PMT16-02871 City of Menifee Permit No.: PMT1 6-02871
< _6CELA> 29714 HAUN RD. Type: Residential Addition
A MENIFEE, CA 92586
MENIFEE Date Issued 08130/2016
P E R M I T
Site Address: 28541 MOON SHADOW DR, MENIFEE, Parcel Number: 364-144-006
CA 92584 Construction Cost: $5,189.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 12'x 40SOLID ALUMAWOOD PATIO COVER WITH 1 FAN
Work:
Owner Contractor
TONY AKFURK AMERICAN HOME REMODELING INC
28541 MOON SHADOW DRIVE 4375 PRADO RD SUITE 108
MENIFEE,CA 92584 CORONA. CA 92880
ApplIcant Phone:9515200654
DAN STINSON License Number:807029
AMERICAN HOME REMODELING INC
4375 PRADO RD SUITE 108
CORONA, CA 92880
Fee DescrIption ON Amount
Receptacle, Switch,Outlet&Fixture 1 116.00
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 5.80
$290.46
The issuance of this permit shall not prevent the building official from thereafter requiring the corTecrion 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 construcrion 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_PerrniLTemp1ate.rpt Page 1 of I
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 contractcr(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and u I am exempt from licensure under the Contractor's State License Law for
Professions Cociland my license is in full force and effect. the following reason:
License Class— I t> Licen By my signature below I acknowledge that except for my Personal residence
Expires3_31— &—Signature
in which I must have resided for at least one year prior to completion of
WORKERS COMPENSATION DECLARATIO��'>� improvements covered by this permit,I cannot legally sell a structure that I
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 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 website:
by Section 3700 of the Labor Code,for the performance of work for which
this permit is Issued. vvww.IegInfo.ca.gov/caIaw_htmI.
Policy# Date
a I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the La bor 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 worker's compensation insurance carrier and policy owner or authorized to act on the property owner's beha If.I have read this
number ar application and the information I have provided is correct.I agree to comply
Carrier with all applicable city and county ordinances and state laws relating to
Expires �/ / building construction.I authorize representatives of this city or county to
Pollcye��5_ I enter the above identified property for Inspection purposes.
(This section need not to be completed is the permit is for one-hundred
dollars($100)or less Date
a I certify that in the performance of the work for which this permit is issued, PROPERTY OWNER OR AUTHORIZED AGENT
I shall not=elo,.sa7,n
personsm any manner so as to become subject to the CITY BUSINESS UCENSE#
Pe .0
_ 1"�
,of
worker's co 4laomia,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
ws of
subject to the w4 e 5 cornice V X provisions of Section 3700 of the Labor
ii�
Code,I shalljbrl;)��I'h it ose provisions. Will the applicant or future building occupant handle hazardous material of a
7
Appllcant!c Date 65, 1�'4 mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
LF4111RE TO SECURE WORKER'S COMPENSATIICD�V�ERAGE IS a Yes a 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
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)?See permitting checklist
for guidelines
CONSTRUCTION LENDING AGENCY o Yes cy No
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified hicifitv 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) n Yes o No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractor's License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkma rk(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material reporting.
Business and Professions Code).Any city or county that requires a permit to oYes a No
construct,alter,improve,demolish or repair any structure,prior to its Date—
issuance,also requires the applicant for the permit to file a signed statement PROPERTY OWNER OR AUTHORIZED AGENT
that he or she is licensed pursuant 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
and the basis for the alleged exemption.Any violation of Section 7031.5 by receiving compensation for most work that disturbs paint In a pre-1978
an Applicant for a permit subjects the applimml:to a civil penalty of not more residence or childcare facility to be RRP-certified firms and comply with
than($500). required practices.This Includes rental property ownersand property
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 Renovatmn Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.epa.Royllead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-80D-424-LEAD(5323).
Code;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 o An EPA Lead-Safe Certified Renovator willl be responsible for this project
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
completion,the Owner-Builder will have the burden of proving that it was Firm Certification No.:
not built or improved for the purpose of sale. o No EPA Lead-Safe Certified Firm Is req ulned for this project beca use:
o 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.
'Wenifee
D A T E PERMIT/PLAN CHECK NUMBER etm 0 -
TYPE: COMMERCIAL NESIDENTIAL 0MULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OAD�ITION CALTERATION 0DEMOUTION OELECTRICAL CIMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES—
DESCRIPTION OF WORK L'3� led 6U�(f
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER 3!�Z1- IZ1400,-, LOT TRACT
OWNER NAME 16 Y
C�'Ly menite ,
ADDRESS suil Ing & SaMty 1),pt.
PHONE c? EMAIL AUG 3 0 20%
APPLICANT NAMIEDe�,o r-% - -
ADDRESS 1-1vuelve(l
PHONE EMAIL
coNTRAcroWSNAME ��J�MrOC
_, OWNER BUILDER? 0 YESj��C,
BUSINESSNAME
5-
ADDRESS 2�1 2 �/—& OIL 10 re C-�D r-01�7 a�
PHONE 6,2 SLI EMAIL
CONTRACTOR!S STATE LIC NUMBER -7(:� LICENSE CLASSIFICATION
VALUATION$ L SQ FT
APPLICANT'S SIGNATU RE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMi'ER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP J— I
INVOICE PAID AMOUNT I C
AMOUNT "-)qo-LA5� I oq 0 0 CASH 0 CHECK# - REDITCARD VISA/MC
PLAN CHECK FEES I PAIDAMOUNT I OCASH OCHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Sofety Deportment 29714 Houn Rd. Menifee, CA 92586-951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-5213