PMT16-02492 City of Menifee Permit No.: PMT16-02492
29714 HAUN RD.
�ACCELAA? MENIFEE,CA 92586 Type: Residential Addition
MENIFEE Date Issued: 0 810 312 01 6
PERMIT
Site Address: 29223 GUAVA ST, MENIFEE,CA 92584 Parcel Number: 333.623-005
Construction Cost: $5,600.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 480 SQ FT SOLID ALUMAWOOD PATIO COVER W/ELECTRICAL 2 FANS,2 POSTLIGHTS
Work:
Owner Contractor
STEPHANIE CASSADY PSLQ INC
29223 GUAVA ST 28910 RANCHO CALIFORNIA RD
MENIFEE,CA 92584 #206
Applicant phone:9517954260
LOIS MONTINI License Number.919885
PSLQ INC
28910 RANCHO CALIFORNIA RD
#206
TEMECULA,CA 92590
Fee Description Of. Amount ISl
Receptacle, Switch, Outlet&Fixture 4 131.00
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 6.55
$306.20
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 slated,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 ❑ I am exempt from licensure under the Contractors'State License Law for the
I hereby affirm under penalty or perjury that I am licensed under provisions of following reason:
Chapter 9(commencing with section 7000)of Division 3 of the Business and By my signature below I acknowledge that,except for my personal residence in
Professions Code and license is in full force and effeet /) (1. which I must have resided for at least one year prior to completion of
License Class Lice s 0. `1 jj improvements covered by this permit,1 cannot legally sell a structure that I have
Expires — — ignature . built as an owner-building if it has not been constructed in its entirety by licensed
v contractors. I understand that a copy of the applicable law,Section 7044 of the
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application is
submitted or at the following Web site:
❑ 1 hereby affirm under penalty of perjury one of the following declarations: htto•/lwww.leainfo.ca.aov/calaw.html.
I have and will maintain a certificate of consent of self-insure for workers'
compensation,issued by the Director of Industrial Relations as provided for by Date '
Section 3700 of the Labor Code, for the performance of work for which this
permit is issued. Property Owner orAulhorizedAgent
Policy# ❑ By my Signature below, I certify to each of the following:I am the property
❑ 1 have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read this
section 3700 of the Labor Code, for the performance of the work for which this application and the information I have provided is correct. I agree to comply
permit is issued.My workers'compensa0an insurance carierand policy numberare: '•with all applicable city and county ordinances and state laws relating to building
construction.1 authorize representatives of this city or county to enter the above-
Carrier / V�yt�n"z� lAll // identified property for the inspection purposes.
Policy# LU(ri�a////CIU� Expires / (i7 ' Date
Ll3 Property Owner orAuthorized Agent :{
(This section need not be completed if the permit is for City Business License# �40✓
one-hundred dollars($100)or less)
HAZARDOUS MATERIAL DECLARATION
❑ 1 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 Will the applicant or future building occupant handle hazardous material or a
workers'compensation laws of California, and agree that if I should become mixture containing Oazardous material equal to or greater that the
subject to the wo rs'compensation provisions of Section 3700 of the Labor amounts specred on the Hazardous Materials Information Guide?
Code,I shall o w h comply ilh those provisions. / •/�7 DYES C-NO
Applica Will the intended use of the building by the applicant or future building
occupant require a permitfor the construction or modification from South
WARNING: FAILURE TO SECURE WORKERS' Coast Air Quali anagement District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL forguidefi
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES ❑NO
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed b it id g r modified facility be within 1000 feet of the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of oo]?
LABOR CODE,INTEREST,AND ATTORNEYS FEES DYES NO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist.I undd9 stand my requirements under the State of
agency for the performance of the work which this permit is issued (Section California Health ety Code,Section 25505 and 25534 concerning
3097 Civil Code) hazardous diab5nal reporting.
OWNER BUILDER DECLARAT16NS ❑Y
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date 62 1;--7d
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OWNER ORAU �ORIZED AGENT
next to the applicable item(s)(Section 7031.5.Business and Professions Code:
Any city or county that requires a permit to construct, alter,improve, demolish, EPA RENOVATION,REPAIR AND PAINTING(RRP)
or repair any structure,prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Provisions of the Contractor's State License Law(Chapter 9(commencing with receiving compensation for most work that disturbs paint in a pre-1978
Section 7000)of Division 3 of the Business and Professions Code)or that he or residence or childcare facility to be RRP-certified firms and comply with
she is exempt from licensure and the basis for the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than($500).) employees.For more information about EPA's Renovation Program visit:
www.epa.gov4ead or contact the National Lead Information Center at
❑ I, as owner of the property, or my employees with wages as their sole 1-800424-LEAD(5323).
compensation,will do( )all of or( )porting of the work,and the structure is 11 Q..,
not intended or offered for sale.(Section 7044,Business and Professions Code; ar1�
The Contractor's Slate License Law does not apply to an owner of a property ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
who, through employees'or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however, Certified Finn Name:
the building or improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that it was not built or improved for the Finn Certification No:
purpose of sale).
❑ I, as owner of the property an exclusively contracting with licensed No EPALeadSafe Certified Finn is required for this project because:
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors License Law does not apply to an owner of a property
r'J
I
BUILDING & SAFETY PERM IT/PLAN CHECK APPLICATION
Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL XRESIDENTIAL C MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION C DEMOLITION O ELECTRICAL O MECHANICAL
•C NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK S •f 1N. 1 L1 io over a ,hid to wail
5 05 s o S��b. a pans a osfi �► hts
PROJECTADDRESS aq aa3 QUM sk
ASSESSOR'S PARCEL NUMBER � ���� LOT r<2!A TRACT 15��
OWNERNAME S hapie aSS
ADDRESS aq aa3 GIua O St mej OQ Gh
PHONE Cg51) g/l b-Y101 05 EMAIL
APPLICANT NAME CG 1 V^Q-'M -(�Ae Y1�},'1 1
ADDRESS "1IO RG71 �G�O cO I� S C n DI MU 1 c a5q o
PHONE cg5��a3�-o351� EMAIL / c
CONTRACTOR'S NAME �— — C� T--i7WNER BUILDER? YES �
BUSINESS NAME
ADDRESS (�t� 'L7�(yV
PHONE 7 of l- 7 5- ( EMAIL CONTRACTOR'S STATE LIC NUMBER �� ?�RvC LICENSE CLASSIFICATION
VALUATION$ 00 SQ FT 4M L SQ FT /
APPLICANT'S SIGNATURE DATE ^6
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION 1 CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN \� SMIP
INVOICE PAIDAMOUNT p
AMOUNT ✓V� `J CASH GCHECKf! CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# C CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER C YES C 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
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