PMT16-03663 City of Menifee Permit No. PMT1 6-03663
29714 HAUN RD. Type: Residential Addition
<A-CCF-L:A> MENIFEE, CA 92586
MENIFEE Date Issued: 11/10/2016
P E R M I T
Site Address: 29100 FOGHORN CT, MENIFEE, CA Parcel Number: 333-341-018
92585 Construction Cost: $3,400.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 452 SIF SOLID ALUMAWOOD PATIO COVER OATH 2 FANS
Work:
Owner Contractor
ADAM KURYLOWCZ PATIO GUY ALUMAWOOD CONTRACTOR
29100 FOGHORN COURT 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 2 121.00
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 6.05
$295.70
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 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 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 BIdgPermit-Ternplate.rpt Page 1 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 project(Section 7044,Business and Professions
Professions Code arto my license is in full Foy
ga d If t Code:The Contractor's License Law does not apply to an owner of a property
License Class—/, ) License No. Mun ? who builds or improves thereon, and who contracts for the projects With a
Expires Le (gignature licensed contractor(s)pursuant to the Contractors State License Law).
WORKER&COMPENSATION DECLARATION
El I am exempt from licensure under the Contractors'State License Law for the
0 1 hereby affirm under penalty of perjury 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# built as an owner-building if it has not been constructed in its entirety 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
section 370D of the Labor Code. for the performance of the work for which this submitted or at the following Web site:httpi/hvww.Igginfo.ca-clov/calaw.html.
permit is issued.My workers'compensallon insurance carrier and policy number are:
Carder Property Owner orAulhorized Agent Date
Explre;:� Policy#
Name of Agent Phone# L11 0 By my Signature below, I certify to each of the following: I am the property
owner or authorized to act an 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 dollars($100)or less) with all applicable city and county ordinances and state laws relating to building
construcflon.Athodze 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 S.
shall not emplo 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 iAtion 3700 of the Labor 0 Dale
Code.I shal)forthwip comply with those pm islons. Property OwAr or Authorized Agent
Date; Z//q //,4�Applicant;_ �/City Business License#
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, OYES OCCUPANT HANDLEA HAZARDOUS MATERIALORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES 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 (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
rRAWTHE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address DWe" DISTRICT(SCAQMD) SEE PERMITTING CHECKLIST FOR
OWNER BUILDER DECLARATIONS GUIDE LINES
I hereby affirm under penalty of perjury 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 rile 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 SCAOMD PERMITTING
she is exempt from licansure 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 0 __U�THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) COD� SECTIO 25505. 25533 AND 25534 CONCERNING
0 1, as owner of the property, or my employees with wages as their sole H DOUS M RIAL REPOi�YING.
compensation, will do( )all of or( )porting of the work,and the structure is P R GE
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder Will have the burden of proving that it was not built or improved for the
purpose of sale).
DATE PERMiTIPLAN CHIELK NUMBER
TYPE: QCOMMERCIAL VRESIDENTIAL QMULTI-FAMILY PMOBILEHOME QFQOV5PA OSIGN
SUBIYPL: UAL)VIIIUN UALIERATION ()DEMOLITION CIELELTRICAL OMECHANILAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DEESUPPOW OF 040" Z 'VX 1 0 L/J')
L-Q Mq I-L) 0/
PA 7 7 Z) D ZC-24 `Wikli 9 & Safety E
CA C ty ot MenifeE
mwwrADDRESS HPA, rL) 0�2- 095S6
[IV J 0 2011
ASSESSOR'$PARCEL NUMBER C)kcF LOT TRACT
OWNERNAME Z A Wye 7
ADDRESS A9/ 1)
PHONE 9,Y/- 39,9 qQq EMAIL
APFUCANTNAME
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ADDRESS fic
PHONE 7'
EMAIL
CONTRACTOWS NAME ��',pbayn owsvmh,�
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BUSINESS NAME I 41-1t,Tzb P�:,- v
ADDRESS r)E J71 Ledo 1-
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IPHONE o F FA A I I J
CONTPACrOrf5$TATE UC NVIVIDER d6 LICENSE CLA$SIFICA-noN
JVALUATION$ aq6l) SO.FT L SQ Fr
APFUCANTISSIGN nlRr DATE
DRAMEWDsnuoUTHM CffYC;FW00:EE6UsmmZLK33MNUMBR
OU LD NG PLANN NG ENGWEERING FIRE GREEN
INVO I
PAID AMOW
AMOUN'r - 0 OWZK 8 OCREWCARD ASAJW
0 C&SH -3 affix* amw� v&vuc
OWNER BURDER VERIFIED 0 YES 0 NO DIL NUMBER NMARIZEDLErrER 0 YES 0 mo
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LEDGER & TRACK
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INSPECTION REQUIRED
city ot Menifee
&T�h,) b4D,& E ilding & Safety Dept.
Sll::�G B1 NOV 10 2016
Received
Sm.wr Lit) &.1
FA w -5
LPr�WMEMFEE PARTMENT
SAFETY DE
REVIEWED By DAR 6
DAII 09
1
tobea rM!tfOTOran
e
*Approval ot these plans ShIll no-,be construed to be a city 0000
ny provj s of state or
r sions of ORA ,state or city
approval of,any violation of any p OVI a ept on th
,h t 01 apprL
0 ans u
f "12" qst be kept on th,�
dpl
regulations and ordinances. Thiswtul
jobsite until cOmPletion'
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