PMT16-02965 City of Menifee Permit No.- PMT16-02965
29714 HAUN RD.
-�A—CCIELA> MENIFEE, CA 92586 Type: Residential Addition
MENIFEE Date Issued: 0910712016
P E R M I T
Site Address: 25428 WAGON TRAIL LN, MENIFEE, CA Parcel Number: 358-440-009
92584 Construction Cost: $4,500.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 420 SO FT SOLID ALUMAWOOD PATIO W/ELECTRICAL 2 FANS,2 POST LIGHTS
Work:
Owner Contractor
VICTOR ARELLANO PSLQ INC
25428 WAGON TRAIL LN 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 CL
q Amount
Receptacle,Switch,Outlet&Fixture 4 131.00
Building Permit Issuance 1 27.00
Deck/Patio, non-standard 1 133.00
GREEN FEE 1 1.00
SM(P 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 orfrom preventing builiding operations being carried on thereunderwhen 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.
AkBIdgPermit—Template.ript Page I of 1
City Of Menifee
LICENSED DECLARATION 0 lam 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 and license i.s in full force and effT�, which I must have resided for at least one year prior to completion of
License Class -iceqsp/ND. 'I improvements covered by this permit,I cannot legally sell a structure that I have
Expires fitnature t--
built as an owner-building if it has not been constructed In its entirety by licensed
erstand that a copy of the applicable law,Section 7044 of the
WORKER&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; htti3.*/Auww.leginfo.ca.novlmlaw.htmI
compenserion,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 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 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 workers'ecimpensation insurance carder and policy number are: with all applicable city and county ordinances and state laws relating to building
Carrier Z14 construction.I authorize representatives of this city or county to enter the above-
d identified property for the inspection purposes.
Policy# W0110N)NI Expires___7 7� 62 -/ I—) Date
LI-11 ZY Property Owner orAuthorized Agent
(This section need not be comple Ed&the permit is for Cr
one-hundred dollarT(�100)or less) City Business License# z�q03
0 1 certify that in the performance of the work for which this permit is issueu,I HAZARDOUS MATERIAL 13ECLARATION
shall not emol 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
th pR rs'compensation provisions of Section 370D of the Labor
subject to a wo amounts spegified on the Hazardous Materials Information Guide?
Code,I shall o h comply ith those provisions.
Ely 0-90,
t;
Applica Will the intended use of the building by the applicant or future building
occupant require a permit for the construction or modification Inorn South
WARNING: FAILURE TO SECURE WORKERS' CDastAir Qua"anagement District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL forguideliDes'
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, Willtheproposed lid66 or modified facility be within 1000 feet of the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of=01,011?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES b'NO
CONSTRUCTION LENDING�GENCY I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm that under the penalty of pedury there is a construiction lending permitting checklist.I unclegatand my requirements under the State of
agency for the performance of the work which this permit is issued (Section California He Code,Sectton 25505 and 25534 concerning
3097 Civil Code) hazardous=1 reporting.
OWNER BUILDER DECLARAT16NS DY
I hereby afflan under penalty of peijury that I am exempt from the Contractor's Date
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OVINER ORAUVORIZED AGENT
next to the applicable item(s)(Section 7031.5.13usiness and Professions Code:
Any city or county that requires a permit to construct,alter,improve,demolish, EPA RENOVATION,REPAIR AND PAINTING(RUP
or repair any structure,prior to its issuance,also requires the applicant for the
permit to file a glimed 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 Division 3 of the Business and Professions Code)or that he or residence or childcare facility to be RRP-cerlified 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 any Applicant for a permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a evil penalty of not more than($500).) employees.For more Information about EPNs Renovation Program visit:
www.epa.gov/lead or contact the National Lead Information Center at
11 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( )porling of the work,and the structure its
not intended or offered for sale.(Section 7044,Business and Professions Code; GLVV-a�
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 property,
provided that the improvements are not intended or offered for sale.If,however Certified Fimi 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
purpose of sale). Firm Certification No.:
0 1, as owner of the property an exclusively contracting with licensed 0 No EPA Lead-Safe Cerlified 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
who builds or improves thereon, and who contracts for the projects With a
DATE 7 -) PERMIT/PLAN CHECK NUMBER 1(0- Mel
TYPE: El COMMERCIAL E11RESiDENTIAL F]MULTI-FAMILY OMOBILEHOME [:]POOL/.5PA []SIGN
SUBTYPE: []ADDITION DALTERATION r_JDEMOLITION DELECTRICAL DMECHANICAL
E'NEW F]PLUMBING [:]RE-ROOF-NUMBEROFSQUARES
DESCRIPTION OF WORK VcRZ)Ad T)Vvz)
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PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER ��6'g AW-001 LOT TRACT
PROPERTY OWNER'S NAME Vj(^
OS
ADDRESS _A ,'�qAk :77&4)LL 4 A)4 L�-`
PHONE 9.:i'/— 5-9 — q i�010 EMAIL
APPLICANTNAME Z, NO/1) 7-//L,),/
ADDRESS (F-)/q
PHONE IL
D OWNERBUILDER7 []YES[4Ne
CONTRACTOR'S NAME
BUSINESSNAME LLI-c"
ADDRESS 9.1;�9
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ SQ FT q�0 LSQFT
APPLICANT'S DATE
CITY STAFF USE ONLY
XPAR I MIzNT DISTRIBUTION IFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN 10 1 SMIP Ilea 77777
INVOICE
AMOUNT PAID AMOUNT -- CASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC_
OWNER BUILDER VERIFIED OYES 0 No DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd Menifee, CA 92585 951-672-6777
www.citypfmenifee.us Inspection Request Line 951-246-6213
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