PMT16-03739 City of Menifee Permit No.: PMT16-03739
29714 HAUN RD. Type: Residential Addition
4:Xccr=Lj-,;> MENIFEE, CA 92586
MENIFEE Date Issued: 1112112016
P E R M I T
SiteAddress: 29191 BLACK MEADOW CT, MENIFEE, Parcel Number: 333-431-011
CA 92585 Construction Cost: $2,000.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 220 SQ FT SOLID ALUMAWOOD PATIO COVER WIELECTRICAL 1 FAN
Work:
Owner Contractor
GEORGE&PAM ACOSTA PATIO GUY ALUMAWOOD CONTRACTOR
29191 BLACK MEADOW CT 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($1
Receptacle, Switch,Outlet&Fbdure 1 116.00
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 5.80
$290.45
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 camed on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherMse stated,a permit for construction under which no work is commenced Wthin six
months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AkBldg_PemijtTemplate.rpt Page 1 of I
City Of Menifee
LICENSED DECLARATION
I hereby affirin 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 aW my license is in full flog a d ff I
im Code:The Contractor's License Law does not apply to an owner of a property
License Class 45 License No,-,2 M who builds or improves thereon, and who contracts for the projects with a
Expires t4p-6 Q (ffiignatoureG)6��� licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION o 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 improvements covered by this permit,I cannot legally sell a structure that I have
permit Is issued. built as an owner-building if it has not been constructed in its entirely by licensed
Policy# 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 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:hft,1Avww.Ieginlo-ca.gmL1oIaw.htmI
permit is issued.My workers'wmpensation insurance carder and policy number are:
Carder Property Owner crAuthorized Agent Date
Expires: Policy#
Name of Agent Phone# 0 By my Signature below, I certify to each of the following: I am the property
owner or authorized to act on the property owners behalf. I have read this
(This gecfion 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 retailing to building
construclion.Athorize representatives of this city orcounty to enter the above�
0 1 certify that in the performance of the work for which this permit is issued,I idenfl y f r a inspection urposes.
shall not employ any persons in any manner so as to become subject to the
workers' compensation laws of California,and agree that If I should become
subject to the workers'compensation provisioa of Non 3700 of the Labor Propedy Owdei or Authorized Agent Date -----—
Code,I shal forthwith comply with those provi ons. -744
Da Applicant;_ -1 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, DYES OCCUPANT HANDLE A HAZARDOUS MATERIAL ORA
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 pedury 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) APPLICANTOR FUTURE BUILDING OCCUPANT REQUIRE
Lender's Name []YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION.
—FROM-THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address U140- DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR
GUIDE LINES
OWNER BUILDER DECLARATIONS PRINT NAME,
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
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 file 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 licensure 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 13 kg__UNDER-THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not More than($500).) C
0 1, as owner of the property, or my employees with wages as their sole H
compensation,will do( )all of or( ) porting of the work,and the structure is P
not intended or offered for sale.(Section 7044,Business and Professions Code; X
The Contractor's State License Law does not apply to an owner of a property
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that It was not built or improved for the
purpose of sale).
DATE PERMIT/PLAN CHECK NUMBER VIAIISQ<25-1
TYPE; Q COMMERCIAL VRESWENTIAL I MULTI-FAMILY Q MOBILE HOME 0 PQOLl.5PA SIQN
SUBlYPt: UAUUIIIUN C)ALIERATION �)UEIVIULITIUN OELECI-RiCAL OMECHANICAL
Q-N15-W OPLUMBING 0 RE-ROOF-NUM13ER OF SQUARES
DESCRffnON OF WORK 112!cul)
PROJECTADDRESS AV91
ASSESSOR'S PARCEL NUMBER LOT TRACT -7C
5( I
OWNER NAME
ADDRESS
PHONE 5 EMAIL
APPLICANT NAME LKI
ADDRESS
PHONE ?.6--/- 3:lL)-J EMAIL
CDNTRAr_TnR'S NAME I OWNER BUILDER? 0 YES &-wd�
BUSINE55 NAME Tz
ADDRESS
PHONE <4,-,PMA L
c 4:
CONTRACTOR'$STATE LIC NUMBER
ENSE CLASSIFICATION
VALUATION$ AL06n SCt FT L SO FT
kp-p-u DATE E=cq -
DEPARTMENT DISTRIBUTION SMIP CITY OF MENIFEE BUSINESS LICENSENUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN llog I
INVOICE PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
AMOUNT
PLAN CHECK FEES PAID AMOUNT OCASH OCHIECKIII OCREDITCARD VISAIMC
OWNER BUILDER VERIFIED 0 YES 0 NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
M L I'N
0i
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"'ER & :TH \CK
LEW
NSPECTION REQUIRED
1 PAN
j' f A,(I j:I
Qqp&p9) S 11-� ETY DEPARTMENT
C PLAN APPROVAL
C- E
REVIEWED BY 'a.
ME %
49-
'4poioval of these plans sha'I not!'q construed to be a Permit for,or an
J'�:l��Waljf'anv Violation of ariv Pinvisicris of the federal,state", I
re?,1113t!oni and ordinances. This set Or aPProved Plans must bATITran t e
jotmte until completion.
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