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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 "d "'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. i�Lac-k rn at>6w CR - Q twon�q�m r—rAr-b P 7M 9 6E7,0P.Ae q-+jWrn HW 10 BUY A"MWVA* C&+M— t:* �gg 4 It Ch %olden %Ctfe wr-4e -* �tt MF,4-b,0a-D CC,. cla%ha -ab?4- sure," 4 .C6113-1 S'S C,)4 LLUrk "ft-%P.�Ark�Loft. .410 w c