PMT17-00951 City of Menifee Permit No.: PMT17-00951
29714 HAUN RD.
�CCEL/ MENIFEE, CA 92586 Type: Residential Addition
MENIFEE Date Issued: 03/31/2017
PERMIT
Site Address: 29832 GARDEN GROVE, MENIFEE, CA parcel Number: 333-680-057
92584 Construction Cost: $7,200.00
Existing use: 1 &2 Family Residence Proposed use:
Description of INSTALL 700 SQ FT ALUMAWOOD ATTACHED PATIO COVER WITH ELECTRICAL-2 FANS,4
Work: LIGHTS AND 4 OUTLETS
Owner Contractor
LARRY&SUNDAY HENDRICKS PSLQ INC
29832 GARDEN GROVE DRIVE 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
Phone:9517954260
Fee Description ON Amount fSl
Receptacle,Switch,Outlet&Fixture 10 161.00
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 8.05
$337.70
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 carded 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_Bidg_Pemut_Templatexpt Page 1 of 1
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 1 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 Contractors State License Law for
Professions Code/a�njd my license is in full force and effect. (j C the following reason:
License Class / License No. /I%S / 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
WORKER'S.COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I
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 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.leeinfp.ca.¢pv/calaw.html.
this permit is issued.
Polity n Date
' ❑I have 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 ❑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
number are: application and the information I have provided is correct.I agree to comply
Carrier C-'" with all applicable city and county ordinances and state laws relating to
�j p building construction.I authorize representatives of this city or county to
a?5 Policy k `/5e 3 n 9- Expires 1 2 —� h enter the above identified property for Inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($300)or less PROPERTY OWNER OR AUTHORIZED AGENT
❑I certify 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 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
Code,I shall forthwl co p -Ith-those . ions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date l-J I I mixture containing a hazardous material equal to orgreater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FA(LtPWE TO SECURE WORKER'S COMPENSATION COVERAGE 15 ❑Yes d"ITO
UNLAWFUL,AND SHALL SUBJECF AN EMPLOYER TO CRIMINAL PENALTIES WIII 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
IN SECTION 3706 OF THE L
ADDITION THE F THEST L COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes upvo
1 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 bound of a school?
(Section 3097 Civil Code) ❑Yes o
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of permitting checklist.I understand my requirements under the State of
y p ty perjury that I am exempt from the California Health&Safe Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the haz rdous material rep ing/
checkmark(s)I have placed next to the applicable items)(Section 7031.5 r ,
Business and Professions Code).Any city or county that requires a permit to es o No r
Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER R UTHORIZED AGENT
issuance,also requires the applicant for the permRto file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors State I 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 I 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 than($500). required practices.This includes rental property owners and property
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 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 I www.epa.zpv/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 a j ❑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. o 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.
APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK
Menifee
DATE Q PERMIT/PLAN CHECK NUMBER MT 11 0
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK e� '�" v n ,a ,e LY B,l I t o wP( Ia:: LJI
(,j A
-ee N L -
PROJECTADDRESS GLr Qn y�vP I 2G
ASSESSOR'S PARCEL NUMBER � D-D_VJL T TRACT
OWNERNAME/ L-QCP V
% Sun�Lk,/ YI
ADDRESS ( 5
PHONE EMAIL
APPLICANT NAME T TIC
ADDRESS
PHONE 9 EMAIL
CONTRACTOR'S NAME no-kil rLy OWNER BUILDER? O YES ONO
BUSINESS NAME
ADDRESS // 0 4M �� P c.. 9,?S1D
PHONE % 5)-�Sq-O_�rj/� pp pp r EMAIL
CONTRACTOR'S STATE LIC NUMBER I"I O/�5 LICENSE CLASSIFICATION
VALUATION$ -7 4mo SO,FT -4OO L SQ FT SD
APPLICANT'S SIGNATURE --Q DATE I 1
IF
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAIDAMOUNT n
AMOUNT GCASH CHECK# 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
Niy.�e_
utiding& Safety Dept.
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213 MAR 3 1 2017
Received
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.P. = GARDEN GROVE DR
OFFICE COPY