PMT16-03020 City of Menifee Permit No.: PMT16-03020
29714 HAUN RD.
<—ACCIELA—> M ENIFEE, CA 92586 Type: Residential Addition
MENIFEE Date Issued: 09/1212016
P E R M I T
Site Address: 25914 LAZY CLOUD WAY, MENIFEE,CA Parcel Number: 335-500-035
92685 Construction Cost: $6,900.00
Existing Use: 1 &2 Family Residence Proposed Use;
Description of INSTALL 540 SQ FT SOLID ALUMAWOOD PATIO COVER WELECTRICAL 2 FANS,2 LIGHTS
Work:
Owner Contractor
JAMES&KIMBERLY QUIROZ PATIO GUY ALUMAWOOD CONTRACTOR
25914 LAZY CLOUD WAY 41197 GOLDEN GATE CIR STE 108
MENIFEE,CA 92585 M URRI ETA, CA 92562
Applicant Phone:9513330056
LOIS MONTINI License Number:872839
PATIO GUY ALUMAWOOD CONTRACTOR
41197 GOLDEN GATE CIR STE 108
MURRIETA,CA 92562
Fee Description Qtv 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
SMIP 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 offidial from thereafter requiring the correction of errors in the plans and
specifications or from preventing buillding 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_81dg_Perrnit Ternplate.rpt Page I of 1
City Of Menifee
LICENSED DECLARATION
I hereby affirm under penalty or perjury that I am licensed under provisions of 0 1, as owner of the property an exclusively contracting With licensed
Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044,Business and Professions
Professions Code a my license is in full fog d�ff Code:The Contractor's License Law does not apply to an owner of a property
4
License Class_;97�License No. who builds or improves themon, and who contracts for the projects With a
Expires Le (10ignature licensed contractor(s)pursuant to the Contractors State License Law).
WORKER&COMPENSATION DECLARATION 0 1 am exempt from licensure under the Contractors'State License Law for the
0 1 hereby affirm under penalty of pedury one of the folloWing declarations: following reason:
I have and will maintain a certificate of consent of self-insure for workers' By my signature below I acknowledge that,except for my personal residence in
compensation,issued by the Director of Industrial Relations as provided for by which I must have resided for at least one year prior to completion of
Section 3700 of the Labor Code, for the performance of work for which this improvements covered by this permit,I cannot legally sell a structure that I have
permit is issued. built as an owner-building if it has not been constructed in its entirety by licensed
Policy# contractors. I understand that a copy of the applicable law, Section 7D44 of the
0 1 have and will maintain workers' compensarion insurance, as required by Business and Professions Code,is available upon request when this application is
section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:http:/Avww.leqinfo.m.no�LiolawhImI
permit is issued.My workers'compensation insurance carder and policy number are:
Carder Property Owner or Authorized Agent Date
Expire37: Policy#
Name of Agent Phone# 0 By my Signature below, I certify to each of the following: I am the property
owner or authorized to act on the property owner's behalf. I have read this
(This section need Do
I be completed if the permit is for application and the Information I have provided is correct. I agree to comply
one-hundred dollars(S100)or less) with all applicable city and county ordinances and state laws relating to building
construction.Athorize representatives of this city or county to enter the above-
0 1 certify that in the performance of the work for which this permit is issued,I identi y I r a inspection urposes.
shall not employ any persons in any manner so as to become subject to the
workers'compensation laws of California, and agree that if I should become
subject to the workers�compensation Provisions of iAdon 3700 of the Labor
Code,I shal)forthwith comply with those provisions. Props,ty Owj le, DrAuthorized Agerit" Date
City Business License 0
Date; Applicant
WARNING; FAILURE TO SECURE WORKERS, HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDING
($100,000), IN ADDITION TO THE COST OF COMPENSATION, [�YES OCCUPANT HANDLEA HAZARDOUS MATERIAL ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGEN SPECIFIED ON THE HAZARDOUS MATERIALS
I hereby affirm that under the penalty of perjury there is a construction lending INFORMATION GUIDE?
agency for the performance of the work which this permit is issued (Section WILL THE INTENDED USE OF THE BUILDING BY THE
3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE
Lender's Name EIYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION...
—SaGM-THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address ONe' DISTRICT(SCAQMD)SEE PERMITrING CHECKLIST FOR
GUIDE LINES
OWNER BUILDER DECLARATIONS PRINT NAME,
I 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 OYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable item(s)(Section 7031.5. Business and Professions Code: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A
Any city or county that requires a permift to construct, alter, improve, demolish, 11!�.�L?
or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the
provisions of the Contractor's State License Law(Chapter 9 (commencing with I HAVE READ THE HAZARDOUS MATERIAL
Section 7000)of Division 3 of the Business and Professions Code)or that he or [3YES INFORMATION GUIDE AND THE SCAOMD PERMITTING
she is exempt from licensure and the basis for the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREMENTS
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to D t__UNDER-THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not mom than(5500).) CA07DIE IECT�10 HIS 25533 AND 25534 CONCERNING
)OUS
0 1. as owner of the property, or my employees with wages as their sole H _ARD R AZIAEPOWYING.
I R A GE
not intended or offered for sole.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property
compensation,will do( )all of or( )porting of the work, and the structure is
who, through employees' or personal effort, builds or improves the property,
provided that the Improvements are not intended or offered for 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 not built or Improved for the
purpose of sale).
& SAFETY PERMIT/PLAN CHECK APPLICATION
2--'M e n i fe e
AZ�,
DATE 9 11-111IZ6 PERMIT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL #RESIDENTIAL 0MULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION 0DEMOUTiON OELECTRICAL OMECHANICAL
@NEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
L I
PROJECTADDRESS 4
ji, 42
ASSESSOR'S PARCEL NUMBER Lof TRACT' o-Z3 o4
4
OWNERNAME &,jqLej
c.le I
ADDRESS c--o lz I—'A -,
PHONE /Y V,3 EMAIL () '
APPLICANT NAME
ADDRESS_
PHON EMAIL
CONTRAcroWS NAME OWNER BUILDER? 0 YES 0 NO
-A
BUSINESSNAME 2-6cez�� A#-, 4A�
ADDRESS
PHONE �?�1\ 333-40,7-6 EMAIL41rjAffic
CONTRACTOR'S STATE LIC NUMBER 9"l 083 9' LICENSE CLASSIFICATION
VALUATION $ 6 9'L),6 SO FT LSQFT
ANT'S SIGNATURE 0
t-7 DATE
"PLIC jjx-271V
CITYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION SM,p CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN
INVOICE
INT F!� PAID AMOUNT
AMOUNT 606;Lo I 1 0 CASH 0 CHECK# a CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT I 1 0 CASH 0 CHECK# 0 CREDIT CARD 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 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
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city Oj menlieO opt.
Building & Sawy D
CZLUL Fb r--S P 2.-7 LA-fft 12 2016
Received
LEDGER & TRA 'A
49"'PECTION REQUIRED
a SPIDT L)6)44'T-S
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LUMU An" DEPARTIME�N'T
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REVIEWED BY
'Apprn,val of these plans�hjo rropd tc tP.1 r1rM4 foi.of ir,
3U,11111 of,any violatfor, �! iii. m v ;,, j�'h, 1%1,i,,,
mbloations and ordinances. T,.�5 ,'(j;d.0,0!0 L:'I Pl.,ns
jobsite until completion,
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