PMT17-01909 City of Menifee Permit No.: PMT17-01909
29714 HAUN RD. Type: Residential Addition
<A_CCECA_ MENIFEE,CA 92586
.MENIFEE Date Issued: 06/14/2017
PERMIT
Site Address: 31375 CAPRICE RD, MENIFEE, CA 92584 Parcel Number: 360-611-020
Construction Cost: $4,700.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL A 10 X 45 SOLID ALUMAWOOD ATTACHED PATIO COVER W/ELECTRICAL-1 FAN&2
Work: LIGHTS
Owner Contractor
CHERRYL COLLINS T F MEADOR CONSTRUCTION
31375 CAPRICE 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 Oft Amount l81
Receptacle, Switch, Outlet&Fixture 3 126.00
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 6.30
$300.95
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 staled,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_Templale.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 in I am exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. ¢ the following reason:
k,
License Class License No. l0 3 O U 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
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
this permit is issued. WWW.Ieeinfo.ca.gov/caiaw.htm].
Policy# Date uq j LI
❑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
Carder with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# 9 W 35311 —I S Expires 7/20 I I v 1 enter th� i d prope inspection purposes.
(This section need not to 6e completed is the permit is for one-hundred Dak
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 emolov 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 workers compensation provision of Section 3700 of the Labor
Code,I shall forth comply Lth those pro sions Will the applicant or future building occupant handle hazardous material or a
c/I L '� mixture containing a hazardous material equal to or greater that the
Applicant G— Date // l�l amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes LCNo
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYERTO CRIMINAL PENALTIES Will the intended use of the building bythe applicant orfuture 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 Ai ality.Management District(SCAQMD)?See permitting.checklist—
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES fo guld astA nes
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 boyRtlary of a school?
(Section 3097 Civil Code) ci Yes o
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 255 5 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the ha ardous material reporti .
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 /es ❑No f I
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 OVAdR O 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(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 Iicensure 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
❑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.eoa:eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 70",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:
❑I,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.
Menifee
DATE PERMIT/PLAN CHECK NUMBERW AOF-I1-10101 0q
TYPE: O COMMERCIAL YESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: XADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES /�
DESCRIPTION OF WORK ��4� A k1 5 I U*,I Avw1 I�+N t-f C7
<'dutl 49 i 4Ar1 Z\ I 'd l' "U i ` Q
PROJECTADDRESS 313-1 CA Cam. flitG3
ASSESSOR'S PARCEL NUMBER 3 I I •02-b LOT 3J TRACT
OWNER NAME 6f\Q cr`d CO I V1
ADDRESS S°\VLC lAtArh-« C-A 92-5 9q
PHONE 9.51— t(4-00 !q "1 EMAIL
APPLICANT NAME �� a
{{ 1
ADDRESS Po 13 O� 7
7 13 Lj i UCO WN-O'l- C A g y 5 65
PHONE CIS[-937- CO l YSO EMAIL
CONTRACTOR'S NAME �� �A�'r ���S - OWNER BUILDER? OYES 40
BUSINESS NAME vv% e-
ADDRESS
PHONE S qV�-e- q EMAIL
CONTRACTOR'S STATE LIC NUMallBER CD 3 ( U' % /7 LICENSE CLASSIFICATION
VALUATION$ ` 1 / d SO FT s L SQ FT / G/
APPLICANT'S SIGNATURE DATE
CRYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION wig CITY OF MENIFEE INESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN (' SMIP I • 3 2
INVOICE ��^ • PAID AMOUNT
AMOUNT co 0 CASH O CHECK# 1 CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH O CHECK N OCREDITCARD VISAIMC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building& Safety Deportment 29714 Houn Rd. Menifee, CA 92586 5city1- MB ♦
www.cityofinenlfee.us Inspection Request Line 951-246-627duildln4 R Safety Dop"
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3t37-5 IZc�- DATE
M e n k`(�-e— 25$1 'Approval of these plans shall not be construed to be a permit for,or an
approval:of,any violation of airy provisions of the federal,state or city
regulations and oidinanies. This set of approved plans"ust be kept on the
iobsite until completion.
City of Menifee
J) { Building t£ Safety Dept.
!�3� JUN 14 2017
Received