PMT16-02808 City of Menifee Permit No.: PMT16-02808
29714 HAUN RD.
4��CCEILA_> MENIFEE, CA 92586 Type: Residential Addition
MENIFEE Date Issued; 0812612016
P E R M I T
SiteAddress: 27830 LADOGA LN, MENIFEE, CA 92585 Parcel Number: 333-741-041
Construction Cost: $1,725.00
Existing Use: I &2 Family Residence Proposed Use:
Description of INSTALL 216 SQ FT SOLID ALUMAWOOD PATIO COVER NO ELECTRICAL
Work:
Owner Contractor
JOCELYN JOHNSON TODD'S PATIO COVERS
27830 LADOGA DR 30905 GREENSBORO DR
M ENIFEE, CA 92585 TEMECULA, CA 92592
Applicant Phone: 9516608665
TODD SKARIN License Number, 834251
TODD'S PATIO COVERS
30905 GREENSBORO DR
TEMECULA, CA 92592
Fee Description pty Amount
Building Permit Issuance 1 27.00
Deck/Patio, non-standard 1 133.00
GREEN FEE 1.00
SMIP RESIDENTIAL 1.00
General Plan Maintenance Fee-Building 6.65
$168.65
The issuance of this permit shall not prevent the building official from thereafter rLquiring the correction of erors 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 Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or Improves thereon,and who contracts for the projects
I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and ci I am exempt from licensure under the Contractor's State Ucense Law for
Professions Code and my license Is In full force and effect. the following reason:
-3 L L
License C ss —Uc se a. S By my signature below I acknowledge that,except for my personal residence
I Signature in which I m ust have resided for at least one year prior to completion of
Expiresvm��_ improvements covered by this permit.I cannot legallysell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed In its entirety by
n 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 certifimte 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 website:
by Section 3700 of the Labor Code,for the performance of work for which www.leginfo.ca.gov/calaw.htm1.
this permit Is issued.
Policy# Date
PROPERTY OWNER OR AUTHORIZED AGENT
o I have and will maintain worker's compensation insurance,as required by
section 3700 of the Labor Code,for the performance of the work for which Yly my signature below I certify to each of the following:I am the property
this permit is issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
n umber 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 buildingconstru 'on.I authorize representatives of this city or county to
Policy# Expires en entified pro erty for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less WM6PEffTY10WER OR AUTHORIZED AGENT
II certify that in the performance of the work for which this permit is issued,
shall not employ any persons in any manner so as to become subject to the CITY BUSINESS UCENSE#
workees compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the%yoirker's compensation provisions of5ection 3700 of the Labor
Code,I shall co ply 14 those provisions Will the applicant or future building occupant handle hazardous material or a
Applica tT: I I ____ (9/0&/( mixture containing a hazardous material equal to or greater that the
—2=�7 — amounts specified on the Hazardous Materials Information Guide?
WARNIW-FJ�ILLIRE`TO' S'ECURE WORKER'S COMPENSATION COVERAGE IS a Yes 'F/�.
H40
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 forguideli es
CONSTRUCTION LENDING AGENCY ElYes Zo
1 hereby affirm that under the penalty of perjury there Is a construction Will the proposed building or modified facility he 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) Dyes �6Nci
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 He lth,&safety codeisection 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the hazardous m I na p
checkma rk(s)I have placed next to the applicable item(s)(Section 7031.5 uYes 16-0
Business and Professions Code).Any city or county that requires a permit to —Date
construct,after,improve,demolish or repair any structure,prior to its ER dRAdTHORIZED AGENT
issuance,also requires the applicant for the permit to file a signed statement
that he or she is licensed pursua nt to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING IRRPI
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-certifled 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 wv�w.epa.goyllead 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 Contractor's State License Law does not apply to an owner of a u An EPA Lead-Safie 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 bemuse:
ci 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's 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
t� -I'Vlenifee
DATE PERMIT/PLAN CHECK NUMBER P
TYPE: OCOMMERCIAL ORESIDENTIAL OMULTI-FAMILY OMOBILEHOME 0 POOL/SPA 0 SIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-N UMBER OF SQUARES
DESCRIPTION OF WORK
PROJECTADDRESS 70
o So Lo,,oto a.,- O� zlje=jd)�c
ASSESSOR'S PARCEL NUMBER -7
;�� - JLJ( -OWLOT <g TRACT 7A4010-5
OWNERNAME ,. )OCOIUIA j0kV754nV-?
ADDRESS 2 1 '9,0 Lodoqo, lnel,414-e_�
PHONE L:7F) -S I -q5 3 9 \JAIL
APPLICANT NAME r) al 5�� Y-/, --�
ADDRESS ��(D �()E (<� /e9tr�-O L�,
PHONE D EMAIL
CONTRACTOR'S N E 16dd I t,-) OWNERBUILDER? 0YESkNO
�LA—m
� C)
BUSINESS NAME T
ADDRESS �� ?0CS7- /"*-i &V A-V V, C-t-C
PHONEIP��T o- 6(oif EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ )j-Z,�r: � SQv /a ) (, L SO FT
APPLICANT'S SIGNATURJ[��" Zyf
DATE
C/TY STAFFUSEONLY
DEPARTMENT DISTRIBUTION CITY UF MENIFEE BUSINL�5 LICENSE NUMBER
BUiLDING PLANNING ENGINEERING FIRE I GREEN SMIP
INVO E-T
)]C 16% PAIDAMOUNT CASH 0 CHECK# 0 CREDIT CARD VISA/MC
AMOUNT
PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building &Sojet,v Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
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