PMT16-03398 City of Menifee Permit No.: PMT16-03398
29714 HALIN RD.
<A-CCiELA-> MENIFEE,CA 92586 Type: Residential Addition
MENIFEE Date Issued: 10114/2016
P E R M I T
Site Address: 25867 BETH DR, MENIFEE, CA 92584 Parcel Number: 358-232-015
Construction Cost: $5,000.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 23X23'DETACHED SOLID ALUMAWOOD PATIO COVER WITH 1 FAN
Work:
Owner Contractor
BEN NOVELL JAMIE AVILA LANDSCAPE
25867 BETH DR 27171 WICKERD RD
MENIFEE, CA 92584 MENIFEE,CA 92584
Applicant Phone: 9517575964
JAIME AVILA License Number: 838428
JAMIE AVILA LANDSCAPE
27171 WICKERD RD
MENIFEE,CA 92584
Fee Description City Amount
Receptacle, Switch,Outlet&Fixture 1 116.00
Building Permit Issuance 1 27.00
DeckJPatio, 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 5.80
$290.45
The issuance of this pe"itshall not preventthe building official 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.fildg2eant-Template-ript 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).
Chapterg(commencing with section 7000)of Division 3 of the Business and a I am exern pt from licensure under the Contra ctor's State License Law for
Professions Code and my license is In full force and effect. the following reason:
License Class—(27 7� License No. By my signature below I acknowledge that,except for my personal residence
Expires //8 Signature in which I must have resided forat least oneyear priorto completion of
4-- &_
WORKER'S COMPENSATION DE N improvements covered bythis permit.I cannot legallysell a structurethat 1
6� have built as an owner-builder if it has not been constructed in its entirety by
a I hereby affirm under penalty of perjury one of the following declara i s:I licensed contractors.I understand that a copy of the applimble law,Section
have and will maintain a certificate of consent of self-insure for worker's 71344 of the Business and 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.m.gov/calaw.litmi.
Policy# Date
a I have and will maintain worker's 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 workees compensation Insurance carrier and policy owner or authorized to act an the property owner's behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
Carrier Z3�Gt�-r c&— with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# Z t!Q Expires enter the above identified property for inspection purposes.
(This section need not to be completed is the permit"is fo'4ne'liuridred
dollars($100)or less Date
�4certffy that In the performance of the work for which this permit is issued, PROPERTY OWNER OR AUTHORIZED AGENT
/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 shall fin e provisions. Will the applicant or future building occupant handle hazardous material or a
Applican N Date mixture containing a hazardous material equal to orgreater that the
amounts specified an the Hazardous Materials Information Guide?
S T4V
WAR ET WORKERS COMPEN A 10
WMWai�"Oi�U�E ayes 0 No
UNLKWFaL—,AND SHALL SUBJECr AN 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 SECTION 3706 OF TH E LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)?See permitting checklist
forguldellnes
CONSTRUCTION LENDING AGENCY ciYes oNci
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 boundary of a school?
(Section 3097 Civil Code) a Yes a No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under theState of
I hereby affirm under penalty of perjury that I am exempt from the California Health&Safety Code,Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)Indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 ayes a No
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
issuance,also requires the applicant for the permit to file a signed statement PROPERTY OWNER OR AUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING IRRP)
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
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-cartified firms and comply wilth
an Applicant for a permit subjects the applica nt to a civil penalty 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
a 1,as owner of the property,or my employee vorith wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work and the structure is www.epa.goyllead 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 a An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through em ployees'or personal effort,builds or Improves the
property provided that the improvements a re 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 bemuse:
a 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractoes 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
...........
ik.V -SIDENCE
�500 50. F-T-
A E5 GATE
CC
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION 14�
""Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL AESIDENTIAL OMULTI-FAMILY OMOBILEHOME 0 POOL/SPA SIGN
SUBTYPE: OADDITION OALTERATION O- DEMOLITION OELECTRICAL OMECHANICAL
)KNEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES_
DESCRIPTION OF WORK P70 !� )&tIAI
-a 7;iI�
f-mn C/
PROIEcTADDRESS �Z-5'F �� &14 pr M", o564
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME
ADDRESS __ Z_5
&7414 le,
PHONE EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME Ada OWNERBUILDER? OYESMO
BUSINESSNAME
ADDRESS :2 7 1%
PHONE Av )ea)(30 '
EMAIL [j)
L
CONTRACrOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ Vf&4 SO FT 22-L;( LSQFT
APPLICANT'S SIGNATURE
answFusEmy
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BU51NESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN —SMIP
INVOICE
AMOUNT PAIDAMOUNT OCASH OCHECK# 0 CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menijee, CA 92SB6 951-672-6777
www.cityofmenifee.LIS Inspection Request Line 951-246-6213