PMT16-02999 City of Menifee Permit No.: PMT16-02999
29714 HAUN RD. Type: Residential Addition
<A-CCELA—> MENIFEE,CA 92586
MENIFEE Date Issued: 0910912016
P E R M I T
Site Address: 28572 CHAUCER DR,MENIFEE,CA Parcel Number: 336-431-008
92584 Construction Cost: $2,640.00
ExistIng Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL SOLID 330 SO FT ALUMAWOOD PATIO COVER NO ELECTRICAL
Work:
Owner Contractor
DAVID HUMPHREY
28572 CHAUCER DR
MENIFEE, CA 92584
Applicant License Number:
DAVE HUMPHREY
28572 CHAUCER DR
MENIFEE, CA 92584
Phone:9494122801
Fee Description ON Amount($1
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
$168.65
The issuance of this permit shall not prevent the building officlial 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 othervVise 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_Pe"it 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).
ChapterSi(commenciing with section 7000)of Division 3 of the Business and a I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class License No. By my signature below I acknowledge that,except for my personal residence
Expires_Signature in which I must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
ti I hereby affirm under pena Ity 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 req uest 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 perfmma noe of work for which
this permit is issued. www.leginfo.ca.goy/calaw.htmi.
Policy# -Date
n I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which ci 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 behalf.I have read this
number are: 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
building construction.I authorize representatives of this city or county to
Policy# Expires enter the ab tffi it property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($101))or less
ROPERTY OWNEF(OR AUTHORIZED AGENT
o I certify that in the performance of the work for which this permit is issued,
I shall not employ any persons in any me nner so as to become subject to the CITY BUSINESS LICENSE#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the La hor
Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 ci Yes ti No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will th e intended use of the building by the applica nt or futu re build Ing
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(SCAQM D)?See permitting checklist
for guidelines
CONSTRUCTION LENDING AGENCY ciYes oNo
I hereby affirm that under the penalty of perjury them is a construction Will the proposed building or modified facility 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) oYes oNo
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 Low for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
hazardous material reporting.
checkmark(s)I have placed next to the applicable Item(s)(Section 7031.5 oYes o No
Business and Professions Code).Any city or county that requires a permit to
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 Contraictor'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(1111P)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-certified firms and comply with
a n Applicant for a permit subjects the applicant to a civil pena Ity of not more
than($500). required practices.This includes rental property owners and property
managers who do the paint-disturbing work themselires or through their
0 1,as owner of the property,or my employee with wages as their sole employees.For more information about EPXs Renovation Program visit:
compensation,will do I )all of or( )portion of the work,and the structure is www.epa.giry/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 70",Business and Professions 1-800-424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a n An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,th rough 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 because:
a 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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
-IN
Menifee
DATE c, PERMIT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL 0"RESIDENTIAL OMULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: -1-A-DDITION 0ALTERATION -DEMOLITION 0- ELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK 7,6
�5�3'x 1 ri
PROJECTADDRESS (?,A4UC4e,-
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME
ADDRESS .242-c- ?A
PHONE EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME 5 se e5:7av-e,-5 OWNER B91LDER?CK4S ONO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ -9-10q& SO,FT LSQFT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDiNG PLANNING ENGWEERING FIRE � GREEN SMIP
INVOICE 1 4&(0 1 PAIDAMOUNT
T� CASH 0 C
AMOUN HECK# 0 CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT CASH 0 CHECK# 0 CREDIT CARD VISA/MC
LOWNER BUILDER VERIFIED C)YES 0 NO DL NUMBER NOTARIZED LE17ER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-245-6213
01
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City of Menif ae
Building & Safet) Dept.
SEP 0 9 2)16
Receivipd
EDGER & TRACK
;NSPECTION REQUIRED
I
CIT r�F MENIFEE
MING AND SAFETY DEPARTMENT
N APPROVAL
!�EA IEWED BY
j,-,va!of these plans sn'l I! x �� 'f�strued tobe a Permitfor,or an -7a
I oval of,any violation Ot ap, Of the federal,state or city
Le,,ulxions
1 tN910Y3cJ L- t!�Ft dgavQd�pm must be kept on the
irusite until completion.
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