PMT17-00120 City of Menifee Permit No.: PMT17-00120
29714 HAUN RD.
�AICCEL/_> MENIFEE, CA 92586 Type: Residential Addition
MENIFEE Date Issued: 01/1912017
PERMIT
Site Address: 31203 MYSTIC LN, MENIFEE, CA 92584 Parcel Number: 372-270-011
Construction Cost $2,800.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 16'x 22'SOLID ALUMAWOOD PATIO COVER
Work:
Owner Contractor
CRAIG DUBOSE PATIO GUY ALUMAWOOD CONTRACTOR
31203 MYSTIC LANE 41197 GOLDEN GATE CIR STE 108
MENIFEE, CA 92584 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 QQtt( Amount ISI
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
$168.66
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 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_Permit_Template.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 perjurythat 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 D I am exempt from licensure under the Contractors State License Law for
Professions Code a�n�(,my license is in full force and e� the following reason:
License Class /J Lice e S. trr � By my signature below I acknowledge that,except for my personal residence
Expires C(J•J��/7 Signature P /l.(/% J in which l must have resided for at least one year priorto completion of
improvements covered by this permit.I cannot legallysell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
❑1 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 workers 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.leeinfa.ca.eov/calaw.lttml.
this permit is issued.
Policy# Date
o I have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which o By my signature below I certify to each of the following:I am the property
this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this
numberare•,^ ( application and the information I have provided is correct.I agree to comply
Carrier W&/Lsj((�/ � A with all applicable city and county ordinances and state laws relating to
/ / building construction.I authorize representatives of this city or county to
Policy# �'"7^�^� 7 Expires enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($200)or less PROPERTY OWNER OR AUTHORIZED AGENT
o I certify that in the performance of the work for which this permit is issued, �111! L
I shall not emnlov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# 0 `44
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 370D of the tabor
Will the applicant or future building occupant handle hazardous material or
Code,1 shall fo wi h comply with th se provisions. PP� B P
mixture containing a hazardous material equal to or greater thatthe
Applicant�. l / Date amounts specs Od on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS oyes 1§10
UNLAWFUL,AND SHALL SUBJECTAN 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(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguideltnes
CONSTRUCTION LENDING AGENCY 0Yes a-0Fo
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 boundaryof .school?
(Section 3097 Civil Code) o Yes o Dlo�
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
Contractors License Law for the reason(s)indicated below by the California Health at Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazard�usmat�r+ai re orting.
Business and Professions Code).Any city or county that requires a permit to oyes o e� ,� //
Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER ORAUTHORIZED AGENT
issuance,also requires the applicant for the pernilt to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRPI
License Law(Chapter9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(ARP)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 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
o I,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( )portion of the work,and the structure is www.eoa.eov/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 Contractors State License Law does not apply to an owner of ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,bulids 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 Owner-Builder 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:
o I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors 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
pAvr(o Cain
FS�-SFF-:
DATE 0/-/7 PERMIT/PLAN CHECK NUMBER ��-
TYPE: G COMMERCIAL &I ESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA C SIGN
SUBTYPE: ^ADDITION 0 ALTERATION ^DEMOLITION ELECTRICAL ^ MECHANICAL
9NEW CPLUMBING 0RE-ROOF=NUMBER OF SQUARES
DESCRIPTION OF WORK _ L L h> L-Lll.-)
bD2> �
PRO)ECTADDRESS M C L4iV izH a
ASSESSOR'S PARCEL NUMBER 3�a-a-to- ni\ LOT TRACT
OWNER NAMECA41 !� City Of Menifee
ADDRESS Q m eP
L
PHONE EMAIL ff�
APPLICANT NAME 1 D /-�� RE:ceiv -
ADDRESS L. /
PHONE /' 3 3�' EMAIL
CONTRACTOR'S NAME m OWNER BUILDER? O YES 4AO--
BUSINESS NAME 4. 0
ADDRESS qj1 9-7 Cj /
PHONE
9SJ- R 3-Sb EMAIL CIM O
CONTRACTOR'S STATE LIC /N.^�U-7M�BER ��'�JoZ �' � LICENSE CLASSIFICATION
VALUATION$ gNV(/ SO FT L SQ FT J
APPLICANT'S SIGNATURE k DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP -
INVOICE
AMOUNT PAIDAMOUNT I� Q �G 0-CASH OCHECK-# ^CREDITCARD -VISA/MC
PLAN CHECK FEES PAID AMOUNT V 0 CASH CHECK# O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
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Po City of Menifee
d LEDGER & TRACK Building & Safety Dept.
INSPECTION REQUIRED JAN 19 2017 O
Received W
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LPARTMENT
PLAN APPROVAL
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REVIEWED BY D ` E
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*Approval of these plans shall. t be construed to be a permit fcr,or ;
' approval of,any violation of an), provisions of the federal,state or city
regulations and ordinances. Th set of approved plans must be kept the.
jobsite until completion.
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