PMT16-03722 City of Menifee Permit No.: PMT16-03722
29714 HAUN RD.
<A_CCiEUA_> MENIFEE, CA 92586 Type: Residential Addition
MENIFEE Date Issued, 11/18/2016
P E R M I T
Site Address: 26689 WESTBROOK CT, MENIFEE, CA Parcel Number: 338-321-001
92586 Construction Cost: $2,600.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 306 SQ FT SOLID ALUMAWOOD PATIO COVER, NO ELECTRICAL
Work:
Owner Contractor
KEVIN MEN PSLO INC
26689 WESTBROOK CT 28910 RANCHO CALIFORNIA RD
MENIFEE, CA 92586 #206
Applicant Phone: 9517954260
JOSH HERRICK License Number 919885
PSLQ INC
28910 RANCHO CALIFORNIA RD
#206
TEMECULA, CA 92590
Fee Description Qtv Amount 1$)
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
$168.65
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 canied 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_PermftTempIate.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)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from ficensure under the Contractoes State License Law for
Professions Code aAmy license is in full force and effect. the following reason:
License Class License N By my signature below I acknowledge that,except for my personal residence
in which I must have resided for at least one year prior to completion of
Expires 7 - Signature —fl�
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
a 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 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 website:
by Section 3700 of the Labor Code,for the performance of work for which www.1eRinfo.m.Rov/caIaw.htrnI.
this permit is Issued.
Policy# Date
PROPERTY OWNER OR AUTHORIZED AGENT
in I have and will maintain worker's compensation insurance,as required by
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 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 relating to
Carrier 7pw+ R�T�h� leV0 fli building construction.I authorize representatives of this city or county to
PoIk:Y#I,A-'1 JC)OC.07.57- Expires )-]Z- 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
o I certify 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# 0
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worke!r's c nsation provisions of Section 3700 of the Labor
Code,I shall forthwith c ith-thoseprovi.sions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
Applicant_ Date amounts spe !fled on the Hazardous Materials Information Guide?
MSICURi�W®RKER'S COMPENSATION COVERAGE 15 0yes
WARNING:FAILURG 20
UNLAWFUL,AND SHALL SUBJECT 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 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 ISCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguldelmes
CONSTRUCTION LENDING AGENCY 0 Y� ow�o'
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 06,
OWNER BUILDER DECLARATIONS I have read 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&Safie n 25505 and 25534 concerning
e,Sectio
Contractor's License Law for the reason(s)indicated below by the h za ous material rep rti
checkmark(s)I haveplaced next to the applicable item(s)(Sectlon7031.5 Vea, in No
Business and Professions Code).Any City or county that requires a permitto C� ON Date ))A1 A
construct,alter,improve,demolish or repair any structure,priorto its PROPERTY OW—NER Gfk-#VHORIZED AGENT
issuance,also requires the applicantforthe permittofile a signed statement
that he orshe is licensed pursuaritto the provisionsof the Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRP)
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-certified firms and comply with
an Applicant for a permit subjects the applicant to a civil pena Ity of not mare required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
n 1,as owner of the property,or my employee with wages as their sole employees.For mare information about EPA!s Renovation Program visit:
compensation,will do( )all of or( I portion of the work and the structure is wwwepa.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 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 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 Certiflution 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:
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 you r project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
Jill
DATE PERMIT/PLAN CHECK NUMBER
TYPE: COMMERCIAL rRESIDENTIAL [-]MULTI-FAMILY E]MOBILEHOME [-]POOL/SPA [:]SIGN
SUBTYPE: [:]ADDITION EJALTERATION [JDEMOLITION [—]ELECTRICAL [-]MECHANICAL
[]NEW OPLUMBING El RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK A �Um4��A "dA F d
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER LOT uppel TRACT �040-I
PROPERTY OWNER'S NAME V-ev�, n III-en
A D D R E SS j-y� �')0,�I lu\,) 0� /^1 40 Q) 52 A
PHONE -4 EMAIL
APPLICANT NAME L�r)Eo n 615
ADDRESS K� Torlecja, 9250
PHONE 951- EMAIL
CONTRACTOR'S NAME rC4.r7 OWNERBUILDER? [-]YESONO
BUSINESS NAME
[ADDjR
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ R, kao SO.FT og L SO FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION SMIP 10 CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN
INVOICE 110(j. (013
AMOUNT I PAID AMOUNT 0 CASH 0 CHECK# OCREDITCARD VISA/Mc
PLAN CHECK FEES I PAID AMOUNT 0 CASH 0 CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 No DL NUMBER NOTARIZED LETTER 0 YES 0 NO
4ewfe�-: 3u;!&ng & sofety 0eportnitnt 29714 I-I'lLm Rd- i'llenifee, CA 92586 951-672-�;777
ww-mcit��ofrnenifee.Lis InsocctiOn Request Lint� 951-246-65213
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