PMT17-00911 City of Menifee Permit No.: PMT17-00911
29714 HAUN RD.
<A—CCi l7. MENIFEE,CA 92586 Type: Residential Addition
MENIFEE Date Issued: 03/27/2017
PERMIT
Site Address: 28819 ESCALANTE RD, MENIFEE, CA Parcel Number: 351-270-010
92587 Construction Cost: $2,000.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 170 SO FT SOLID ALUMAWOOD PATIO COVER W/ELECTRICAL 2 LIGHTS
Work:
Owner Contractor
ROWENA DAVIS FRERICHS CONSTRUCTION
28819 ESCALANTE RD 1236 LONGPORT WAY
MENIFEE,CA 92587 CORONA, CA 92881
Applicant Phone:9517358289
GENE FRERICHS License Number. 992261
FRERICHS CONSTRUCTION
1236 LONGPORT WAY
CORONA,CA 92881
Fee Description QtV Amount t5)
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-Electrical 1 6.05
$289.06
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 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 Code antny license a in full force and effect. the following reason:
License Class -IL,� Lice a No Z Z� ) By my signature below I acknowledge that,except for my personal residence
a
Expires "l 134 111, 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
❑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 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,goy/caIaw.htmL
this permit is issued.
Policy#
Date
PROPERTY OWNER OR AUTHORIZED AGENT
❑I have and will maintain worker's compensation insurance,as required by
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 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
Carrier with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# 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($100)or less PROPERTY OWN ER OR AUTHORIZED AGENT
'O.Ycertify that in the performance of the work for which this permit is issued,
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compe ,a ion provisions of Section 3700 of the Labor
Code,I shall fo h t OTI)i� i those provisions. Will the applicant or future building occupant handle hazardous material or
Applicant Date .� Z 7� p mixture containing a hazardous material equal to orgreater thatthe
amounts2cified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes rrTla
UNLAWFUL,AND SHALL SUBJECT AN 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 for guideline}
CONSTRUCTION LENDING AGENCY ❑Yes oV10
I hereby affirm that under the penalty of perjury there is 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 school?
(Section 3097 Civil Code) ❑Yes o 0
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
1 hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
California Health&Safety p9de,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the haz dous ma ' I r po
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 N
Business and Professions Code).Any city or county that requires a permitto Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR 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 Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRP)
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 or through their
o I,as ownerof 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 for sale.(Section 7044,Business and Professions 1-80D-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 forthis 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.
PERMIT/PLANBUILDING & SAFETY APPLICATION
IQ
,Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL tfRESIDENTIAL Q MULTI-FAMILY O MOBILE HOME O POOL/SPA OSIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
e'NEW r�OPLUMBING ORE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK 'O'T t_c -FJta.4 S "G fro"' F '• t� T'
PROJECTADDRESS "? 9y ASSESSOR'S PARCEL NNUMBER 35( -a'(bfl•Q' LOT TRACE 3C>5 p 2
®
OWNERNAME i'�taa„J^,J,'�i4 tvZ_
ADDRESS 2. b6i ' SIYJI >.J1' i20 �i'+ITFCE ��2 •-�
PHONE EMAIL mow I3 _ 4j tow
APPLICANT NAME F AZ',(4-k C)JS P :•'1 (LV
ADDRESS l`I Jko LArsT Pb r_-j J.JeraV dL-��f��n Cam • g Za&-� �I
PHONE RSA ' ��5�' Z &� EMAIL r(�1+�cksCOrI, ,( L la'n C1 ��+� X -11u�
CONTRACTOR'S NAME -'�-AC r.'n..3.., OWNER BUILDER? 'OYES °fNO
BUSINESS NAME ,F'•q.JSc..' C4rA/S-Tv(x%t1:t6vJ
ADDRESS (.i 31 (-Z r p.f d,A j- f.)4 I Cs N.or l t_ T', 1�
PHONE fir/ -t Zr-?%G EMAIL rr J^ c (',1 1 uo J _F
CONTRACTOR'S STATE LIC NUMBER Z ZL LICENSE CLASSIFICATION
VALUATION$ M FT 00 L SO FT
APPLICANT'S SIGNATURE �- `� DATE
LOTYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MEN70CRED7ITCARD
E NUMBER
BUILDING PLANNING ENGINEERING .1 GREEN SMIP
INVOICE Qrj PAID AMOUNT AMOUNT O CASH OCHECK# VISA/MC
PLAN CHECK FEES PAID AMOUNT O�H C}CHECK# VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building& Safety Department29714 Haun Rd. Menifee, CA 92586951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
PLOT/SITE PLAN
REAR PROPERTY LINE
LEDGER & TRACK
INSPECTION REQUIREL'
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4 I' y of �), ENIFEE
fLDING AND SAFETY DEPARTMENT
W W
z .,','d PJ;PROVAL z
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W W
aVED BY�- 4Di'L. o
w Lu*0
al of these plans shatl >t he construed to be a per t far,or an
0
aal of,any violation of any o1ovisions of the federal
dtions and ordinances. This set of approved planlust he kept on thz I ,
ite until completion. V
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FRONT PROPERTY LINE
Property Owners Name
Property Address -z83s'i EScsa t;y . 5"+55�1