PMT17-00369 City of Menifee Permit No.: PMT17-00369
29714 HAUN RD. Type: Residential Addition
'!—ACCEL/> MENIFEE,CA 92586
MENIFEE Date Issued:
02/06/2017
PERMIT
Site Address: 28053 WINDJAMMER CT, MENIFEE, CA Parcel Number: 333-380-001
92585 Construction Cost: $10,000.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 3 SOLID ALUMAWOOD PATIO COVERS, 15'X 27', 18'6"X 12',7'X 18'6" W/ELECTRICAL 4
Work: LIGHT STRIPS,2 GFCI OUTLETS
Owner Contractor
NOOM ROGERS TRADER DAN'S INC
28053 WINDJAMMER CT 840 S ROCHESTER AVE STE C
MENIFEE, CA 92585 ONTARIO, CA 91761
Applicant Phone:9093900555
DON DAUGHENBAUGH License Number. 517575
TRADER DAN'S INC
840 S ROCHESTER AVE STE C
ONTARIO, CA 91761
Fee Description City, Amount($
Receptacle, Switch,Outlet&Fixture 6 141.00
Building Permit Issuance 1 27.00
Deck/Patio, non-standard 1 133.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 2.00
General Plan Maintenance Fee-Building 1 6.65
General Plan Maintenance Fee-Electrical 1 7.05
$317.70
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_aldg_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 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 ❑I am exempt from licensure under the Contractor's State License Law for
Professions CodT aid my license is in full force and effect. the following reason:
License Cl s \/ Ufe-PIiN o. By my signature below I acknowledge that,except for my personal residence
Expires Signature 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
o 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 7044 of the Business and Professions Cade,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.leginfo.ca.f!ov/calaw.html.
this permit is issued.
Policy H Date
shave 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 ❑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 pollcy owner or authorized to act an the property owners behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
yG(�(,/ with all applicable city and county ordinances and state laws relating to
Carrier q -�T��JU D 7 p/ / ) � building construction.I authorize representatives of this city or county to
Policy A(�SP CJ!/ O Expires `L! errM'th ove��ectlon purposes.
(This section need not to he completed is the permit is for one-hundred Date Z
dollars($300)or less R AGENT
❑I certify that in the performance of the work for which this permit is issued, PRO R
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE p
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Cade,I shalFforth ' h com r r visions. Will the applicant or future building occupant handle hazardous material or a
Applicant ate mixture containing a hazardous material equal to or greater that the
amounts sppppyyeeeeeecified on the Hazardous Materials Information Guide?
WARNING: LU (ER'S COMPENSATION COVERAGE IS ❑Yes No
UNLAWFUL,AND SHALL SUEU CT AN EMPLOYER TO CRIMINAL PENALTIES Will th intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($300,000),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 for guideli s
CONSTRUCTION LENDING AGENCY ❑Yes To
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 bounary of a school?
(Section 3097 Civil Code) ❑Yes ❑ o
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 hazardous
Health&Safety Code,Section 25505 and 25534 concerning
ha�(zardous materFahre ortin
checkmark(s)1 have placed next to the applicable item(s)(Section 7031.5 ❑a25 ❑No
Business and Professions Code).Any city or county that requires a permit to Date /
construct,alter,improve,demolish or repair any structure,priorto its PROPERTY OWNER AU ENT
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 Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRP)
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 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 orthrough their
❑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.epa.gov/lead or contact the National Lead Information Center at
not intended or offered.forsale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a ❑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 Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
❑1,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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE 2I / PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL `E IDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION (31L—ECTRICAL O MECHANICAL
'O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK 7 6 FIx �Z 7 X) �I �d G� �LGvt�Ld7q K/d eiLt�jf
13 / lr his Cz Fcl 6WLr�g
PROJECTADDRESS 7s 6 5- 3�jWjtAd ,kyr'kUr 44
-
ASSESSOR'S PARCEL NUMBER ? 1*0`WI LOT _� TRACT b U5
OWNER NAME �1,f,41M go'' 11 11 JLO -tr
W ADDRESS d y 4 ^ k'n w (j
PHONE _J ,�D - &� y 46 7 1 EMAIL
APPLICANT NAME d ✓ 0 �e)V A(,L /7
ADDRESS
PHONE 6101 EMAIL
CONTRACTOR'S NAME reems -I iwcrf OWNER BUILDER? O YES ONO
BUSINESS NAME O "
ADDRESS ( 0 S• Y r S FiV V(- rv,-)- `✓yL0 CO I G
11
PHONE 101 -3I,t(05r EMAIL
CONTRACTOR'S STATE LIC NUMBER 5175 75 LICENSE CLASSIFICATION
VALUATION$ SQ FT 7 -A, -`-lb L SQ FT
APPLICANT'S SIGNATURE A, DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION nL� CITY OF MENIFEE BUSI S LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN v_ SMIP ;56(Jy
INVOICE pglD AMOUNT
AMOUNT 7O U CASH U CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 1 0CASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building& Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
OWNER
. r
ADDRESS 2801�1 MIA
� i
CITY
LOT NO. --- TRACT - � APN _
CONTRACTOR
ROOMS N' COVERS PROPOSED APDITI N(S)
840 S ROCHESTER AVE#C rDsq 2zz
ONTARIO, CA 91761 ��X / • �O 7l J2� , Q�
LIC. B-517575
909-390-0555 7
WORK COMP
ICW GROUP
WSA5000386-07
EXP6/14/2017 2 enifee
& Safety Dept.
I iLi FE 0 8 2017
ODOM
uoI��.O�� 2 � "?, Received
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291
bU LDING AND SAI ETY D PARTMENT Q�'1
�L r .T.1-OPROVAL
E;F i; VELD E37Y DA
,v I f these plans shall:1 rt be construed to he a permit for,or an m
G ' . ov
a „ ova any violation of ac: o[ ='isions of the federal,state or city u
P„
r-gAlti and ordinances. ih
e
lof ^ o sir^ ; On I tion. STREET