PMT16-03901 City of Menifee Permit No.: PMT1 6-03901
29714 HALIN RD. Type: Residential Addition
<ACCELA—> MENIFEE, CA 92586
MENIFEE Date Issued: 12102/2016
P E R M I T
Site Address: 29727 COOL MEADOW DR, MENIFEE, Parcel Number: 339-392-003
CA 92584 Construction Cost: $5,400.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 491 SQ FT SOLID/LATTICE COMBO PATIO COVER W/ELECTRICAL 2 FANS, 1 OUTLET
Work:
Owner Contractor
JIM GEIBEL PSLQ INC
29727 COOL MEADOW DR 28910 RANCHO CALIFORNIA RD
MENIFEE, CA 92584 #206
Applicant Phone:9517954260
JOSH HERRICK License Number.,919885
PSLQ INC
28910 RANCHO CALIFORNIA RD
#206
TEMECULA,CA 92590
Fee Description Qtv Amount
Receptacle, Switch,Outlet&Fixture 2 121.00
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 6.05
$295.70
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 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.Bldg_Penit Template.rpt Page 1 of 1
CITY OF MENWEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
with a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of
Chapter9(commencing With section 7000)of Division 3 of the Business and ci I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following mason:
UcenseClass— is License No. C2 By my signature below I acknowledge that,except for my personal residence
Expires b )fL_Signature in which I must have resided for at least one year prior to completion of
improvem ents covered by this permit.I ca nnot 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
a I hereby affirm under pena Ity of perjury one of the following decla rations:I licensed contractors.I understand that a copy of the applicable law,Section
have a nd will mainta in a certificate of consent of self-Insu re 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.Ieginfo.ca.gov/calaw.html.
this permit is issued.
Policy# Date
wa�ve 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 relating to
Carrier a ft building construction.I authorize representatives of this city or county to
4—* enter the above identified property for Inspection purposes.
Policy V_Vn54J6L52- _Expires W 1-1?-1
(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, 02!6"to
Ishallinaternplo any persons In any manner so as to become subject to the CITY BUSINESS LICENSE#.
worker's compensation laws of California,and agree that If I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,I shall fort rovislons. Will the applicant or future building occupant handle hazardous material or a
Applicant Date mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TOSECURE WORKER'S COMPENSATION COVERAGE IS 0 Yes 13..N�o
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applica in or future build ing
AND CIVIL FINES UP TO ONE H U NORED THOUSAND DOLLARS($100,000),IN occupant req uire a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST;AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY o Yes 4-Wo
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 &fro—
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&Safety Code,Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the haza0ous matanria�Ing
checkmark(s)I have placed next to the applicable item(s)(Section 7032 5 EW9 ci No
Business and Professions Code).Any city or county that requires a permit to —Date /Z-7-m
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNA'Qk 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 fRRP1
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 com pensation 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 childca re facility to he RAP-certified firms a nd comply with
an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
a 1,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( I portion of the work,and the structure Is www.epa.guy/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 o An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or persona I effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sa le.If,however,the build Ing or improvement is sold within one yea r of Firm Certification No.:
completion,the Owner-Bu lider will have the burden of proving that it was
not built or improved for the purpose of sale. o No EPA Lead-Safe Certified Firm is required for this project because:
ci 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
'fee
lweni
DATE PERM IT/PLAN CHECK NUMBER f*TT1(0- I)MOI
TYPE: OCOMMERCIAL AESIDENTIAL 0MULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK ra1;A11A&w r-o,��a 9,ke r-w-e!;
PROJECTADDRESS Coal 1�"W '>r-
�0" ,
ASSESSOR'S PARCEL NUMBER 7-ri 112-MbT TRACT
OWNER NAME 61 1
N!��C /Al
ADDRESS 02`91o"I (20A A&A,.,3 i
PHONE EMAIL
APPLICANT NAME
ADDRESS
PHONE 151-374-10n EMAIL %I JI Ce c-p�
CONTRACrOR'S NAME non fi-oce OWNER BUILDLR? 0 YES Q�<O
BUSINESS NAME
ADDRESS T,,.,,,,,J4L QA 0
PHONE EMAIL
CONTRACTOR'S STATE LIC NUM13ER LICENSE CLASSIFICATION ig
VALUATION$ 5, 03 , A SQFT _ L SO FT . -5;;
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIE BU INES610ENSE NUMBER
SMIP
BUILDING PLANNING ENGINEERING FIRE GREEN I I
INVOICE � PAID AMOUNT OCASH OCHECK# 0 CREDIT CARD VISA/MC
AMOUNT I I
PLAN CHECK FEES PAID AMOUNT 0 CASH 0 CHECK# OCREDITCARD VISA/MC
[OWNERBUILDER VERIFIED 0 YES 0 No DLNUMBER 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
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