PMT17-01278 City of Menifee Permit No.: PMT17-01278
29714 HAUN RD.
<ACCEG/ MENIFEE, CA 92586 Type: Residential Addition
MENIFEE Date Issued:
04/25/2017
PERMIT
Site Address: 30632 STAGE COACH RD, MENIFEE,CA Parcel Number: 358-450-024
92584 Construction Cost: $15,500.00
Existing Use: 1 &2 Family Residence Proposed use:
Description of INSTALL 16'x 18',21'x 18'6",AND 21'x 16 ATTACHED SOLID ALUMAWOOD PATIO COVER WITH 3
Work: FANS, 2 LIGHT STRIPS
Owner Contractor
CHARLES WILHITE TRADER DAN'S INC
30632 STAGE COACH ROAD 840 S ROCHESTER AVE STE C
MENIFEE,CA 92584 ONTARIO, CA 91761
Applicant Phone:9093900555
DON DAUGHENBAUGH License Number.517575
TRADER DAN'S INC DBA ROOMS N COVERS
840 S ROCHESTER AVE STE C
ONTARIO, CA 91761
Fee Description Qtv Amount 151
Receptacle,Switch, Outlet&Fixture 5 136.00
Building Permit Issuance 1 27.00
Deck/Patio,non-standard 1 133.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 3.00
General Plan Maintenance Fee-Building 1 6.65
General Plan Maintenance Fee-Electrical 1 6.80
$313.45
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 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_Bldg_Pernit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
1 hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter-9(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. the following reason:
License Clas No. 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 DECLARATI N
improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION - 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 leeinfo:ca:aov/calaw.html.
this permit is issued.
Polity# Date
PROPERTY OWNER OR AUTHORIZED AGENT
.efl have and will maintain workers compensation insurance,as required by
section 3700 of the Labor Code,for the performance of the work for which agy 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 y�'� with all applicable city and county ordinances and state laws relating to
�-,I`�t �1-L / ,,� / building construction.I authorize representatives of this city or county to
Policy#t,,)V.7 o),39&2/ 7Expires O enema rat Rare identif erty for inspection purposes
(This section need not to be completed Is the permit is for one-hundred Ul L S `
dollars($100)or less Date
PROPERTY ROR 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#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subjectto the workers ompensation provisions of Section 3700 of the bar
Code,I shaRfie ith c mply�i i those provisions. J WIII the applicant or future building occupant handle hazardous material or a
Applicant Date Z /�/f7 mixture containing a hazardous material equal to or greaterthatthe
amounts specified on the Hazardous Materials Information Guide?
WARNING: RE ORKER'S COMPENSATION COVERAGE IS ❑Yes o No
UNLAWFUL,AND SHALLSUB3ECT 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 guidelines
CONSTRUCTION LENDING AGENCY ❑Yes ❑No
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 No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that am exempt from the permitting checklist.I understand my requirements underthe State of
Contractors License Law for the reason(s)indicated below by the California Health al Safety Code,Section 25505 and 25534 concerning
hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oyes ❑No
Business and Professions Code).Any city or county that requires a permit to 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(RRPI
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($500). managers who do the paint-disturbing work themselves or through their
❑1,as owner of the property,or my employee with wages as their sale employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.epa.gov/lead orcontact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
❑1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
& SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE % L 7 /7 PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL CSRESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION 0-ECECTRICAL O MECHANICAL
,"EW OPLUMBING O/RE-ROOF-NUMBER OF SQUARES /J ^^��/(��
DESCRIPTION OF WORK 6 X 1(/� Z 1'/y l$ /b tl Z�'X /6 ��(� / cA;Os l
47A+/ coo'r-. 1, lid
PROJECTADDRESS Sob 3 z 5'1,i ram(lZI
ASSESSOR'S PARCEL/NUMBER/ � "LACO- CQLA LOT TRACT N
v � -
OWNER NAME / 7 /iL✓I/G'S ID,
ADDRESS 36 6 3 Z l`-7<a C�ad� ,/YLeNt-FCC �,f�- Z S�
Buiidin & Safety PHONE GSI- �(6— 0 yZG EMAIL s y pt.
APPLICANT NAME O4-7 A-I/l 461vI tA APR 2
ADDRESS �r-�
PHONE Col-7gd- d,-� J EMAIL ,UcelVe
CONTRACTOR'S NAME ��f�/I'7S �l / �OV�f^S a OWNER BUILDER? O YES :rNO
BUSINESS NAME L
ADDRESS 2NO C r'T 174
PHONE g6cl-3a6-6 5- — EMAIL p
CONTRACTOR'S STATE LIC NUMBER ,$�/7� 7(� LICENSE CLASSIFICATION
VALUATION$ �5 5 SOFT I"l I, 5 L sQ Fr
APPLICANT'S SIGNATURE DATE //Z S
7DEPARTMENT7-m-3.
N CITY OF MENIFEE BUSINESS LICENSE NUMBER
NGINEERING FIRE GREEN SMIP1�' PAID AMOUNT /j LV5 013•L45 0 CASH O CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O 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 Deportment 29714 How) Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
OWNER — 0� hh)X
ADDRESS 3D(o?)2 S C
CITY �jp_,�p0 PHONE(95
LOT NO. �� TRACT APN
CONTRACTOR
ROOMS N' COVERS PROPOSED ADDITION(S) Cn I
840 S ROCHESTER AVE 9C , MAX i 3t9
ONTARIO, CA 91761 �� )C 21 jC ( � (G ` Q{'1 r� Zi k (5
LIC. B-517575
909-390-0555 1LJ11 G� . ( � I t�1�1CT (cam -D 4-I 0
WORK COMP
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ILr_A1 ,SA ETYDEPART _E
APPROVAL APR 2 5 2017
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ITITVIWED:BY: t - O.,, Received
VI u t ,k t �irt�+��
DATNSPECTIC N REQUIRED
'Apconstruedto be a permit for,a an
appal.o,anyt"my provisions of the federal,stateorcity STREET
regulations andbrdfnances. This set of approved plant must be kept on the
jobsite until completion. O / T 1n • o,/1a-iq OFFICE C 0 PY