PMT16-03361 City of Menifee Permit No.: PMT16-03361
29714 HAUN RD.
<A_CCEL:A> MENIFEE, CA 92686 Type: Residential Addition
MENIFEE Date Issued: 10/12/2016
P E R M I T
Site Address: 27829 PORTAL WAY, MENIFEE, CA Parcel Number: 333-700-045
92585 Construction Cost: $2.500.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 250 SO FT LATTICE ALUMAWOOD PATIO COVER
Work:
Owner Contractor
LARRY HICKS SUPASITES CONTRACTING
27824 PORTAL WAY 208 NORTH VIOLET STREET
MENIFEE, CA 92585 CORONA, CA 92882
Applicant Phone:9514546478
BENJAMIN TAMEIFLINA License Number:706861
SbPASITES CONTRACTING
208 NORTH VIOLET STREET
CORONA, CA 92882
Fee Description Qtv Amount
Building Permit Issuance 1 27.00
Deck/Pafio, 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 official from thereafter requiring the correction of effors 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�BIdg_PemritTemplate.rpt Page I 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 a in under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter!)(commeneing with section 7000)of Division 3 of the Business and a I am exempt from ficensure under the Contractor's State License Law for
Professions Code and my license Is in full force and effect. the following reason:
'? 7276 2?(- /�
License Class I � & Uc 5 Se.go— By my signature below I acknowledge that,except formy personal residence
Expires 5 Signature in which I must have resided for at least one year prior to completion of
f=4Z 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
o I hereby affirm under penalty of perjury one of the following clecla rations:I licensed contractors.I understand that a copy of the applicable law,Section
have a Ind will maintain a certificate of consent of self-insure for worker's 7044 of the Business a Ind Professions Code,is available 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.html.
Policyff ez Date
o I have and will maintain workees compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which a By my signature below I certify to each of the following:I am the property
this permit is issued.My worker's compensation insurance ca rrier and policy owner or authorized to act on the property ownees behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
Carrier 5tM_--1_e 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 above identified property for inspection purposes.
(This section need not to be completed Is the permit is for one-hundred
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT Date
a I certify that in the performance of the work for which this permit is issued,
Ishallnotemmil any persons in any manner so as to become subject to the CITY BUSINESS LICENSE if
workerrs ccimpensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to'heffiFeFE's�pens tion provisions of Section 3700 of the Labor
Code,I shall in �,
in ft�h th se provisions. Will the applicant or future building occupant handle hazardous material or a
' 1 mixture containingA hazardous material equal to or greater that the
Applicant Date X,� amountssp 61fied on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURY/ZORKER'S COMPENSATION COVERAGE IS o Yes Y-No
UNLAWFUL,AND SHALLSUBJECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
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 SECrION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)?See permitting checklist
forguideli
CONSTRUCTION LENDING AGENCY u Yes X
I hereby affirm that under the Pena Ity 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 bound ry of a school?
(Section 3097 Civil Code) ci Yes 71
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 underthe State of
Contractor's License Law forthe reason(s)indicated below by the California Hea h&5 f Code,Section 25505 and 25534 concerning
ous malt S!P
ha t, - � __-
checkmark(s)I haveplaced next to the applicable item(s)(Section7031.5 ;es ON 0 Ing.
Business and Professions Code).Any city or county that requires a permit to Date /10
ccinstruct,alter,Improve,demolish or repair any structure,prior to its M/0
issuance,also requires the applicant for the permit to file a signed statement PROPERTY OWNER OR AUTHMIZED AGENT
that he or she Is licensed pursue nt to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING JRRP)
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[!censure receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Section 703 1.5 by residence or childcare facility to be RRP-certlfied firms and comply with
a It Applicant for a perm it 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 themselves or through their
o 1,as owner of the property,or my employee With wages as their sole 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.gov/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 Contmctoes State License Law does not apply to an owner of a a An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through 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. a No EPA Lead-Safe Certified Firm is required for this project because:
ci 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.
& SAFETY PERMIT/PLAN CHECK APPLICATION
Wenifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL * RESIDENTIAL 0MULTI-FAMILY OMOBILEHOME 0 POOL/SPA 0 SIGN
SUBTYPE: OADDITION CALTERATION ODEMOLITION OELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES-
DESCRIPTION OF WORK _A-WqALNp0lp T>Ai-\n cNov— I jff-x�9
PROJECTADDRESS W" aJC,�t Ft�p, CA �,?54iq
ASSESSOR'S PARCEL NUMBER tm-lco LOT TRACT
OWNER NAME m cj:��
ADDRESS elhL� VVAy &Ag�N I F-vq� I r-Ae
PHONE EMAIL
APPLICANT NAME
ADDRESS 90E \110L=I�� S-r CA
PHONE EMAIL 64DI VAe-AA rVcL P Q0 c 0 k"
CONTRACTOR'S NAME -P
,?Ol�:rPCMLN -rjWJtn?tAl\,A OWNERBUILDER? CYESONO
BUSINESS NAME SX I-e>A 51 J-J�Q e-rDN-rW-A 45FI Nk,-
ADDRESS 7,09 !�,T CA 25 9,
PHONE (q(�;Q EMAIL
CONTRACTOR'S STATE LIC NUMBER 54Q(0 1 LICENSE CLASSIFICATION
VALUATION$ 2/E�,VQ�j Q FT L SQ FT
(z/Sc
I APPLICANT'S SIGNATURE DATE
CITYSTAFF USE ONLY
ULPARTMLNT DISTRIBUTION
BUILDING PLANNING ENGINEERING FIRE I GREEN � Ito SMIP 10 CITY OF MENIFEE BUSINESS LICENSE NUMBER
INVOICE
AMOUNT PAIDAMOUNT
I I OCASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT I I OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 No DILNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Budding&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-0'777
www.cityofmenifee.us Inspection Request Line 951-246-6213