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PMT16-01626 City of Menifee Permit No.: PMT16-01626 _ 29714 HAUN RD. Type: Residential Addition �ACCELA" MENIFEE, CA92586 MENIFEE Date Issued: 05/2512016 PERMIT Site Address: 29307 GUAVA ST, MENIFEE, CA 92584 Parcel Number: 333-624-005 Construction Cost: $1,400.00 Existing Use: 1 &2 Family Residence Proposed use: Description of INSTALL 160 SQ FT SOLID ALUMAWOOD PATIO COVER NO ELECTRICAL Work: Owner Contractor LENNOX BELLE BOBBY BURGESS 29307 GUAVA ST 25772 CASA FANTASTICO MENIFEE, CA 92584 MORENO VALLEY, CA 92551 Applicant Phone:9512149988 ROBERT BURGESS License Number:974368 BOBBY BURGESS 25772 CASA FANTASTICO MORENO VALLEY, CA 92551 Fee Description CRY Amount f51 Building Permit Issuance 1 2T00 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 contracts for the projects with a licensed contractor(s)pursuant to the Contractors State License Law). I hereby affirm under penalty of perjury that I am under provisions of Chapter9(commencing with section 7000)of Division 3 of the Business and o 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 $SL'L`� bJ3 Umns P. J7 By my signature below I acknowledge that,except for my personal residence Expires Ic `10 H- Signature in which 1 must have resided for at least one year priorto 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 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 w,ww.leeinfo.ca.eov/calaw.html. this permit is issued. Policy# Date PROPERTY OWNER OR AUTHORIZED AGENT o I have and will maintain workers compensation insurance,as required by 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 carrier and policy owner or authorized to act on the property owners behalf.I have read this number are: application and the information I have provided is correct.I agree to comply with all applicable city and county ordinances and state laws relating to Carrier 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($300)or less PROPERTY OWNER OR AUTHORIZED AGENT _ certify that in the performance of the work for which this permit is issued, GE�,/t�/'��;5I D I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# workers compensation lawt,IIuof California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the workers o pensation provisions of Section 3700 of the Labor Code,I shall ford c ly with those provisions. _ ] Will the applicant or future building occupant handle hazardous material or •L'J .I Le mixture containing a hazardous material equal to or greater that the Applicant Date amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SVCURE WORKER'S COMPENSATION COVERAGE IS ❑Yes ANo 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 a permit forthe construction or modification 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 for guidelines CONSTRUCTION LENDING AGENCY oYes �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) o Yes ANo OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD permitting checklist.I understand my requirements underthe 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 California Health al SafeVCdAection 25505 and 25534 concerning hazardous material r o checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oYes i)zNo 'I Business and Professions Code).Any city or county that requires a permit to Date construct,alter,improve,demolish or repair any structure,priorto Lts PROPERTY OWNER bRiUT041ZED 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 EPA RENOVATION,REPAIR AND PAINTING(RRPI License Law(Chapter9(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 Rcensure 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 o 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.eva.gov/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 Contractors 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-Builder will have the burden of proving that it was not built or improved for the purpose of sale. o No EPA Lead-Safe Certified Firm is required for this project because: o 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. BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION Menifee DATE a by "l O� PERMIT/PLAN CHECK NUMBER TI 01(0 TYPE: C COMMERCIAL &RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA C SIGN SUBTYPE: O ADDITION C ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL C NEW OPLUMBING C RE-ROOF-NUMBER OF(S�Q--UARES DESCRIPTION OF WORK it 51I* PI UM,InI . t- WJm o U PROJECTADDRESS lPt30-7 yuawe_ Sf ASSESSOR'S PARCEL NUMBER - S 3- �,n94—C S LOT jjq_ TRACT OWNER NAME L-enrxox ge . ADDRESS PHONE 1!51 1 3 1 L EMAIL QQ APPLICANT NAME R0�2 c�n�Ip Fowl ADDRESS IS1`IZ Cp' So, o.R iPs I �Of �u PHONE A'J •ZI QQ I EMAIL CONTRACTOR'S NAME p I Rob-,{ 9,f -6S OWNER BUILDER? O YES NO BUSINESS NAME //��TaY�O //S��yy. 1 ADDRESS '0 I Z `-a L{ /�aJac /Gv )) /• PHONE 161 2rV TUN EMAIL �O�/' sS y6Z C/1vj ev CONTRACTOR'S STATE LIC NUMBER 31a ..nn LICENSE CLASSIFICATION CIo I 03 VALUATION$ 1# 11400 SO,FT I ID V L SQ FT APPLICANT'S SIGNATURE DATE '25 •l L' CITYSTAFFUSEONLY DEPARTMENT DISTRIBUTION 10 #0 CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN ( SMIP Q _-N INVOICE 1T„p .(Q PAIDAMOUNT AMOUNT GVJDD OCASH 0 CHECK# OCREDITCARD VISA/MC PLAN CHECK FEES PAIDAMOUNT 0CASH 0 CHECK N OCREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO City of Menifee Building &Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us inspection Request Line 951-246-6213 LAH L SITE ADDRESS ASSESSORS PARCEL&UMB nifee Buiiding & a �a� 2 5 TRACK flravtdQ North Arrow REAR PROI�E�� � mil Soi''; g,&ND SAFETY DEPARTMENT 4 S ;:tV1EWED Y DATE E ;qp naval of these p am,shall nn rrouisionsrof thued e federal,ederal,state or of an approval of,any viol lion of any regulations and ordi antes. Thi set of proved plans must be kept n the \� r R johsite until comple on. , 7 p b'S„ E to 1 7'k * x T I — Y r L x— is9 Ul n e E _.—— FRONT PROPER 1Y LIKE 284-199 (Rev. 06/2009) .