PMT17-01138 City of Menifee Permit No.: PMT17-01138
29714 HAUN RD.
�l-\CCELA-� MENIFEE,CA 92586 Type: Residential Addition
MENIFEE Date Issued: 04/17/2017
PERMIT
Site Address: 28392 STORMY SKIES CIR,MENIFEE, Parcel Number: 333-581-012
CA 92585 Construction Cost: $2,200.00
Existing use: 1 &2 Family Residence Proposed use:
Description of INSTALL SOLID 180 SO FT ALUMAWOOD PATIO COVER W/ELECTRICAL, 1 FAN
Work:
Owner Contractor
VICTORIA LUAT T F MEADOR CONSTRUCTION
28392 STORMY SKIES CIR PO BOX 713
MENIFEE,CA 92585 WILDOMAR,CA 92595
Applicant Phone:9518376180
TOM MEADOR License Number:639087
T F MEADOR CONSTRUCTION
PO BOX 713
WILDOMAR, CA 92595
Fee Description 01rt Amount
Receptacle, Switch, Outlet&Fixture 1 116.00
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 5.80
$290.45
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 building operations being varied 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 contractors)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 effect. p the following reason:
License Class L.� Lice a No J b o 7 By my signature below I acknowledge that,except for my personal residence
Expires ki 3n 7 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.legiiifo.ca.gov/calaw.litml.permit is issued.
Policy# 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 worker's compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
number are: L/ ,(y application and the information I have provided is correct.I agree to comply
Carrier ��?�/ �n " with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
q
Policy# I H 3531{ '- ( S Expires 7 20 1 (-7 enterthe above identified propertyfor inspection purposes.
(This section need not to be completed is the permit is far one-hundred Date
dollars($100)or less PROPERTY OW NER OR AUTHORIZED AGENT
❑I certify that in the performance of the work for which this permit is issued, O
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's 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,l shall forthwith comply with t se provisions. Will the applicant or future building occupant handle hazardous material or
Applicant „Jr{T ",JAI/°J-(�J� Date H f(7fI 7 mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 ❑Yes ) No
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($300,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant
Air Quality Management District(SC construction
or See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forCoast
Air i es
CONSTRUCTION LENDING AGENCY ❑Yes cKNo
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 boundary 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
Contractor's License Law for the reason(s)indicated below by the California Health al Safety Code,Section 505 and 25534 concerning
checkmark(s)I have placed next to the applicable Items)(Section 7031.5 )ffhazardous material reporting.
Business and Professions Code).Any city or county that requires a permit to
❑No
construct,alter,improve,demolish or repair any structure,prior to its Date
PROPERTY OWNER O
issuance,also requires the applicant for the permit to file a signed statement AUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING IRRPJ
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
❑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 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 Contractor's 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:
D I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code;The Contractor's 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.
SAFETYBUILDING & . • APPLICATION
Menifee
DATE I ] PERMIT/PLAN CHECK NUMBER 1
TYPE: O COMMERCIAL VRESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA OSIGN
SUBTYPE: .<ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK 12XI,j /l/M,'Vk;^ ('ct'o coL"e-`-
u1 Z 1COL"
PROJECT-ADDRESS- 2 8.3 -2- 2 (r- - -
ASSESSOR'SPARCEL1NrUMBER �j �jry � rjS��D(aoT 6!5 TRACT 5`41 SO
OWNER NAME ViL-t&A'C-, Uat
ADDRESS 5 kV^t--
PHONE [p I c, - 319' -77?b EMAIL
APPLICANT NAME -ro✓-\ [/ f C,�O
ADDRESS 50�vvvc
PHONE 015 � _937-Col t'O EMAIL
CONTRACTOR'S NAME 7F _lam C �- CC,, V,,5t OWNER BUILDER? O YES NO
l
BUSINESS NAME -9C 'V�t
f
ADDRESS U B bo,�, -7 13 W`! mc,,c- 20Y 92.J� S
PHONE C151' 83 7- Cc I kV EMAIL
I
CONTRACTOR'S STATE LIC NUMBER 63 � O 0 7 LICENSE CLASSIFICATION
VALUATION$ 0 b o� SO FT j pd L SO FT
APPLICANT'S SIGNATURE L -f_ DATE
DEPARTMENT DISTRIBUTION r `O CITY OF MENIFFEEEEBBUUSIINNESS I- /.CENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN ( SMIP I �/✓Q`W� �f•//�
INVOICE PAIDAMOUNT O O
AMOUNT O. CASH CHECK# 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0 CASH 0 CHECK# O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
d
— 3 U�a.`l a JX/'
C
l 1s /
'Z jv
ryo emea
Building & Safety Dept.
APR 17 2017
Received
r)
d�,,,e� LEDGER
RACK
r H�v r'!S)PE('TI R QUiR.Fr:I
� V�c�tor� I,�afi
61 q— 3 let- -2770
J 2 $3gZ $ i�frr`y Skits crrY1 � �Vl 1'
xasr��� Cod 92-585 5
CITY OF MENIFEE
BUILDING AND SAFETY DEPARTMENT
PLAN APPROVAL 0
REVIEWED BY q ` r
`Approval of these plans shall not be c strued to be a permit for,or an
approval of,any violation of any provision of the federal,state or city
regulations and ordinances. This set of app ved plant must be kept on the *ice job site tilcrmyyjpn�
` � f