PMT16-01419 City Of Menifee Permit No.. PMT16-01419
_ 29714 HAUN RD.
�CCEL:A-? MENIFEE, CA 92586 Type: Residential Addition
oo..«. xx.A—' MENIFEE Date Issued: 05/04/2016
PERMIT
Site Address: 27659 POTOMAC DR,MENIFEE,CA Parcel Number: 336-350-017
92586 Construction Cost: $4,200.00
Existing use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 400 SQ FT SOLID ALUMAWOOD PATIO COVER WlELECTRICAL 4 LIGHTS
Work:
Owner Contractor
HAZELL HOBBS T F MEADOR CONSTRUCTION
27659 POTOMAC DR PO BOX 713
MENIFEE, CA 92586 WILDOMAR,CA 92595
Applicant Phone: 9518376180
GINA MEADOR License Number:639087
T F MEADOR CONSTRUCTION
PO BOX 713
WILDOMAR, CA 92595
Fee Description Oft Amount(S)
Receptacle,Switch, Outlet&Fixture 4 131.00
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 6.55
$306.20
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_Pe"it_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 contmctor(s)pursuant to the Contractors State License Law).
Chapter9(commencingwith section 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contractor's State License Law for
Professions Code. my license is in full force and eff ct. the following reason:
License(lass Ice No. By my signature below I acknowledge that,except for my personal residence
Expires Signatu a 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 DECIA TIO have built as an owner-builder if it has not been constructed in its entirety by
❑I hereby affirm under penaltyof 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 www.le¢info.ca.¢ov/calaw.html.
this permit is issued.
Policy# 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 owner's behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
Cartier 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 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
I certify that in the performance of the work for which this permit is issued,
G I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,I sh ith c ply { th �e provisions. Will the applicant or future building occupant handle hazardous material or a
that
Applican r Date amoure nts specified
iedonng a azardoushe Haar pus material equal to Ivor anon Guidthe
amounts specified on the Hazardous Materials Information Guide?
WARNI FAIL E TO SECURE WORKER'S COMPENSATION VE GE ❑Yes ❑No
UNLAWFUL SHALLSUBIECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CAVIL FINES UPTO ONE HUNDRED THOUSAND DOLLARS($300,000),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 for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes Flo
1 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 bquniitary of a school?
(Section 3097 Civil Code) ❑Yes Po
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
hereby affirm underpenalty of perjury that I am exempt from the
Contractor's License Law for the reason(s)indicated below by the Califomi Safety Cod Sec[' n 25505 and 25534 concerning
h art us mat ri I ortin .
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 r Yes ❑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 PROF O R RAU ORIZED 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 Contractor's State EPA REND TTON REPAIR AND PAINTING RRP
License Law(Chapter 9(commencing with Section 70DO)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 childure 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( I portion of the work,and the structure is www.eoa.¢ov/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 Contractor's 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 bemuse:
o I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's 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.
C & SAFETY PERMIT/PLAN CHECK APPLICATION
,5 _`- �`Menifee
f _
DATE 5 PERMIT/PLAN CHECK NUMBER "`Ito - O
TYPE: O COMMERCIAL XRESIDENTIAL O MULTI-FAMILY 0 MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION >(ELECTRICAL O MECHANICAL
)(NEW OPLUMBING ORE-ROOF-NUMBEROFSQUARES
DESCRIPTION OF WORK V X `/
' L . 1—
PROJECTADDRESS T(.JIV' hh I
ASSESSOR'S PARCEL NUMBER � O' UV�V�� LOT TRACT
OWNER NAME �CJ� 11
ADDRESS aaQ L�r. 1 "�-
PHONE �`� �3 JLJOI EMAIL
APPLICANT NAME [, 2
ADDRESS , 0, ( / �J (`
Ph
PHONE `,l "(')�� 7 — cj 1 rj l EMAIL
CONTRACTOR'S NAME UGC OWN��EooR``�BUILDER? O YES NO
BUSINESS NAME ,C ,° �'( - LPL:
ADDRESS pp Y�itl 'rV c-A
PHONE � - �j,3� —�j EMAIL
CONTRACTOR'S STATE LIC NM/ UMBER �lO�)? LICENSE CLASSIFICATION
�412VALUATION$ W SQ U LSQFT
APPLICANT'S SIGNATUR DATE
DEPARTMENT DISTRIBUTION t� �� CITY OF 9QE,y1JEE�k151 I SE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN ` SMIP F//1_//Sf,�/
INVOICE .l� PAIDAMOUNT n
AMOUNT U O CASH O CHECK# CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT I OCASH 0CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building& Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
I u-Cc
tr_ty of Menlfee
t - +Ing & Safety Dept.
t`3 MAY 0 4 2016
Received
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