PMT16-03704 City of Menifee Permit No.: PMT16-03704
29714 HAUN RD.
'5i\CCELA—> MENIFEE, CA 92586 Type: Residential Addition
...... MENIFEE Date Issued: 11/1712016
P E R M I T
Site Address: 27944 LUCERNE DR, MENIFEE, CA Parcel Number: 333-730-012
92585 Construction Cost: $6,500.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 1 Tx 60'SOLID ALUMAWOOD PATIO COVER WITH 3 FANS
Work:
Owner Contractor
GUADALUPE IVAN WEST COAST SIDING&TRIM
27944 LUCERNE DRIVE 675 LACEY OAK DIRVE
MENIFEE, CA 92585 CORONA, CA 92881
Applicant Phone: 9517353379
DANIEL SULLIVAN License Number:615917
WEST COAST SIDING&TRIM
675 LACEY OAK DIRVE
CORONA, CA 92881
Fee Description Qtv Amount($1
Receptacle, Switch,Outlet&FWure 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 1 630
$300.95
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
spedfications or from preventing builiding 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 wristruction 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.Bk1g_Perrnft—Template.rpt Page I of I
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts forthe 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).
Chapter!)(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure under the Contractor's State License Law for
Professions Code icense is in full form and effect. the following reason:
License Class yl� Ucens"o. By my signature below I acknowledge that except for my personal residerim
Expires 17 )& in which I must have resided for at least one year prior to completion of
Signature I
improvements covered by this permit.I cannot legally sell a structure that I
WORKEWS COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed In Its entirety by
ci I hereby affirm under penalty of perjury one of the fiallowmg declarations:I licensed contractors.I understand that a copy of the applicable law,Section
have and will maintain a certificate of consent of self-insure for worker's 7044 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 welasite:
by Section 3700 of the Labor Code,for the performance of work for which
this permit is issued. www.leginfo.ca.gov/calaw.htmL
Policy If Date
o 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 ci By my signature below I certify to each of the following:I am the property
this permit is issued.My worker's 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
with all applicable city and county ordinances and state laws relating to
Carrier VArJ -ft � building construction.I authorize representatives of this city or county to
Policv#/D.AV/( 7 �)M C1 Expires —- E/1 .11 enter the above identified property for inspection purpose,s.
(This section need not to be completed is the permit Is for one,hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
Acertify that in the performance of the work for which this permit is issued,
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's compensation lais. of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the mre
10,7s cpbpenslftlon provisions of Section 3700 of the Labor
Code,I shall for J h w h t se provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant !Y11 I I /I mixture containing a hazardous material equal to orgmater that the
1. IV" Date I amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS Oyes ONG
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applIca nt or futu re building
AND CIVIL FI NES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQUID)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY a Yes a No
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) o Yes o No
OWNER BUILDER DECLARATIONS I have mad the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the California Health&Safety Code,Section 2SSOS 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 ciYes ci 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 PROPERTY OWNER OR AUTHORIZED AGENT
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 EPA RENOVATION,REPAIR AND PAINTING IRRPI
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 . . ampensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by receiving c
residence or childcare facility to be RRP-certified firms and comply with
an Applicant for a permit subjects the applica nt to a civil penalty of not mom required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
ci 1,as owner of the proparty�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.gowflead 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 Contractoes State License Law does not apply to an owner of a o 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 sa le. a No EPA Lead-Safe Certified Firm is required forthis project because:
o 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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION 0�4
"Menifee
DATE 11/1-) Lxt PERIMIT/PLAN CHECK NUMBER D�A
TYPE: OCOMMERCIAL ORESIDENTIAL 0MULTI-FAMILY OMOBILEHOME OPOCILISPA OSIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES—
DESCRIPTION OF WORK R166 z,�W LivmvIon,) �(0 (OLI(r
— -)45 5F- flo� il'o 8"=,Pt.
PROJECTADDRESS j,i(eriAe- Ar, lj�g 0
ASSESSOR'S PARCEL NUMBER !6,7Z- '730 - njQ LOT TRACT NIOV 17 2016
OWNER NAME )�,I,& Lion -A
bl-;'46 , - �;eeeivweu
ADDRESS vdovv IjrJl(-1
PHONE EMAIL
APPLICANT NAME
ADDRESS 1,(Iy C)!�J(, af.
PHONE - q?jLl EMAIL
CONTRACTOR'S NAME &r-6� 5C)i�4 kl'r OWNER BUILDER? 0YESJFN0
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ 6,50D sc.FT 'M LSQFT
APPLICANT'S SIGNATURE X DATE
"I Awl"0- ME I
DEPARTMENT DISTRIBUTION CITY OF MENIFFE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE
AMOUNT je300-CI�5 PAID AMOUNT &X A-5 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC
I
PLAN CHECK FEES P�IDAMOUNT 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line-951-246-6213
A�uwv;�wrc) QAzo (ovff 4-
(coc p)( - \\AoVe 5 LvouWuk >
t, 0
PL C
C.
City ot Menifee
Building & Safety Dept tj
NOV 17.2016
L
LEDGER & TRACK Received C
ALI
INSPECTION REQUIRED
CITY OF MENIFEE
BUILDING. AND SAFETY DEPARTMENT
PLAN AP PROVAL
'A
REVIEWED BY-.& OX /
MTE It
'Approval of these plans shall not be construed to be a pemdtfKoran C
approval of,any violation of any provisions of tie federal,st*or dty wo
regulations and ordinances. This set of approve I plans mitst be kept on the
<
_j"until completion.
Al
low
�b