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PMT16-03212 City of Menifee Permit No.: PMT1 6-03212 29714 HAUN RD. Type: Residential Addition <A—CCEU� MENIFEE,CA 92586 MENIFEE Date Issued: 09/28/2016 P E R M I T Site Address: 29526 MOORINGS CT, MENIFEE, CA Parcel Number: 333-710-055 92585 Construction Cost: $3,000.00 Existing Use: 1 &2 Family Residence Proposed Use: Description of INSTALL 346 SO FT SOLID ALUMAWOOD PATIO COVER WELECTRICAL 1 FAN,4 POSTILIGHTS Work: Owner Contractor DERRICK SAXTON PATIO GU�ALUMAWOOD CONTRACTOR 29526 MOORINGS CT 41197 GOLDEN GATE CIR STE 108 MENIFEE, CA 92585 MURRIETA, CA 92562 Applicant Phone:9513330056 LOIS MONTINI License Number.872839 PATIO GUY ALLIMAWOOD CONTRACTOR 41197 GOLDEN GATE CIR STE 108 MURRI ETA,CA 92562 Fee Description City Amount Receptacle, Switch,Outlet&Fixture 5 136.00 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 $304.65 The issuance of this permit shall not prevent the building official from thereafter requiring the correction of emors in the plans and specifications or from preventing building 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 Templaterpt Page 1 of 1 City Of Menifee LICENSED DECLARATION I hereby affirm under penalty or perjury that I am licensed under provisions of 13 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 ag f my icense is in full f)oa a 9 If t Code:The Contractor's License Law does not apply to an owner of a property License No. c� License Class who builds or improves thereon, and who contracts for the projects with a Expires te-,9 licensed contractor(s)pursuant to the Contractors State License Law). WORKER&COMPENSATION DECLARATION E) I 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 compleflon 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 7044 of the 0 1 have and Vill maintain workers' compensation 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:hftp,il�.leginfo.ca.gov/calaw.html permit is issued.My workers'oumpensation insurance carder and policy number are: Carder Property Owner orAuthonzed Agent Date Expire 37: Policy# Name of Agent Phone# 0 By my Signature below, I certify to each of the following: I am the property to act on the property owner's behalf. I have read this (This dection need not be completed if the permit is for application and the information I have provided is correct. I agree to comply one-hundred dolIws—(`S1 00)or less) with all applicable city and county ordinances and state laws relating to building construcrion.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 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 9 subject to the workers'compensation provisions of igdon 3700 of the Labor Code,I shal forthwi comp,ly with those provisions. Property Owr(er'or Authorized AgeW 0 Date T ��J City Business License 9 44 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 HANDLE A HAZARDOUS MATERIALORA DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL LABOR CODE, INTEREST,AND ATTORNEYS FEES 949--M—UAL TO OR GREATER THAN THE AMOUNTS CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS I hereby affirm that under the penalty of pedury 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 DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION.. .,_-F-RMHE SOUTH COAST AIR QUALITY MANAGEMENT; Lender's Address DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR OWNER BUILDER DECLARATIONS GUIDE LINES I hereby affirm under penalty of pedury that I am exempt from the Contractor's PRINT NAME License Law for the reason(s)indicated below by the checkmark(s)I have placed DYES 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 permit to construct, alter, improve, demolish, 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 []YES INFORMATION GUIDE AND THE SCAQMD PERMITTING she is exempt from ficensure 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��THE STATE OF CALIFORNIA HEALTH AND SAFETY a civil penalty of not more than($500).) CODE, SECTIO 25505, 25533 AND 25534 CONCERNING CI 1, as owner of the property, or my employees with wages as their sole HAZARDOUS M RIAL REPWYING. compensation,will do( )all of or( )porting of the work, and the structure is PROP R A GE not intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's State License Law does not apply to an owner of a property X who, through employees' or personal effort, builds or improves the property, provided that the Improvements are not intended or offered for sale.If.however. the bOi ding or Improvement is sold Within one year of completion, the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). LAG L41E Y, LEDGER & TRACK !NSPECTION REQUIRF. C)ity of Menliee Building & Safety r aPt- FA*b cm ta r c—L SEP 2 14S is"T.- Receives d 401 Sep.pr - ell-F-Crmt1c . A&MA-0 BUILDING AND SAFETY DEPARTMENT ^N�Wib L rli -�& L IL I fg n r V I G DATL A 0 o roval of these plans sh a 11 n ot be constnied to be a permit h oran dMInq), it 3nv violation of aw,oro,,i5ions of the federal,state( city C "'Ipproved I plansmustbe ept on the 7& t1a)ml;Z)LOjj6k XAI�Z) w 4+,D r- rA r-b e—W w U'll hNT,0 BUY 40maomb Cq4Aj 46t e 14� 4 11 "Wri�- VL C'A IbPO S 'S L)re--" 4 -got 13-1 is LODrk CDfAp-,1l1MS44ft 47D:Var r Menifee DATE PERMIT/PLAN CHECK NUMBER TYPE: OCOMMERCIAL' 9;�RESIDENTIAL OMULTI-FAMILY OMOBILEHOME 0 POOLAPA 0 SIGN 5U5lYPI:: UADL)IIION UALTERAHON uulimuffiuN ,— ELECTRICAL vmtCHANICAL -WK-EW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK 7X /3 . 17xl:�' A�9,0 120V,�5t� - / FAd- Li 4S7- PROJECT ADDRESS ASSESSOR'S PARCEL NUMBER LOT TRACT OWNER NAME AuLIKESS cekq o�A e—:r. PHONF EMAII APPLICANT NAME Z�) A97�//k-) ADDRESS PHONE EMAIL CONTRACTOR'S NAME 2WNER BUIlDERl 0- YES &-Nfb BUSINESS NAME t) v ADDRESS 6� A-M� O�A(2 ,4w&, PHONE CONTRACTOR'S STATE LIC NUMBER 46 ?Qla LICENSECLASSIFICATION VALUATION$ SO FT q3 L SO FT APFLiCANT'S SIGNATURE DATE DEPARTMENT DISTRIBUTION SMIP I (Vo I CITYOFMENIFEESU INESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN INVOICE_F PAIDAMOUNT 1 0 CASH AMOUNT 0 CHECK# OCREDITCARD VISA/MC PLAN CHECK FEES PAID AMOUNT I I 1 0 CASH 0 CHECK# El CREDIT CARD VISA/MC OWNER BUILDER VERIFIED 0 YES 0 No DL NUMBER NOTARIZED LETTER 0 YES 0 NO