PMT16-01509 City of Menifee Permit No.. PMT16-01509
29714 HAUN RD. Type: Residential Addition
�CCELA_. MENIFEE, CA92586
MENIFEE Date Issued: 0 511 312 01 6
PERMIT
Site Address: 28306 PLEASANTON CT, MENIFEE, CA Parcel Number: 340-292-044
92584 Construction Cost: $4,000.00
Existing Use: 1 &2 Family Residence Proposed use:
Description of INSTALL SOLID 200 SQ FT ALUMAWOOD PATIO COVER NO ELECTRICAL
Work:
Owner Contractor
VAN METER JIM BECKER CONSTRUCTION
28306 PLEASANTON CT 1956 ANAHEIM AVENUE
MENIFEE, CA 92584 COSTA MESA, CA 92627
Applicant Phone:9492309228
JIM BECKER License Number: 1012268
JIM BECKER CONSTRUCTION
1956 ANAHEIM AVENUE
COSTA MESA,CA 92627
Fee Description QtV Amount($1
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 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 mntracts for the projects
I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractors)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 Class (, icense No.
2 By my signature below I acknowledge that,except for my personal residence
Expires, Signature I-- l�� in which lmust 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 N 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 fallowing declarations:I licensed contractors.I understand that 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 ,,y�y�v.leeinfo.ca.eov/calaw.html.
this permit is issued.
Policy# Date
91 have and will maintain workers 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 workers compensation insurance carder and policy owner or authorized to act on the property owners behalf.l have read this
number are: application
a- /l application and the information I have provided is correct I agree to comply
Carrier /r �r—I— e_;_ Uit/J/t_C.Q o with all applicable city and county ordinances and state laws relating to
n building construction.I authorize representatives of this city or county to
�/b Policy# "' s ! Expires r7 �-7�� 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,
I shall not erroloV any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to tfle workers compensation provisions of Section 3700 of the Labor
Code,I she I forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equalto orgreaterthatthe
Applicant Dale �� amounts specified on the Hazardous Materials Information Guide?
WARNIN AILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS D Yes aQlo
UNL WF ,AND SHALLSU13J CrAN EMPLOYER TO CRIMINAL PENALTIES /te
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($300,000),IN Will the intended
require a permit for the constructionnded use of the building by the applicant modification future or building from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQM D)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY ❑Yes -ji.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 boundary of a school?
(Section 3097 Civil Code) ❑Yes ', No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractors License law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item D s)(section 7031.5 ha rdous aten I reporting.
Business and Professions Code).Any city or county that requires a permit to s' . o
Date 1 ,v
construct,alter,improve,demolish or repair any structure,prior to its PRQP 'RTY OWNER OR AUTHORIZED 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 Contractors State EPAKENOVATION,REPAIR AND PAINTING(RRP)
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
❑1,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.aov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 70",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 Arm Is required for this project bemuse:
❑1,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
i & SAFETY PERMIT/PLAN CHECK APPLICATION ri
Menifee
DAT ):3 �/� PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL RESIDENTI O MULTI-FAMILY O MOBILE HOME 0 POOL/SPA 0 SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION 0 ELECTRICAL O MECHANICAL
O NEW O PLUMBING 0 RE-ROOF-NUMBER OF SQUARES
-
DESCRIPTION OF WORK C f( O c/GA_ f Q"
PROIECTADDRESS
ASSESSOR'S PARCEL NUMBER ✓ ^ `�p5 L s�-04 LOT 56 TRACT 5
OWNER NAME
ADDRESS
PHONE EMAIL
APPLICANT NAME A,
ADDRESS
PHONE / O (� EMAIL
CONTRACTOR'S NAME 'ell OWNER BUILDER? 0 YES ONO
BUSINESS NAME �haT-" 1
ADDRESS /I -/S� /N A-
` i�•>L t✓a0 1?,, %a��
PHONE 6 %/J d-: dJd 9 d F EMAIL
CONTRACTOR'S STATE LIC NUMBER / (�d-{p ,� LICENSE CLASSIFICATION
All)
ll) LSQ FT
APPLICANT'S SIGNATURE I �+� DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION z �� CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN I $MIP
INVOICE I � ��/
AMOUNT l IL7(�-b PAID AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER 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
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