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PMT16-03707 City of Menifee Permit No.: PMT16-03707 29714 HAUN RD. Type: Residential Addition <A-CCIELJ� MENIFEE, CA 92586 MENIFEE Date Issued: 11/17/2016 P E R M I T Site Address: 27756 POINTE BREEZE DR, MENIFEE, Parcel Number; 333-352-003 CA 92586 Construction Cost: $3,000.00 Existing Use: I &2 Family Residence Proposed Use: Description of INSTALL 12'x 47'SOLID ALUMAWOOD PATIO COVER VIATH 2 FANS,6 LED RECESSED LIGHTS, 3 Work: POST LIGHTS Owner Contractor TIM&SUSAN TIEKEN PRO INSTALLATION 27756 POINTE BREEZE DRIVE 43043 CAMINO CARUNA MENIFEE, CA 92586 TEMECULA, CA 92592 Applicant Phone:7142348652 TOM MOORE License Number.895950 PRO INSTALLATION 43043 CAMINO CARUNA TEMECULA, CA 92592 Fee Description Qtv Amount(S) Receptacle, Switch,Outlet&Fixture 11 166.00 Building Permit Issuance 1 27.00 Deck[Patio, non-standard 1 133.00 GREEN FEE I 1�00 SMIP RESIDENTIAL 1 1.00 General Plan Maintenance Fee-Building 1 6.65 General Plan Maintenance Fee-Electrical 1 8.30 $342.95 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 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 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. AA6_B1dg_Parm1t-Temp1ate.rpt 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)pursua nt to the Contractors State License Law). Chapterg(commencing with section 7000)of Division 3 of the Business and m I am exempt from licensure underthe Contractor's State License Law for Professions Code and my license is in full force and effect. the folloWing reason: License Class (3 12�, License No. By my signature below I acknowledge that,except for my personal residence T_ _ — Expires nature inwhich I must have resided for at least one year priorto completion of .51 g)ij t it 1 Sig ee� improvements covered bythispermit.I cannot legally sell a structurethatl WORKER'S COMPENSATION DECLARATION'/V have built as an owner-builder if It has not been constructed in it entirety by ci I hereby affirm under penalty of perjury one of the following 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 workees 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 website: by Section 3700 of the Labor Code,for the performance of work for which this permit is issued. www.leRinfc,.ca.gov/calaw.Iitml. Policy# Date .,,2<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 on 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 relatingto Carrier Mfd building construction.I authorize representatives of this city or county to Policy#A.A 54'7-7 Expires I enter the above identified property for inspection purposes. (This section need not to be completed is the permit is for one-hundred Date dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT ci I certify that in the performance of the work for which this permit is issued, I shall not emp] any persons in any manner so as to become subject to the CITY BUSINESS LICENSE$t worker's compensation[am of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subjectto the worker's compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a Applicant Date mbaurecontal Ing a hazardous material equal to or greater that the amountssp fied on the Hazardous Materials Information Guide? No WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS 0 Yes 5? UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the a pplkant or future building AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),1 N ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant req uIre a permit for the construction or modification from South IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)?See permitting checklist forguideli CONSTRUCTION LENDING AGENCY 0 Yes nl;N:o I hereby affirm that under the penalty of perjury there is a construction Will the prop ed building or modified facility be within 1000 feet of the lending agency for the performance of the work which this permit is issued outer bou Zmsy of a school? (Section 3097 Civil Code) o Yes 7No OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQNID I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of Contractor's License Law for the reason(s)Indicated below by the Ca lifornia Hea Ith&Safety Code,Section 25505 and 25534 conce n Ing checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous la'lerfair rting. Business and Professions Code).Any city or county that requires a permit to. oyes construct,alter,improve,demolish or repair any structurej prior to its issuance,also requires the applicant for the permit to file a signed statement PROPERTY E%NEFW AUTHORIZED AGEN that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRPJ 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 ficensure receiving compensation for most work that disturbs paint in a pre-1978 a nd the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply With an Applicant for a permit subjects the applica rit to a civil pena Ity of not more required practices.This includes rental property owners and property than($Soo). managers who do the paint-disturbing work themselves or through their o 1,as owner of the propeft 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 I I 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 1-80G-424-LEAD(5323). Code;The Contractor's State License Law does not apply to an owner of a ci 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. m No EPA Lead-Safe Certified Firm is required for this project because: u 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 PERM IT/PLAN CHECK APPLICATION "'Menifee DATE PERMIT/PLAN CHECK NUMBER TYPE: C COMMERCIAL P(RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POCL/SPA 0 SIGN SUBTYPE: OADDITION OALTERATION ODEMOUTION OELECTRICAL OMECHANICAL CNEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES— DESCRIPTION OF WORK W\A"0 0 �]___Pvlk+�G (20 Gx4-1 A PV* N00!5 %J PROJECTADDRESS Z-)-7 &' _Q_UzL d"/(-- elzv�- ASSESSOR'S PARCEL NUMBER wo-Ims LOT TRACT OWNER-NAME I lAA ADDRESS PHONE EMAIL APPLICANT NAME m6c\u ADDRESS �?, (� w 7- -AAA PHON(_�tL��41Z- �53-3� EMAIL L S4PX N 0 CON RACTOR'S NAME OWNERBUILDER? OYE BUSINESS NAME ADDRESS 4,�6 (�Wj 6 Ld )v� PHONE�� -1 - � EMAIL CONTRACTOR'S STATE LIC NUMBER 56 LICENSE CLASSIFICATION Dd 3 VALUATION$ 1�660 SO FT L SO FT APPLicANrs SIGNATURF.�pY.1-,J-,J-,�l—,::2i DATE CITY STAFF USE OA.'iY DEPARTMENT DISTRIBUTION Ll I Y U�MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE I GREEN I I INVOICE ��.05 PAIDAMOUNT 0 CASH OCHECK# 0 CREDIT CARD VISA/MC AMOUNT PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO City of Menifee Building& Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777 www.cityofmenifee.us Inspection Request Line 951-246-6213