PMT16-02437 City of Menifee Permit No.: PMT16-02437
29714 HAUN RD. Type: Residential Addition
q:XCCEL/� MENIFEE, CA92586
MENIFEE Date Issued: 0 810112 01 6
PERMIT
Site Address: 29037 WAYFERER RD, MENIFEE, CA Parcel Number: 333522-002
92585 Construction Cost: $4,000.00
Existing use: 1 &2 Family Residence Proposed use:
Description of INSTALL SOLID 640 SO FT ALUMAWOOD PATIO COVER W/ELECTRICAL 2 FANS, 8 LIGHTS
Work:
Owner Contractor
RICHARD MADRIAGA MORENO VALLEY, CA 92553
29037 WAYFARER RD
MENIFEE,CA 92585
Applicant Phone:9518672081
EDUARDO SALAZAR License Number: 16-PEOP-00028
MORENO VALLEY,CA 92553
Phone:9518672081
Fee Description ON Amount t$)
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 carded 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_Bidg Permit_Templale.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts forthe 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 License No. By my signature below I acknowledge that,except for my personal residence
Expires 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 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 webske:
by Section 3700 of the Labor Code,for the performance of work for which
this permit is issued. www.le info.ca, ov calcaw.html. p /
Policy# o(/LL✓// .)c!,. rGk 1 - Date D v
o I 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 carrier and policy owner or authorized to act on the property owners behalf.I have read this -
number are: application and the information 1 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 identifi property for inspection purp�sCe�s. /
(This section need not to be completed is the permit is for one-hundred -�r���111; �(El�j'7j�� Date V `
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
o 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 5ection 3700 of the Labor
Code,I shall forthwith comply with those provisions. WIII the applicant or future building occupant handle hazardous material or a
Date mixture containing a hazardous material equal to or greater that the
Applicant amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes o No
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 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY oYes oNo
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) oYes .o No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guideand the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjurythat 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 oYes o No
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,Improve,demolish or repair any structure,prior to its PROPERTY 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 EPA RENOVATION,REPAIR AND PAINTING IRRP)
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 Bcensure 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($500). managers who do the paint-disturbing work themselves or through their
as owner of the pr erty,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do Wil of or( )portion of the work,and the structure is www.eoa.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a o An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. o No EPA Lead-Safe Certified Firm is required for this project because:
% as owner of the property am exclusively contracting with licensed
c ntractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK
Menifee
DATE U ( PERMIT/PLAN CHECK NUMBER -TI ' 03 --39
TY E: O COMMERCIAL 0 RESIDENTIAL C MULTI-FAMILY O MOBILE HOME 0 POOL/SPA O SIGN
SUBTYPE: O ADDITION OALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBINGp 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK ) ,{ ue 6
PROJECTADDRESS q0 J7 / qz,51Sj
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME CGI,()
ADDRESS
PHONE EMAIL
APPLICANT NAME
ADDRESS ` dZ
PHONE �cc� �+ 07 -Zv i EMAIL
CONTRACTOR'S NAME OWNER BUILDER? XYES ONO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
LUATION$ -) SQ FT 6' L SQ FT
A PLICANT'SSIGNATU RE DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION ' ��V CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP L
INVOICE ' ; F7 AID AMOUNT
AMOUNT J OCASH CCHECKN CCREDIT CARD VISA/MC
PLANCHECKFEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED O YES C NO DL NUMBER NOTARIZED LETTER O YES 0 NO
City of Menifee Building&Safety Department 29714 Noun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
City of Menifee
Building & Safety Dept,
AUG 01 2016
We It MAY CC�4Ctj,N , Received
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CALIFORNIA ALL- PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies only the identity
of the individual who signed the document to which this certificate is attached,
and not the truthfulness, accuracy, or validity of that document.
State of California }
County of Riverside J}
On before me, I`{ 64 ft- C1itO✓/1 11 cz
Qere inert name an eo eo ¢er)
personally appeared V� t'01��� Y I oL a
who proved to me on the basis of satisfactory evidence t be the persor•<vvhose
name(z) is/ape subscribed to the within instrument and acknowledged to me that
he/sk6/-tp6y executed the same in his/ptsr/tWr authorized capacity(Ws), and that by
his/hKr/ter signatureA on the instrument the persory(a'J, or the entity upon behalf of
which the person*) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that
the foregoing paragraph is true and correct.
KIMBERIY MARTINEZ
i/2026089 'o
WITNESS my hand and official seal- g NO COMM.
TARYPUBLJC
RNE RSIDE-CALIFORNW '>
Vwl1' —� COUNTY {
My Comm,Eglires June 21,2017 f}
Notary Public S' nature (N nary Public Seal)
ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM
Tit fortcmopliesivith nnrerrt Califoniastancesregardingnotoywordingarid.
DESCRIPTION OF THE ATTACHED DOCUMENT !(needed,should be completed and attached to die doctmrent.Acknowledgments
from other states may be completed for documents being sent to that state so long
-,/ I T as tine wording floes not require die California noteny to violate Calrftn•nia notary
Imp.
(Title or description of attached document) • State and County information must be the State and County where the document
signer(s)personally appeared before the notary public for acknowledgment.
• Date of notarimtion must be the date that the signer(s)personally appeared which O
(Tithe or description of attached dominant continued) must also be the same date the acknowledgment is completed.
• The notary public must print his or her time as it appears within his or her
Number of Pages Document Date commission followed by a comma mid then your title(notary public). '
• Print the name(s) of document signer(s) who personally appear at the time of
notarization.
CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms(i.e.
❑ Individual (s) he/she/diey,is or circling the correct fors.Failure to comedy indicate his
information may lead to rejection of document recording.
❑ Corporate Officer • "the notary seal impression must be clear and photographically reproducible.
Impression must not cover text or lines. If seal impression smudges,re-seal if a
(Title) sufficient area permits,otherwise complete a different acknowledgment form.
❑ Partner(s) • Signature of the notary public must match the signature on rile with the office of
the county clerk.
❑ Attorney-in-Fact Additional information is not required but could help to ensure this
❑ Trustee(s) acknowledgment is not misused or attached to a different document.
Other Indicate title or type of attached document,number of pages and date.
❑ Indicate the capacity claimed by the signer. If the claimed capacity is a
corporate officer,indicate the title(fe.CEO,CFO,Secretary).
201,,Version v;r, Securely attach this document to the signet)document with a staple.
1 � Menifee
Building &CitYt aWv Dept.
fk /S?1tj AUG 01 2016
Received
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1L a3dm3d NoIA36N1
NOVHI 'S N39033
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CITY OF 1+.IENIFEE -♦
3UIL ING AND SAFETY DEPARTMENT v
IAr APPROVAL 2-qO37 INA>-t-Afte I�/fin
-VIEWED BY
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I of these plans shall not be construed to be a permit for,or an
of,any violation of any provisions of the federal,state or city
s and ordinances. This set of approved plans must be kept on the O
til completion.
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