PMT16-03286 City of Menifee Permit No.: PMT16-03286
29714 HAUN RD. Type: Residential Addition
<A—CCELA> MENIFEE,CA92586
MENIFEE Date Issued: 10/0612016
P E R M I T
Site Address: 28403 FOX RIDGE CV, MENIFEE, CA Parcel Number: 333-571-016
92585 Construction Cost: $4,000.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 498 SF SOLID ALUMAWOOD PATIO COVER WITH 3 POST LIGHTS
Work:
Owner Contractor
TOM&ADLYNN MYERS PATIO GUY ALUMAWOOD CONTRACTOR
28403 FOX RIDGE COVE 41197 GOLDEN GATE CIR STE 108
MENIFEE, CA 92585 MURRIETA, 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 3 126.00
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 6.30
$300.95
The issuance of this pernnit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications or from preventing bulliding 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 pe"it 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_Pennit Template.rpt Page I of I
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 pmject(Section 7044,Business and Professions
Professions Code a my license Is in full lb a d ff t Code:The Contractoes License Law does not apply to an owner of a property
License Class—Z7�License No. who builds or improves thereon, and who contracts for the projects with a
Expires_te�- Z) (&gnature
licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
0 lam exempt from licensure under the Contrackirs'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
permit is issued. improvements covered by this permit,I cannot legally sell a structure that I have
Policy 9 built as an owner-building if it has not been constructed in its entrely,by licensed
contractors. I understand that a copy of the applicable law, Section 7044 of the
0 1 have and will maintain workers' compensation insurance, as required by Business and Professions Code.is available upon request when this application is
motion 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:httE).,//www.leoinfo.ca.govicalaw.htmI
permit is issued.My workers'compensation Insurance carder and policy number are:
Carrier Property Owner or Authorized Agent Date
Expire 57: Policy# 1p&�l �—'
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 not be completed if the permit is for application and the Information I have provided is correct. I agree to comply
one-hundred dollar�—($100)or less) with all applicable city and county ordinances and slate laws relating to building
construction.na thorize 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 identili y r a nspec on urposes.
shall riot employ any persons in any manner so as to become subject to the
workers'compensation laws of California,:ind agreeAhat If I should become
subject to the workers'compensation provi on ton 3700 olf the Labor
Code,I shal forthwit comply with those pro isions. Property Ow4ercrAuthortzed AgeW U -7 4q Date
Date; Applicant; /City Business license#
WARNING: FAILURE TO SECURE WORKERS' HAZARDOUS MATERIAL 13ECLARATION
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, E]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 NP*---EQ—UAI- TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY 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 (Secton WILL THE INTENDED USE OF THE BUILDING BY THE
3097 Civil Code) APPLICANTOR FUTURE BUILDING OCCUPANT REQUIRE
Lender's Name DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION..
Lender's Address --FROM-THE SOUTH COAST AIR QUALITY MANAGEMENT
DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR
OWNER BUILD R 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 OFA
Any city or county that requires a permit to construct, alter, improve, demolish, 11��v
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)or Division 3 of the Business and Professions Code)or that he or E]YES INFORMATION GUIDE AND THE SCAOMD 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 Qj__jJWDER-THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODIE SECTI10 ?,1,,515,25533.AND 25534 CONCERNING
lOUS M R AL P
0 1, as owner of the property, or my employees with wages as their sole HAZARD E ORTING.
compensation,will do( )all of or( )porting of the work, and the structure is i R A GE
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property
who, through employees' or personal effort, builds or improves the property,
provided that the Improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that it was not built or Improved for the
purpose of sale).
DATE 42 PERMIT/PLAN CHECK NUMBER P�,��,o - ?D-
TvPE,. 0 COMMERCIAL elfi-ESIDENTIAL Q MULTI-FAMILY Q MOBILE HOME Q POOLISPA, 0 510
SUBIYPL: UALJIJIIION uALTERATION ODEMOLITIUN 0ELECTRiCAL QMECHANiCAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DES PTIONOFWORK / 7 z� It
PROJECTADDRESS oaize>5
ASSESSOR'$PARCEL NUMBER —33 —,�]j 0\10 LOT LOt TRACT am F3 c) -2�
f�y))ji�R-5
'U /L
OWNER NAME k7-) Qf— 4—J
AUUKESS 4 .0 n vz-,�7- I
ng 1 vienife,
PHONE LP )q - EMAIL euil&J", 8, Sakty D,p,
APPLICANT NAME 4n, A,97-27 A2 OCT 0 6 2a.1-6
ADDRESS e c 61 ve—c)
PHONE EMAIL
CONTRACTOR'S NAME
-77.1 OWNERBUILDER? OYESVW07
BUSINESS NAME 71
ADDRESS L/// ?7 41 J4-M�
9c
w
PHONE �. MAI!La-da in Ca)0 g2ad P vni=ro
CONTRACTOWS STATE LIC NUMBER d6 C) LICEME CLAS51FIQATION
VALUATION$ qboz) SO FT _ I q99 LSQFT
APPLICANT'S SIGNATURE DATE C/,c*A-7 —J ,(v
il 1 1 ' '1". - 11 1100
DEPARTMENWT DIST I ION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP
INVOICE- PAIDAMOUNT
F
AMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYESO No DL NUMBER NOTARIZED LETTER 0 YES 0 Ng=�j
Ll
City of Menifee
Lj3rTT'E; aiety Dept.
iL\,1-7 n—r ilding & Safety Dept.
6 P% le-t 17- 1 LEDGER & TRACK OCT 0 6 2016
INSPECTION REQUIRE Fleceiver'
ILI '7
jw 2, letAcmite, U9 )-rT-S
CITY OF MENIFEE
L6AFETY EPAJ !MENT
"WV)qG LMPAFETY
PLAN APPROVAL
REVIEWED BY iiial
*Approval of these plans shall nA rued to be a wM for,or M
ap p royal of,an�violation of a ny p rovisi o of the W",90 or dtV
isio d plaot MW be kept on the
ofa
regulations and O"dHnances. This set rove
jobsite until completion
I&M&OLDAGIe� ZM) 1 70 1 9 kL4 e'!, �0 wri TAF 2� t-A e—*wi aw
-a 1 0 ja L �-J A—) MNJ L::-v WTI ockov
- - 7 , � I I IN 4 11 CM toiden Moe wrek 4001?
F-,O'x' )R )b2 4�- e__.b V G fjw-M��q. 9. qatba
:ni L=- A Bbnw. sure-4 4-calls-V&S
Loallve C-ZMP:140-soft. Azow- t
0.0-Ck 1-7