PMT16-03022 City of Menifee Permit No.: PMT16-03022
29714 HAUN RD. Type: Residential Addition
<A-CCELA—> MENIFEE,CA92586
MENIFEE Date issued: 10107/2016
P E R M I T
Site Address: 31391 MANILO CT, MENIFEE, CA 92584 Parcel Number: 360-611-035
Construction Cost: $7,000.GO
Existing Use: 1 &2 Family Residence Proposed Use:
Description of CONSTRUCT ENGINEERED PATIO COVER 360 SO FT NO ELECTRICAL
Work:
Owner Contractor
KIM KAMERIN WOOD BUILDERS CONSTRUCTION ING
31391 MANILO CT 7191 SARSAPARILLA DRIVE
MENIFEE,CA 92584 CORONA, CA 92881
Applicant Phone: 9517357617
BRUCE MANGOLD License Number.376902
7191 SARSAPARILLA DRIVE
CORONA, CA 92881
Phone:9513122737
Fee Description Qtv Amount
Building Permit Issuance 1 27.00
Deck/Patio, non-standard 1 133.00
Inspections not specified 258 258.14
Additional Plan Review Electrical 105 105.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 1.00
General Plan Maintenance Fee-Building 1 6.65
$531.79
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 Bidg_Permit—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).
Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure under the Contractor's State License Law for
Professions Code the following reason:
'8 my license is in full force and effect.
License Class License a. 07(090 By mysignature below I acknowledge that,except for my personal residence
Expires Velc Signatur in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I
have built as an owner-builder if it has not been constructed in its entirety by
o I hereby affirm under penalty of perju ry 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 a nd Professions Code,is availa ble upon request 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 performance of work for which
this permit Is issued. www.leginfo.ca.goy/calaw.litmi.
Policy# Date
by PROPERTY OWNER OR AUTHORIZED AGE NT
)a-L,have and Will maintain worker's compensation insurance,as required
section 3700 of the Labor Code,for the performance of the work for which c 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
with all applicable city and county ordinances and state laws relating to
Carrier building construction.I authorize representatives of this city or county to
enter the above identified property for inspection purposes.
Policy# Expires 7
(This section need not to be completed Is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
ci I certify that in the performance of the work for which this permit is issued,
I shall not employ any persons in any manner 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 Labor
Code,I shal arthw omply with t as p��Mlons. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
Applican Date amounts ffied on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECt4E WORKER'S COMPENSATI V(RAGE 15 0 Yes
UNLAWFUL,AND SHALL SUBJECr AN EMPLOYER TO CRIMINAL PENA K
LTIES Will the intended use of the building by the applica nt or future building
AND CIVIL FINES UP TO ONE H UNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQM D)?See permitting checklist
I N SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES farguldeljAes
CONSTRUCTION LENDING AGENCY 0 01�0
I hereby affirm that under the penalty of perjury there 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 b d ry of a school?
(Section 3097 Civil Code) a Yes XZ
OWNER BUILDER DECLARATIONS I have mad the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirin under penalty of perjury that I am exempt from the California Health&Safety Code,Section 05 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the hazardouispaterial reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 0—Yes
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,prior to its UTHORIZEDAGENT
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 EPA RENOVATION,REPAIR AND PAINTING(RRP)
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)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
a nd the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and corn ply with
an Applica nt for a permit subjects the applicant to a civil pena Ity of not more required practices.This includes rental property owners a nd property
than($500). managers who do the paint-disturbing work themselves or through their
o 1,as owner of the property,or my employee with wages as their sale employees.For more information about EPA's Renovation Program visit:
compensation,will do( I all of or( )portion of the work,and the structure is www.epa.jzov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a o An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,th rough em ployees!or persona I 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 bu rden of proving that it was
not built or improved for the pu rpose of sa le. o No EPA Lezid-Safie Certified Firm is required for this project because;
ci 1,as owner of the property am exclusively contracting wfth licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contmctor's State License Law does not apply to an owner of a If your project does not com ply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
M e n i f e e
DATE PERMIT/PLAN CHECK NUMBE]Rvvqlb-01503c�o-
TYPE: []COMMERCIAL EIRESIDENTIAL F]MULTI-FAMILYE]MOBILEHOME []POOL/SPA E]SIGN
SUBTYPE: E]ADDITION E]ALTERATION [-]DEMOLITION E]ELECTRICAL [-I MECHANICAL
FINEW E]PLUMBING [:1 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK 3670 5o �, 0 41ZCI o4 P4--�7 D Co Lj
PROJECTADDRESS 111 3'2 /-1 () C-4,
ASSESSOR'S PARCEL NUMBER LOT TRACT
PROPERTY OWNER'S NAME A--4 M 0
ADDRESS '75 / 5 92 1 /,7,4/u L, C4,
PHONE 5-5-r7 - -7 -7 9(o EMAIL
APPLICANT NAME 61te-, c-rj; llz-7,4A_)C7 r)L
ADDRESS -7/ 9 2Z�A�-5; � al lx-E-1/
PHONE 96-1- -31 EMAIL 6mvjncxtbt4[c(e#-sPyAk0
CONTRACTOR'S NAME e�e�e�7JCJJ) 46C-1 Cic:i-v S.-A �W-NERBUILDER? OYESRfNO
BUSINESS NAME
ADDRESS 7/ (fb&a� C4- '� 2-J-V
PHONE -7-3 �7 EMAIL
CONTRACTOR'S STATE LIC NUMBER 3 '26902- 0 LICENSE CLASSIFICATION
VALUATION$ 7676'0- 0 0 sQ FT L SO FT
APPLICANT'S SIGNATURE D E
AT
DEPARTMENT DISTRIBUTION CITY OF MENIFEE.BUSINESS LICEVSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN 100 SMIP Ir 4711-;0-11(0
INVOICE PAID AMOUNT
AMOUNT =(05 1 1 0 CASH 0 CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT I 1 0 CASH 0 CHECK# 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 92586 951-572-5777
www.city,ofmenifee.us Inspection Request Line 951-246-6213