PMT16-02768 City of Menifee Permit No.: PMT16-02768
29714 HAUN RD. Type: Residential Addition
MENIFEE,CA 92586
MENIFEE Date Issued: 08123/2016
P E R M I T
Site Address: 27934 LAKES LANDING ST, MENIFEE, Parcel Number: 333-361-013
CA 92585 Construction Cost; $6,500.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 14X1 9. 16X31 SOLID ALLUMAWOOD PATIO COVERS.2 FANS&2 OUTLETS
Work:
Owner Contractor
VIC ROMERO PATIO GUY ALUMAWOOD CONTRACTOR
27934 LAKES LANDING 41197 GOLDEN GATE CIR STE 108
MENIFEE, CA 92585 MURRIETA, CA 92562
Applicant Phone:9513330056
LOIS MONTINI License Number.872839
PATIO GUY ALUMAWOOD CONTRACTOR
41197 GOLDEN GATE CIR STE 108
MURRIETA, CA 92562
Fee Description 9—ty. Amount($1
Receptacle, Switch,Outlet&Fixture 4 131.00
Building Permit Issuance 1 27.00
DecklPatio,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 buillding 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.
AkB1dg_PerrnJtTempIate.rpt Page 1 of I
City Of Menifee
LICENSED DECLARATION
I hereby affirm under penalty or perjury that I am licensed under provisions of 0 1, as owner of the property an exclusively contracting with licensed
Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044,Business and Professions
Professions Code al my license is in full foleptaUd Code:The Contractor's License Law does not apply to an owner of a property
License Class License No. I�Le__ who builds or improves thereon, and who contracts for the projects with a
Expiresfg-6D (ffi-gnature C!JS�J�� licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION 0 1 am exempt from licensure under the Contractors'State License Law for the
El I hereby affirm under pe.nalty of perjury one of the following declarations: following reason:
I have and will maintain a certificate of consent of self-insure for workers' By my signature below I acknowledge that,except for my personal residence in
compensation,issued by the Director of Industrial Relations as provided for by which I must have resided for at least one year prior to completion of
Section 3700 of the Labor Code, for the performance of work for which this improvements covered by this permiL I cannot legally sell a structure that I have
permit is issued. built as an owner-building if it has not been constructed in its entirety by licensed
Policy 9 contractors. I understand that a copy of the applicable law, Section 7044 of the
0 1 have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is
section 3700 of the Labor Code. for the performance of the work for which this submitted or at the following Web site:http-/Iw�,leoinfo.m.goy/calaw.himl
permit is issued.My workers'compensation insurance carrier and policy number am:
Carrier C� Property Owner crAuthorized k9ent Date
Expires Policy# /ORJ�:_ql _� _-
D By my Signature below, I certify to each of the following: I am the property
Name of Agent Phone# owner or authorized to act on the property owner's behalf. I have read this
(This dection need not be completed if the perrnit is for 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 building
one-hundred dollars($100)or less) construction.Arthorize representatives of this city or county to enter the above-
0 1 certify that in the performance of the work for which this permit is issued,I identi y for the inspection purposes.
shall not employ any persons in any manner so as to become subject to the
workers'compensation laws of California, and afree,,h I If I should become
'a J2
subject to the works&compensation provisic ns a Un 3700 or the"Oul tho zed Agent Date
Code,I shal forthwith comply with those provisions. Property OwKer orAuthori
Date; ?' 19 //,cS,Applicant; 11 City Business License# 44
WARNING: FAILURE TO SECURE WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDING
($100,000). IN ADDITION TO THE COST OF COMPENSATION, E]YES OCCUPANT HANDLEA HAZARDOUS MATERIAL ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES SNe---ff5UAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS
I hereby affirm that under the penalty of perjury there is a construction lending INFORMATION GUIDE?
agency for the performance of the work which this pennit is issued (Section WILL THE INTENDED USE OF THE BUILDING BY THE
3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE
Lender's Nam DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION-
_.ER6M-THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address 0*0' DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR
GUIDE LINES
OWNER BUILDER DECLARATIONS PRINT NAME,
I hereby affirm under penalty of pedury that I am exempt from the Contractor's
Jcense Law for the reason(s)indicated below by the checkmark(s)I have placed OYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable item(s)(Section 7031.5.Business and Professions Code: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A
Any city or county that requires a permit to construct, alter, improve,demolish, 11��io
or repair any structure, prior to its issuance, also requires the applicant for the
permit to rile a signed statement that he or she is licensed pursuant to the
provisions of the Contractor's State License Law(Chapter 9(commencing with I HAVE READ THE HAZARDOUS MATERIAL
Section 7000)of Division 3 of the Business and Professions Code)or that he or []yES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from licensure and the basis for the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREMENTS
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to [I t1_1NDER-THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) C
0 1, as owner of the property, or my employees with wages as their sole H
compensation,will do( )all of or( )porting of the work, and the structure is P
not intended or offered for sale.(Section 7044,Business and Professions Code; X
The Contractor's State License Law does not apply to an owner of a property
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however.
the building or improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
A]MMIL
2 3
Z
DATE PERMIT/PLAN CHECK NUMBER
TYPE: 0 COMMERCIAL 0 RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA 0 SIGN
SUBTYPE: U ADDITION 0 ALTERATION 0 DEMOLITION 0 ELECTRICAL 0 MECHANICAL
&NEW -OPLUMBING 0 RE-ROOP-NUMBER OF SQUARES
OERIPTION OF WORK 9 4p ')�3 o L I I) L_Ll"7# ID 40&b
9--nD C_,0jtC-
1-#NS . 6 t_)7_A L:�7-5
PROJECT ADDRESS
ASSESSOR'S PARCEL NUMBER
S LOT tk TRACT ov- 3
OWNER NAME 94614t]
ADDRESS c,
PHONE 01.3 EMAIL
APPLICA�T NAME
ADDRESS
PHONE EMAIL
CONTRACTOWS NAME OWNER BUILDER? 0 YES *NO
BUSINESSNAME
ADDRESS �&? 7
PHONE�9,.T_/) .3 41_1jfnA1dWb o),t
ogo EMAIL 19bjAp
CONTRACTOR'S STATE LIC NUMBER 2 LICENSE CLASSIFICATION
VALUATION$ �� 5--e)o �, SO FT I Le cR LSQFT
APPLICANT'S SIGNATUR(_
DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE JEEN IP I
INVOICE PAID AMOUNT OCASH OCHECK# 0 CREDIT CARD VISA/MC
AMOUNT -�otk- w I I I
PLAN CHECK FEES PAIDAMOUNT CASH 0 CHECK N OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER 0 YES C' NO
Cit,v Of Menifei? Building e,5a"Ecy Deparbwent29714 Hamil Rd. Menifee, CA 92585 951-672-57,77
Line951.24C-6213
I ty ot Menife9ep
Bui Ig & Safety D t
DL 1-b UG 2 3 2016
9 eceived
LEDGER & TRAG
�IR DI
NSPECTION REQUI
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d
eLgcra le
di 66bz) CITY OF MENIFEE
13U!LDING AND SAFETY C EPARTMENT
G(::� I E T,4 IPA ff:8 0 VA L
REVIEWED BY ((Le
fA
'Approval of these plansAalWot Construed to be a permit*or an
I
app,oval of,any vioiatjow'w�Pr isions of the federal,state or city
,IV, to
reguiatiobs and ordinances. This s of approved Plans must be kept on t
jobsite until completion. N
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