PMT16-04015 City of Menifee Permit No-: PMT16-04015
29714 HAUN RD, Type: Residential Addition
'r;kCCF_LP?' MENIFEE, CA 92586
01 MENIFEE Date Issued: 12/08/2016
P E R M I T
Site Address: 29403 GRANDE VISTA AVE, MENIFEE, Parcel Number; 340-541-013
CA 92584 Construction Cost: $2,400.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 300 SQ FT SOLID ALUMAWOOD PATIO COVER, NO ELECTRICAL
Work:
Owner Contractor
LUIS HERNANDF:7 PSLQ INC
29403 GRANDE VISTA AVE 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
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 requidng 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.
AA.Bldg_PermitTemplate.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 a I am exempt from ficensure under the Contractor's State License Law for
Professions Code s�In full force and effect. the following reason:
License Claw LicenMN.. 2)V�XCj By my signature below I acknowledge that except for my personal residence
Expires 13 h)% sig..tu In which I must have resided for at least one year Prior to Completion Of
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
cz 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 70"of the Business and Professions Code,is available upon request when
conn pen5ation,issued by the Director of Industrial Relations as provided for this application is submitted or at the followfing welasite;
by Section 3700 of the Labor Code,for the performance of work for which www.leginfo.ca.govIcalaw.litirl.
this permit Is Issued.
Policy# Date
dMhave 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 folloVing:I a in the property
this permit Is Issued.My worker's compensation Insurance carrier and policy owner or authorized to act an the property owner's behalf.I haw 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 la'r 'Y15 building construction.I authorize representatives of this city or county to
Policy 450;�17 5?- Expires enter the above identified property for inspection purposes.
(This section need not to be completed Is the permit is for onehundred Date
dollars[$10D)or Jew PROPERTY OWNER OR AUTHORIZED AGENT
a I certify that In the performance of the work for which this permit is issued,
I shall not em Ploy any persons in any manner so as to become subject to the CITY BUSINESS LICENSE If
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 ose provisions. Will the applicant or future building Occupant handle hazardous material or a
Applicant —Date /0 -9 mixture containing a hazardous material equal to or greater that the
amountsspecifl on the Hazardous Materials Information Guide?
WARNING:FAIILUVWE TO SECURE WORKER'S COMPENSATION COVERAGE IS crYes G21ffi
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future build Ing
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,00),IN occupant require a permit forthe 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 guidelln!s.,
CONSTRUCTION LENDING AGENCY a Yes 100
I hereby affirm that under the penalty of perjury them 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 a4lb
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 H a t &So e Code, ecti.on 25505 and 25534 concerning
le
Contractor's License Law for the reason(s)Indicated below by the hazardous material re rd
checkmark(s)I have placed next to the applicable item(s)(Section 703LS %Y6 o No
Business and Profiessions Code).Any city or county that requires a permit to —Date
construct,alter,improve,demolish or repair any structure,prior to its FROPERTY OWNEO QAUTHORIZEDA—GENT
issuance,also requires the applicant for the permit to rile a signed statement
that he or she Is licensed pursue nt to the provisions of the Contractor's State EPA RENOVATION.REPAIR AND PAINTING(RRP)
License Law(Chapter 9(commencing vvith Section 7000)of Division 3 of the The EPA Removatium,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 pTe-3.978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified furns;and comply with
an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owner;and property
than($500). managers who do the paint-disturbing work themselves or through their
o 1,as owner of the property,or my employee with wages as their sale employees.For more information about EPA!s Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.epa.smyllead or contact the National Lead Information Center at
not intended or offered forsale.(Section 7044,Business and Professions 1-800-424-LEAD(S323).
Code,The Contractor's State License Law does not apply to an owner of a cr 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 Omer-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. cz No EPA Lead-Safe Certified Firm is required for this project because:
rr 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 role please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
LLL100 ",III
Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: F—ICOMMERCIAL W<ESIDENTIAL F]MULTI-FAMILY []MOBILEHOME [:]POOL/SPA OSIGN
SUBTYPE: F-JADDITION F]ALTERATION F]DEMOUTION [—]ELECTRICAL []MECHANICAL
ffNEWE]PLUMBING 1-1 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK 300 SOFT.Solid Alumawood Patio cover attached to house.
PROJECTAIDDRESS 29403 Grande Vista Ave, Menifee CA 92584
ASSESSOR'S PARCEL NUM13ER :t)LkO -541-015 LOT TRACT A
PROPERTY OWNER'S NAME Luis Hernandez
ADDRESS SAME AS PROJECT ADDRESS
PHONE (951)423-9211 EMAIL
APPLICANT NAME SAME AS CONTRACTOR Art-A
ADDRESS
PHONE q0�51 EMAIL
CONTRAcTOR'S NAME Greenbee OWNERBUILDER? [:]YESgW
BUSINESS NAME Greenbee
ADDRESS 28910 Rancho California Rd#206 Temecula CA92590
PHONE (951)234-0356 EMAIL
CONTRACTOR'S STATE LICNUM13ER 919885 LICENSE CLASSIFICATION 13
VALUATION$ $2,400.00 SO FT 300 L SO FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION 01 MINIIII BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP
[NVOICE I ((0IW(06 PAIDAMOUNT CASH OCHECK# 0 CREDIT CARD VISA/MC
AMOUNT I
PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED C,YES 0 No DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menfee Building& Safety Deportment29714 Houn Rd. Menfee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
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