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PMT16-01924 City of Menifee Permit No.. PMT16-01924 29714 HAUN RD. � _CCEL/� MENIFEE, CA 92586 Type: Residential Addition MENIFEE Date Issued: 0 612 012 01 6 PERMIT Site Address: 25409 GANT CT, MENIFEE, CA 92584 Parcel Number: 358-422-014 Construction Cost: $5,000.00 Existing Use: 1 &2 Family Residence Proposed Use: Description of INSTALL 660 SO FT COMBO LATTICE/SOLID ALUMAWOOD PATIO COVER W/ELECTRICAL 2 FANS Work: &8 LIGHTS Owner Contractor ASHLEIGH FICKLIN ROBLES CONTRACTORS INC 25409 GANT CT 4010 CERVEZA CIRCLE MENIFEE, CA 92584 CORONA, CA 92881 Applicant Phone:7144488163 WILL BRAVO License.Number:914397 ROBLES CONTRACTORS INC 4010 CERVEZA CIRCLE CORONA, CA 92881 Fee Description Qtv Amount IS7 Receptacle, Switch, Outlet&Fixture 10 161.00 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 8.05 $337.70 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 Contractors State License Law for Professions Code and my license is in full force and effect. the following reason: License Class D License No. �C�3 ��—7 By my signature below I acknowledge that,except for my personal residence Expires yJ (, Signature `�� in which l 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 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 ,A,ww.leeinfo.ca.eov/calaw.htmi. this permit is issued. �7 Policy# `,� 3& 7y 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 1 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 �S 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# I /2 3 zO -? 0 Expires d 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 employ 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 the workers compensation provisions of Section 3700 of the Labor Code,I shall forthwith co ith rovisions. 6 Will the applicant or future building occupant handle hazardous material or a mixture containing a hazardous material equal to or greater that the Applicant Date amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TD SECURE WORKER'S COMPENSATION COVERAGE IS o Yes &o 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 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 37050F THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines CONSTRUCTION LENDING AGENCY o Yes rallo 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 VNo OWNER BUILDER DECLARATIONS I have read the 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 Contractors License Law for the reason(s)indicated below by the hazardous material reporting. checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 ryes ❑No Business and Professions Code).Any city or county that requires a permit to �' � Date v — l construct,alter,improve,demolish or repair any structure,prior to its PROPERTY O R 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 EPA RENOVATION,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 in 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( )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 ❑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 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. & SAFETY PERMIT/PLAN CHECK APPLICATION � Menifee DATE PERMIT/PLAN CHECK NUMBER �YJ'tJI'10` TYPE: O COMMERCIAL *RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION $ELECTRICAL O MECHANICAL * NEW O PLUMB, Q INGG O RE-ROOF-NUMBER OF SQUARES L-DESCRIPTION OF WORK l(Jj/I'I 00W r --ZV 15sc �Ie4- ASSESSOR'SGG fv l l oL L PROJECTADDRESS v �� I Gj�'"I'L,1) G% 'f� PARCEL NUMBER : 56 5- u��- Dl y LOT TRACT J I OWNER NAME r-!�h 1 e-( I A T ( (i k i t- ADDRESS -S(4QC�I �^ G�/,r, 1 G7, PHONE `cS( - r g/J Q - 1 g 30 EMAIL APPLICANT NAME W T ( r-OL V 0 ADDRESS 13 tC S r, d/- kl v - G, l � � PHONE gy- qs y- C�f6) EMAIL CONTRACTOR'S NAME Aco, Ao"sOWNER BUILDER? O YES A NO BUSINESS NAME Z^-e. ADDRESS g0t0 PHONE t7ty - 'f4e-6'1 61 EMAIL CONTRACTOR'S STATE LIC NUMBER 1q 3 !G 7 LICENSE CLASSIFICATION CS VALUATION$ SOOrJ SO FT G L SO FT APPLICANT'S SIGNATURE < DATE ,oT C(7'1t{7 DEPARTMENT DISTRIBUTION 10° CITY�9f• PEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN �w SMIP V INVOICE :1� PAIDAMOUNT AMOUNT O CASH O CHECK# O 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 C NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6 777 www.cityofinenifee.us Inspection Request Line 951-246-6213 L5 , 0 � � . moil ADPS.""MFETY NER & TRACK cI i Y c!' LION REQUIRED JGIUILDING*' DPPARTNIENT PLAN APPROVAL �` ` iW Y 2'b If0 r r *Approval of these plans sh.I.not L. cor. trued ro he a permit for,or an approval ot,any violation of any provisions of,h:rederal,state or city regulations and ordinances. This set or appioved plans must be kept on thc- jobsite until completion. �-I'or✓s� 0._+I ' V z �( bask u.s 10 � ��I �� - z � rs , 191,aSGnaw