PMT16-01446 City of Menifee Permit No.: PMT16-01446
29714 HAUN RD. Type: Residential Addition
`�ACCEL/? MENIFEE, CA92586
W— MENIFEE Date Issued: 05/09/2016
PERMIT
Site Address: 29434 WILDCAT CANYON DR, MENIFEE, Parcel Number: 351-250-008
CA 92587 Construction Cost: $2,300.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 12'x 20' SOLID ALUMAWOOD PATIO COVER, NO ELECTRICAL
Work:
Owner Contractor
TIM DOMICCIO PATIO GUY ALUMAWOOD CONTRACTOR
29434 WILDCAT CANYON DRIVE 41197 GOLDEN GATE CIR STE 108
MENIFEE, CA 92587 MURRI ETA, 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 O_yl Amount ISI
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
$168.65
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 building 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
I 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 and my license is in full fo,Mad t Code:The Contractor's License Law does not apply to an owner of a property
License Class //__� License No. '` who builds or improves thereon, and who contracts for the projects with a
Expires (y�gnature licensed contractor(s)pursuant to the Contractors Stale License Law).
WORKERS'COMPENSATION DECLARATION
❑ lam 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:http,//www.leginfo.m.goy/calaw.html.
permit is issued.My workers'compensation insurance carder and policy number are:
Carrier Property Owner orAuthorized Agent Date
Expires � Policy#
❑ By my Signature below, I certify to each of the following: I am the property
Name of Agent Phone If 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
construction.Athorize 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 f r e inspection urposes.
shall not emni any persons any manner so to become subject to the
compensation
workers'compensation laws off California, and agree that if I should become
subject to the workers'compensation provisions of iAlkin 3700 of the Labor Property Owifer or Authorized Agent 0 Date
Code,I she[ forthwith comply with those provisions. I I
Q �/9 //c City Business License If
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 A 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 � ,, �fvYTHE SOUTH COAST AIR QUALITY MANAGEMENT
Lnit 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 DYES 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, NL?
or repair any structure, prior to its issuance, also requires the applicant for the
permit to rile 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 ❑M I�DF?THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE, SECTIO 25505, 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS M RIAL REPORTING.
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).
�ir ��f116s1r.r.
BUILDING & SAFETY PERMIT/PLAN CHECK A. • 1�ov
of Me" _- � �
Menifee MAY 0 9 2016,q
DATE PERMIT/PLAN CHECK NUMBER d
TYPE: " COMMERCIAL Ct-�SIDENTIAL G MULTI-FAMILY '.- MOBILE HOME POOL/SPA O SIGN
SUBTYPE: 0 ADDITION 0 ALTERATION 0 DEMOLITION OELECTRICAL 0 MECHANICAL
'�IEW O PLUMBING -%'o RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
D E 74 D 9 L C.
PROJECT ADDRESS
ASSESSOR'S PARCEL NUMBER \' ( LOT TRACT
OWNER NAME
ADDRESS Ac I L 43 U
PHONE C4_4�1- 4 7 EMAIL
APPLICANT NAME
ADDRESS
PHONE q5'�- 3�y-1� lam_ EMAIL
CONTRACTOR'S NAME OWNER BUILDER? O YES 31-Nb
BUSINESS NAME ,
ADDRESS �y v{ % L. WPAIM
PHONE q�� � 3'� ^UbSIP EE MAIL 06Q02jijQjLAn- U2ftd rn
CONTRACTOR'S STATE LIC NUMBER A� 0�� I �LICENS�E CLA'S—SIFICATION
VALUATION $ SO FT a D L SO FT
APPLICANT'S SIGNATURE I DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN — SMIP r
INVOICE
AMOUNT 1 •�� PAID AMOUNT \ •�� 0 ��
CASH CHECK# %"CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT CCASH '0CHECK# <.%CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES •- NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
- ---�.s� ity of Menlfee
Bull ing $ Safety Dept.
1al1 AY 09 2016
vv -h eceived
l DI � nL �1 ...i�L�w:ALf-� L! I I dACi�
®� = e 1 ECTION REQUIRED
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° BUILD"'-!G AND SAFETY DE ARTMENT
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REVIEWED BY Gj 1
fl a1 DAT
N �d� 'Approval of these plansshQge nstruedtobeapermitfor,oran
approval of,any violation of any provi ons of the federal,state or city
regulations and ordinances. This set s approved plans must be kept on the
e a'
jobsile until completion.
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