PMT17-01054 City of Menifee Permit No.: PMT17-01054
_ 29714 HAUN RD. Type: Residential Addition
�!-�CCELA? MENIFEE, CA 92586
MENIFEE Date Issued: 04/11/2017
PERMIT
Site Address: 31784 QUILT WAY, MENIFEE, CA 92584 Parcel Number: 360-720-037
Construction Cost: $3,000.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 12'x 2T SOLID ALUMAWOOD PATIO COVER WITH 1 FAN,2 LIGHTS, 1 SWITCH
Work:
Owner Contractor
HUGO VILLA T F MEADOR CONSTRUCTION
31784 QUILT WAY PO BOX 713
MENIFEE, CA 92584 WILDOMAR,CA 92595
Applicant Phone: 9518376180
TOM MEADOR License Number:639087
T F MEADOR CONSTRUCTION
PO BOX 713
WILDOMAR, CA 92595
Fee Description Qty, Amount l$1
Receptacle, Switch, Outlet&Fixture 4 131.00
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 6.55
$306.20
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 and my license Is in full force and eff/ecL ( cy�7 the following reason:
License Class License /No. 103 I,.d a/ By my signature below I acknowledge that,except for my personal residence
Expires 3V 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 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 ,�„�,,,�,leainfo.ca.eov/calaw.html.
this permit is issued.
Policy# Date
)1,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 ❑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
�'tA'CRhVY� b with all applicable city and county ordinances and state laws relating to
Carrier building construction.I authorize representatives of this city or county to
Policy# `t143539- 15 Expires TO ' 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 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#
workers 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 forth ith cgpl I wfth th se provisions. Will the applicant or future building occupant handle hazardous material or a
c/OI' ✓//�{/ mixture containing a hazardous material equal to or greater that the
Applicant Date will specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 ❑Yes p?No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYERTO CRIMINAL PENALTIES Willtheinntended use ofthe 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 guide Ines
CONSTRUCTION LENDING AGENCY ❑Yes )kNo
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 forthe performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) o Yes ❑ko
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I 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 Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Byes ❑No /'7
Business and Professions Code).Any city or county that requires a permitto Date �16 I /
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 IRRPI
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 703LS 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
❑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 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 ❑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.
& SAFETY PERMIT/PLAN CHECK APPLICATION Fl
Menifee
DATE 1 I PERMIT/PLAN CHECK NUMBER Pw 1-1 -D
TYPE: O COMMERCIAL PRESIDENTIAL 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 PIILUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK XX51 k I\ '-AZII - I Al L.IMi nvm PA'C) Co%e v--
2-v� ,Z 4,y\ ' I YI'ts
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PROJECT ADDRESS 3 1791 CCU�J'r
ASSESSOR'S PARCEL NUMBER 4,00-'QO-(�3�I LOT TRACT
Of ffou
OWNER NAME t f u l� My&Sa etV OPt
ADDRESS S kv,--C APR i i O
PHONE I S I - 7(o �- A37 7 EMAIL
APPLICANT NAME ((�� -To ✓� //��
ADDRESS PC) 1�0� W I&cti � — C/k 0)2..5'7
PHONE 9SI-- 837-&1 EMAIL
CONTRACTOR'S NAME �''ICCi��'r COV,3-t OWNER BUILDER? O YES NO
BUSINESS NAME S
ADDRESS
PHONE SDI ✓n c- EMAIL
CONTRACTOR'S STATE LIC NUMBER 6) �r 7 c LICENSE CLASSIFICATION
p
VALUATION$ 3000 SOFT '�� 1 LSO FT
APPLICANT'S SIGNATURE ^ DATE `�//I I i` 7
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN , SMIP
INVOICE PAID AMOUNT
AMOUNT • O CASH 0 CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0CASH 0 CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZEDLETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92596 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-621-3
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LEDGER tit TRACK Building 8 Safety Dept.
INSPECTION REQUIRED APR 11 2017
Received
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9 51— 76A— 83 77
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CITY OF MENIFEE
BUILDING AND SAFETY DEPARTMENT
PLAN APPROVAL
REVIEWED
I
'Approve o f ese p ens s a no e
approval of,any violation of any rovisions of the federal,state or city
regulations and ordinances. This set of approved plans must be kept on the
jobsite until completion.
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