91761
Applicant Phone:9093900555
DONALD DAUGHENBAUGH License Number:517575
TRADER DAN'S INC
840 S ROCHESTER AVE STE C
ONTARIO, CA 91761
Fee Description gty Amount fE1
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_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 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 licensure under the Contractor's State License Law for
Professions Codee�..33(nd my license Is in full force and effect. 7 the following reason:
License Class V License No 5 7-57 S By my signature below I acknowledge that,except for my personal residence
Expires Signature in which I 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 DECLARA 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 thata copy of the applicable law,Section
haveand 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.Ieginfo.ca.;mv/caIaw.htmI.permit is issued.
Policy p Date
,151,111have and will maintain worker's compensation insurance,as required by PROPERTY OWN ER 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
numberare: application and the information I have provided Is correct.I agree to comply
Carrier T6 W with all applicable city and county ordinances and state laws relating to
cc ��rr��tt // G At / building construction.I authorize representatives of this city or county to
Policy#Lz5.+Voo3spoj1 Expires 19 enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
❑1 certify that in the performance of the work for which this permit is issued, Q / 13
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE ri ✓ 1
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers sation provisions of Section 3700 of the Labor
Code,I shall i cmply will those provisions. n/ Will the applicant or future building occupant handle hazardous material or a
LL6 Applicant Date mixture containing a hazardous material equal to orgreaterthatthe
amounts sp ified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes 70
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
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction D modification from South
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Co guide Quality Management District(S[AQMD)7 See permitting checklist
forguideli
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 boun of a school?
(Section 3097 Civil Code) ❑Yes o
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the
Contractors License Law for the reason(s)indicated below by the hazard He h al Safety Code,Section 25505 and 25534 Concerning
byes 0u atenal repo g
checkmark(s)I have placed nett to the applicable item(s)(Section 7031.5 Oye, 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 OWN A IZE
issuance,also requires the applicant for the permit to file a signed statement
AGENT
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION.REPAIR AND PAINTING IRRPI
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
❑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.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 Firm 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.
PERMIT/PLANBUILDING & SAFETY APPLICATION
Menifee
DATE Zb b PERMIT/PLAN CHECK NUMBER
TYPE: 0 COMMERCIAL -elFESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION ELECTRICAL O MECHANICAL
NEW O PLUMBING O RE
/-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK �� /X d / ,��l ' 0d/Nq
.Guru': ) p
PROJECTADDRESS 315A. h-�Ot4 l'Th-L"
ASSESSOR'S PARCEL NUMBER 3� `eco-00( LOT * 4� TRACT
/ dVr+'I
OWNERNAME p 1 '/ tI-Cj/q -TC044S +
ADDRESS /g� IC9u G 51'L� V'1447i F"e<- If,4-
PHONE L7 S53 �_ y z EMAIL
APPLICANT NAME
ADDRESS (/ Jl�
PHONE EMAIL
CONTRACTOR'S NAME VA01)'L3 ...0` r()UZ/e-S OWNER BUILDER? O YES. 440-
BUSINESS NAME
S�cc�� 6/
ADDRESS VtO �(J-6C4,-eSV e, r Av (- om4oYrlIO L-A �7/
PHONE 'j0j-3'20 '0F5.5- EMAIL
CONTRACTOR'S STATE LIC NUMBER JI-77- -5— LICENSE CLASSIFICATION
VALUATION$ L�j Q`� O ` FT 306 L SQ FT //'
APPLICANT'S SIGNATURE `_ DATE Za 1116
MIT i _
DEPARTMENT DISTRIBUTION �� n!1 CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP V" 3513 3
INVOICE c�Q
AMOUNT A-�O• PAID AMOUNT 0CASH 0CHECK# 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES C.' NO DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-572-5777
www.cityofinenifee.us Inspection Request Line 951-246-6213
LEDGER & TRACK
OWNER cam} PEC7I0N REQUIRED
` LtG�1 I DQ a
ADDRESS 3lscog J
CITY IP Z-g PHONE�S/�, �3-( �Z
LOT NO. U TRACT APN
pity of men"I"ePt
CONTRACTOR
Building & Safety
APR 2 6 2016
ROOMS N' COVERS PROPOSED ADDITIONS)
840 S ROCHESTER AVE #C C i
ONTARIO, CA 91761 l Cl
LIC. B-517575
909-390-0555 �
WORK COMP /
ICW GROUP
WSA5000386-07
EXP6l1412016
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CITY OF MENIFEE �D �:t,�,ry�
BUILDING AND SAFETY DE Z_"
PLAN APPROVAL RTMENT
REVIEWED BY
DATE
'Approval of these plans shall not be tonst u7ttoe a permit for,or an N
approval of,any violation of any provisions
tederal,state or regulations and ordinances. This set of ap e kept plans must b c
jobsiteuntilcompletion. Pt t o ShfREET