PMT16-02893 City of Menifee Permit No.: PMT1 6-02893
29714 HAUN RD. Type: Residential Addition
<ACCEiCA_> MENIFEE, CA 92586
MENIFEE Date Issued: 08131/2016
P E R M I T
Site Address: 30298 SILICATE DR, MENIFEE, CA 92584 Parcel Number: 360-810-052
Construction Cost: $2,825.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 320 SQ FT SOLID ALUMAWOOD PATIO COVER, NO ELECTRICAL
Work:
Owner Contractor
VIC ZAMBRANO PSLQ INC
30298 SILICATE DR 28910 RANCHO CALIFORNIA RD
MENIFEE,CA 92584 #206
Applicant Phone:9517954260
LOIS MONTINI License Number:919885
28910 RANCHO CALIFORNIA RD
#206
TEMECULA,CA 92590
Fee Description Amount(S)
Building Perrnit 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
$168.65
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 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.B1dg_Permjt_Temp1aterpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION 0 [am exempt from Doensure under the Contractors'State License Law for the
I hereby affirm under penalty or pedury 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 py license Is in full force andeffi�/ 9 ")5 which I must have resided for at least one year prior to completion of
License Class— Licerlse/No. 'I improvements covered by this permit,I cannot legally sell a structure that I have
Expires—Z-21-1 ignaturia built as an owner-building if it has not been constructed in its entirely by licensed
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
0 1 hereby affirm under penalty of pedury one of the following declarations* submitted or at the following Web site:
I have and will maintain a certificate of consent of self-insure for workers: htti).,Ilw�.leginfo.m.govlmlaw.htmI
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 orAuthorized Agent
Policy# 0 By my SlUnature below, I cerlify to each of the following:I am the property
0 1 have and Will maintain workers' compensation insurance, as required by owner or authorized to act on the property owners 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 workere compensation insurance carder and policy number are: with all applicable city and county ordinances and slate laws relatfing to building
construction.I authorize representatives of this city or county to enter the above-
Carrier fz,Z2�jd/2'_ identified property for the Inspection purposes.
Policy# Wo" ON)NI Expires Date
q�)Z/ Property Owner or Authorized Agent
(This section need not be completedilf the permit is for City Business Ucense# rr?�6403
one-hundred dollars7(S1 00)or Ws)
HA7ARDOUS MATERIAL DECLARATION
0 1 cerfify that In the performance of the work for which this permit is issued,I
shall not emnloy 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
subjec�to th woj� rsccompensation provisions of Section 370D of the Labor amoun on
go ad the Hazardous Materials Information Guide?
she those provisions. 0
a V om
Code,, n1pI DYES
Applic, Will the intended use of the building by the applicant or future building
occupant require a permit for the construction or modification from South
WARNING: FAILURE TO SECURE WORKERS' CoastAirQuali briagement District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidell
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES 0 NO
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed b ild-inigoir modified facility be Alhin 1000 feet of the outer
co
boundary of ool?
If
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE ".9=00
LABOR CODE,INTEREST,AND ATTORNEYS FEES DYES bNO
CONSTRUCTION LENDING�4GENCY 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 unqdg�mland my requirements under the State of
agency for the performance of the work which this permit is issued (Section California HealIh_4,Sffft5V Code,Section 25505 and 25534 concerning
3097 Civil Code) hazardous ifiatefial reporfing.
OWNER BUILDER DECLARAT16NS
I hereby affirm under penalty of pedury that I am exempt from the Contractor's Date 62
PROPERTY OWN
License Law for the reason(s)Indicated below by the checkmark(s)I have placed ERORALI 'ORIZEDAGENT
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 pigned 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 Divislion 3 of the Business and Professions Code)or that he or residence or childcare facility to be RRP-cerfified firms and comply with
she is exempt from ficensure and the basis for the alleged exemption. Any required practices.This Includes rental property owners and property
violation of Section 7031.5 by anyApplicant 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($500).) employees.For more Information about EPA!s Renovation Program Visit:
www.epa.gov/lead or contact the National Lead Infounation Center at
0 1, as owner of the property. or my employees with wages as their sole 1-800-424-LEAD(5323).
compensation,will do( )all of or( )porting of the work,and the structure Is . _W�
not intended or offered for sale.(Section 7044,Business and Professions Code; emm
The Contractor's State License Law does not apply to an owner of a property 0 An EPA Lead-Safe Certified Renovator will be responsible for this project
who, through employees' or personal effort, builds or improves the propertA
provided that the Improvements are not Intended or offered for sale.If,however Certified Firm Name:
the building or improvement is sold within one year of completion.the Owner-
Builder will have the burden of proving that it was not built or improved for the Firm Certification No.:
purpose of sale).
0 1, as owner of the property an exclusively contracting with licensed 0 No EPA Lead-Safe Certified Firm Is required for this project because:
contractors to construct the project(Section 7044.Business and Professions
Code:The Contractor's License Law does not apply to an owner of a property
DATE PERMIT/PLAN CHECK NUMBER PM-1 1(0 ., ()
TYPE: F-1 COMMERCIAL []RESIDENTIAL OMULTI-FAMILY E]MOBILE HOME El POOL/SPA []SIGN
SUBTYPE: F]ADDITION DALTERATION ODEMOUTION []ELECTRICAL F]MECHANICAL
[I]NEW F]PLUMBING F1 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK �C)
o, 1 - ��l NWAC-Uxcd
vlwse, vp
PROJECTAIDDRESS c 554
ASSESSOR'S PARCEL NUM BER LOT TRACT
PROPERTY OWNER's NAME V rnbra-Hib
ADDRESS
PHONE EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACPOR'S NAME OWNERBUILDER? DYESDNO
BUSINESS NAME
ADDRESS 22� 10 QaKf�0 (YU
PHONE C2311
0��6 EMAIL
I CONTRACTOWS STATE LIC NUMBER (6 V/qy&((�5 LICENSE CLASSIFICATION
VALUATION$ aSQ,5- !22 SQ FT �Vo L SO FT
APPLICANTS SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION C11YOF MENIFEE BUSINESSLICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE � GREEN SMIP
INVOICE
AMOUNT PAIDAMOUNT 0 CASH 0 CHECK# OCRED[TCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT OCASH OCHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 No DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586-951-672-6777
www.cityojmenifee.us Inspection Request Line 951-246-6213
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