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PMT17-01666 City of Menifee Permit No.: PMT17-01666 `_ 29714 HAUN RD. Type: Residential Addition ACCEL/> MENIFEE,CA 92586 MENIFEE Date Issued: 05/26/2017 PERMIT Site Address: 26945 PINEHURST RD,MENIFEE, CA Parcel Number: 338-D61-006 92586 Construction Cost: $4,000.00 Existing Use: 1 &2 Family Residence Proposed Use: Description of INSTALL COMBO 12'X 36'ALUMAWOOD LATTICE&9'X 20'ALUMAWOOD SOLID PATIO COVER, Work: NO ELECTRICAL Owner Contractor LURA CLOUGH SOUTH COAST SHADE 26945 PINEHURST RD 12223 HIGHLAND AVENUE#326 MENIFEE,CA 92586 RANCHO CUCAMONGA,CA 91739 Applicant Phone:9099042102 RICH EDMON License Number:823582 SOUTH COAST SHADE 12223 HIGHLAND AVENUE#326 RANCHO CUCAMONGA, CA 91739 Fee Description City Amount lb) 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 $168.65 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.rpl Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects with a licensed contractor(s)pursuant to the Contractors State License Law). I hereby affirm under penalty of perjury that I am under provisions of Chapter9(commencing with section 7000)of Division 3 of the Business and ❑Iam exempt from licensure under the Contractors State License Law for Professions Code and my license is in full force and eff ^/ the following reason: License Class (:G I Lice N `� By my signature below I acknowledge that,except for my personal residence ssr�2 Expires�Q 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 wwwleginfo.ca.gov/calaw.html. this permit is issued. Policy If Date PROPERTY OWNER OR AUTHORIZED AGENT ❑I have and will maintain workers 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 workers 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 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 p 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 OWNER OR AUTHORIZED AGENT I rtlfy that in the performance of the work for which this permit is issued, s II not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE A workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subjectto the workers compensation provisions of Section 3700 of the Labor Code,I shall f it pl r 41n f os provisions. Will the applicant or future building occupant handle hazardous material or a Applicant Date 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 IS ❑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($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)7 See permitting checklist IN SECTION 37GG-OF THE LABORCODE,INTEREST,AND ATTORNEYS FEES - --— - —- —-- — - - --- --Tor 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 ❑No 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 hazardou ater' repo . checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oyes 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 forthe 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(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 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 fora 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.eov/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 o 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: ❑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. & SAFETY PERMIT/PLAN CHECK APPLICATION E� Memee DATE PERMIT/PLAN CHECK NUMBER TYPE: O COMMERCIAL ESIDENTIAL 0 MULTI-FAMILY O MOBILE HOME O POOL/SPA Y SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PLUMBING 0 RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK I2 y 3� p I I.VIA.au-, r tie_-e (� to cog y32 "K Zd' ,Jr'(ma-wood Sold �a'to Gocl�GP l9c> PROJECTADDRESS ��SF ASSESSOR'S PARCEL/NUMBER 33�-06 I 0 o.G LOT y TRACT OWNER NAME pL�/V�CV nliJO/ �I ADDRESS Z.6 1 ! �Q (Y!/y'eVl I/VS'� �OL.p,(/I PHONE ( �j0 f—/126 I EMAIL APPLICANT NAME / / /� ADDRESS I ZZZ3 ziam '�/J Aw 013�j PHONE _ faQ qoy-zla2. EMAIL CONTRACTOR'S NAME �ff I // L �^L�uwL t OWNERBUILDER? OYES NO BUSINESS NAME 4V U'FVY C009f SU ADDRESS (2223 lf( kcl-vW ke W-W3Z6 0. L, C'i . 903111 PHONE 9j)q 9oY 21oz �j EMAIL / . CONTRACTOR'S STATE LIC NUMBER D Z3> DZ f�LICENSE CLASSIFICATION C`b I VALUATION$ CJab SO FT �� `c'FO' I L SO FT APPLICANT'S SIGNATURE DATE • DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE I GREEN I SMIP INVOICE PAID AMOUNT �, AMOUNT OCASH OCHECKII CREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# OCREDIT CARD VISA/MC OWNER BUILDER VERIFIED 0 YES 0 NO DL NUMBER NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.US Inspection Request Line 951-246-6213 LEDGER & TRTRACKINSPECTION REQUIRED �f�, City of Menifee Building & Safety Dept. Zof MAY 2 6 2017 Received �SI �c 3 Zar sol`c0 AIvvkc:'Vq Q 9 �� ttoCavRt- o[Q c.00.5� Lj�_Lo �- W I �� 6 . 39 U �23Sk2 U . U. nor 909 9��L�-Z��2 C, F Y OF MENIFEE ;! ILDING AND SAFETY DEPART EN �a,,eawoac : Luf Q-GLOOM^ �.. Z�9yS PN-ehVr^Sf d foo lfED BY_ svv'. C' y C� � �2?� ATE 1 p�# >i 26 I `Auproval of these plans shall not be construed to be a permit for,or an 9'1S-/ 3�j� approval of,any violation of any provisions of the federal,state or city f' reulations and ordinances. This set of approved plans must be kept on the jobsite until completion. �, nQhvy- goE+.