PMT16-02895 City of Menifee Permit No.: PMT16-02896
29714 HAUN RD. Type: Residential Addition
<A-CCEiLA> MENIFEE,CA 92586
MENIFEE Date Issued: 08131/2016
P E R M I T
Site Address: 30457 SHENANDOAH CT, MENIFEE, CA Parcel Number: 358-441-012
92584 Construction Cost: $3,075.00
Existing Use: I &2 Family Residence Proposed Use:
Description of INSTALL 280 SQ FT SOLID ALUMAWOOD PATIO COVER WELECTRICAL 1 FAN,2 POST LIGHTS
Work:
Owner Contractor
VICTORIA PAYNE PSLQ INC
30457 SHENANDOAH CT 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 Qtv Amount
Receptacle, Switch,Outlet&Fixture 3 126.00
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 6.30
$300.95
The issuance of this permit shall not prevent the building offidal 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_Bldg_Permit Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION 0 [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 and7y license i.s in full force and eff which I must have resided for at least one year prior to completion of
License Class 'Iceqsp/,No. 7�1/ improvements covered by this permit,I cannot legally sell a structure that I have
built as an owner-bullifing if It has not been constructed in its entirety by licensed
Expires-2--Z ignature e_� contractors.I understand that a copy of the applicable law,Section 7044 of the
WORKERS'COMPENSATfON DECLARATION Business and Professions Code,is available upon request when this application is
0 1 hereby affirm under penalty of perjury one of the following clecia submitted or at the following Web site:
rations: http*.Il�.leginfo.m.ciovlmlaw.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 or Authorized Agent
Policy# 11 By my Signature below, I certify 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 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.Myworkers'compensafion insurance carder and policy number are: With all applicable city and county ordinances and state laws relating to building
construction.I authorize representatives of this city or county to enter the above-
Carrier a47�9-d/-2,_ identified property for the inspection purposes.
Poficy# W0,10Z)D6,61 Expires: Date
Property Owner crAuthorized Agent
L_/141 Qq:f-qQ3
(This section need not be completedlif the permit is for
one-hundred dolIari_(_$1 00)or less) City Business License#
HAZARDOUS MATERIAL DECLARATION
0 1 certify that in the performance of the work for which this permit is Issued,I
shelf 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 bewme mixture containing Oazardous material equal to or greater that the
r-s'compensation provisions of Section 3700 of the Labor
subjec amounts spec9fiefif on the Hazardous Materials Intonation Guide?
'on those provisions.
m
"o'he wo� P
Code,I shall bil .. I DYES 0-90
Applic ate.—A-d Will the intended use of the building by the applicant or future building
Z7;NT occupant require a pormit for the construction or modification from South
WARNING: FAILURE TO SECURE WORKERS' Coast Air Qualanagement District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE 15 UNLAWFUL, AND SHALL forguidellues'
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 lId,-ngor modified facility be within 1000 feet of the outer
)f 00
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of DoR
"9��
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES bNO
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 und9otand my requirements under the State of
agency for the performance of the work which this permit is issued(Section California Health&
Code,Section 25505 and 25534 concerning
3097 Civil Code) hazardous&-ACnal reporting.
OWNER BUILDER DECLARAT16NS / A� Date
1 hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OWNER OR At 414ORIZED AGENT
next to the applicable item(s)(Section 7031.5.Business and Professions Code:
Any city or county that requires a permit to construct, after,improve,demolish, EPA RENOVATION,REPAIR AND PAINTING fRRPI
or repair any structure, prior to its issuance. also requires the applicant for the
pernilit to file a 5igned statement that he or she is licensed pursuant to the The I 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 fadifify to be RRP-certified finas 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($500).) employees.For more Information about EPA!s Renovation Program visit:
www.epa.gov/lead or contact the National Lead Information Center at
13 1, as owner of the property, or my employees with wages as their sole 1-800-424-LEAD(5323).
compensation,Vill do( )all of or( )porting of the work,and the structure is *
not intended or offered for sale.(Section 7044,13usmess and Professions Code; Gvele_*�_
The Contractor's State Uicense Law does not apply to an owner of a property 0 An EPA Lead-Safe Certified Renovator will be responsible for this project
who, through employees'or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If.however Certified Firm Name:
the building or improvement is sold within one year of completion,the Owner-
Burilder Vill have the burden of proving that it was not built or improved for the Firm Certification No.:
purpose of sale).
0 1, as owner of the property an exclusively contracting with licensed 0 No EPA Lead-Safe Certified Firm is required for this project because:
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's License Law does not apply to an owner of a property
�Vienitee
DATE PERMIT/PLANI CHECK NUMBER
TYPE: OCOMMERCIAL PJRE�SIDENTIAL []MULTI-FAMILY [:]MOBILEHOME [:]POOL/SPA E]SIGN
SUBTYPE: F]ADDITION DALTERATION [-]DEMOLITION DELECTRICAL FIMECHANICAL
[]NEW F]PLUMBING El RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK —.A ;W,4AIVMC,�av� 57e;IA
4 '51 k\v, \ S�An ;? ea,;4 hk�lr 4
PROJECTADDRESS �aq�:l �A-Inqh�oi%VI Lh
ASSESSOR'S PARCEL NUMBER LOT 0,71 TRACT
PROPERTY OWN ER'S NAME Vdy,e
ADDRESS -;0454 sb+,k�&A�m L-,,
PHONE EMAIL �wr-,-Lon�t*AmQf@ YkVt)�.r--Or�
APPLICANTNAME 1,015
ADDRESS ;�T\NO
PHONE EMAIL
CONTRACTOR'S NAME OWNERBUILDER? 0YES[:]NO
BUSINESS NAME f,6t-,kJ
ADDRESS YIIA.,C3 09\11S�C.14. YN�-
PHONE 951 1`15- LIA66 EMAIL
CONTRACTOR'S STATE LIC NUMBER I)IIII LICENSE CLASSIFICATION
VALUATION$ '3()15 SO.FT 0?S0 L SQ FT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION IOU CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILaING PLANNING ENGINEERING FIRE GREEN 1,0 SMIP
INVOICE �5w .ojs PAIDAMOUNT
AMID NT I I OCASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMIDUNT 0 CASH 0 CHECK# 0 CREDrf CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 No DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-5777
www.cityo/menifee.us inspection Request Line 951-246-5213
*7
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