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PMT16-01502 City of Menifee Permit No.: PMT16-01502 29714 HAUN RD. �A►CCEL/? MENIFEE, CA 92586 Type: Residential Addition MENIFEE Date Issued: 05/13/2016 PERMIT Site Address: 28562 AUTUMN LN, MENIFEE, CA 92584 Parcel Number: 3724112-002 Construction Cost: $5,000.00 Existing Use: 1 &2 Family Residence Proposed Use: Description of INSTALL 507 SO FT SOLID ALUMAWOOD PATIO COVER W/ELECTRICAL 2 FANS,3 POSTLIGHTS Work: Owner Contractor JOHN MATYKA ANTHONY COCILOVA 28562 AUTUMN LN 31321 PALOMAR ROAD MENIFEE, CA 92584 MENIFEE,CA 92584 Applicant Phone:9513146910 ANTHONY COCILOVA License Number.962132 ANTHONY COCILOVA 31321 PALOMAR ROAD MENIFEE,CA 92584 Fee Description QQttt Amount(SI Receptacle,Switch, Outlet&Fixture 5 136.00 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 6.80 $311.46 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 carded on thereunder when in violation of the Building Code or of any other ordinance of City of Menifee.Except as otherwise staled,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 perjurythat 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 Code and my license is in full force and effect. the following reason: License Clas 3 License No By my signature below I acknowledge that,except for my personal residence Expires 7 Signature f 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 DECLARATION have built as an owner-builder if it has not been constructed in its entirety by o I 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 ,Nw;,v,leeinfo.ca.eov/calaw.html. ' this permit is Issued. Policy# Date V 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 o 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 an the property owner's behalf.I have read this number are: application and the information I have provided is correct.I agree to comply S'`� Cmwith all applicable city and county ordinances and state laws relating to Carrier : ^-� building construction.I authorize representatives of this city or county to Policy# //'�Y n Tr�11 L '-�ll—kxpires f—1 V— f 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 o l certify that In the performance of the work for which this permit is issued, �2f' 1�/�( — I shall not employ any persons in any manner so as to become subject to the - CITY BUSINESS LICENSE# % J L (J 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 shall fo hwit 6mplywith rose r fisions. L f Will the applicant or future building occupant handle hazardous material or a Applicant 'r Date J —� ��fe mixture containing a hazardous material equal to orgreater that the amounts 1 ied on the Hazardous Materials Information Guide? WARNING:FAILU CURE WORKER'S COMPENSATION COVERAGE IS o Yes �NGp 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 use t e r thebuild construction li modification from South ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management DistricttSCAQMDr2 See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines CONSTRUCTION LENDING AGENCY o Yes o 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 bo} Y of a school? (Section 3097 Civil Code) bp /m'No' OWNER BUILDER DECLARATIONS I have readdtthe 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 California Health&Safety Code,Section 25505 and 25534 concerning Contractor's License Law for the reason(s)Indicated below by the hazardo terial repo ng. checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Business and Professions Code).Any city or county that requires a permit to Dyes Date construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWhERVRIWTAORIZED 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 RENOVATION,REPAIR AND PAINTING(RRPI 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 radices.This includes rental property than($500). q P p p rty owners and property managers who do the paint-disturbing work themselves or through their o I,as owner of the property,or my employee with wages as theirsole 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.eua.Rov/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 178OD-424-LEAD(5323). Code;The Contractor's State License Law does not apply to an owner of a o 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-guilder will have the burden of proving that it was not built or improved for the purpose of sale. in 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 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. & SAFETY PERMIT/PLAN CHECK APPLICATION Menifee DATE �� PERMIT/PLAN CHECK NUMBER PM 'D 160�;, TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES DESCRIPTION O WORK , / /7I /O / S / `Jf 1/7 Pe 5A PROJECTADDRESS S �Gl .ry1G�t,� ASSESSOR'S PARCEL NUMBER 'l� (�'� t!✓J LOT I�J_J TRACT ��[Q OWNER NAME / �r/l a CL ADDRESS ;�?, (ry a Of%//"I PHON9 7,jo �d �� - �O EMAIL APPLICANTNAME OP7 4 ADDRESS PHONE�9��j ��. (CJ 9l(/ EMAIL CONTRACTOR'S NAME J'/ jJ OWNER BUILDER? O YES ONO BUSINESS NAME , ADDRESS � QI rn6t r t Ae PHONE .��> ��y—�j g l Q EMAIL e C// !/Ct. CONTRACTOR'S STATE LIC NUMBER 96a / 3 a LICENSE CLASSIFICATION VALUATION$ DO �� SOFT D L SO FT APPLICANT'S SIGNATURE DATE DEPARTMENT DISTRIBUTION CITY OF�yMEEry�EEGB is LICENSE NUMBER BUILDING PLANNING ENGINE RING FIRE GREEN Q SMIP �� (�/"✓ INVOICE �11. PAIDAMOUNT n AMOUNT 0CASH 0CHECK# CREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT OCASH 0CHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO City of Menifee Building&Sofety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 12PY1s . _EDGER & TRACK "PECTION REQUIRED d City of Menifee Building & Safety Dept. MAY 13 2016 Received CITY Of MEN 1FEE � U9 G At D SAFETY DEPARTMENT PL Aid APPR AL111=2.4*01 loom REVIEWED BY ow DATE '.Approval of these plans shall not be construed t be a permit for,or an approval of,any violation of any prpwsions of the Metal,sae or city regulations and ordinances. This set of approved plans must be kept on the jobsite until completion. Chi Z o � I3 (rA qtY O D A It&u Cover � y To -Fence U •he