PMT17-02055 City of Menifee Permit No.: PMT17-02055
29714 HAUN RD. Type: Residential Addition
CCEL/A> MENIFEE,CA 92586
MENIFEE Date Issued:
O6/22/2017
PERMIT
Site Address: 28768 WOODCREST LAKE DR, Parcel Number: 364-181-001
MENIFEE, CA 92584 construction cost: $10.000.00
Existing use: 1 &2 Family Residence Proposed use:
Description of INSTALL 16 x IV AND 16'x 14'SOLID AND 14'x 15' LATTICE ALLIMAWOOD PATIO COVERS WITH 2
Work: FANS, 8 LIGHTS
Owner Contractor
JIM DIAZ SOCAL HOME IMPROVEMENT
28768 WOODCREST LAKE DRIVE 16331 LAKESHORE DR#G161
MENIFEE, CA 92584 LAKE ELSINORE,CA 92530
Applicant Phone:9512364282
TROY CRISWELL License Number:930540
SOCAL HOME IMPROVEMENT
16331 LAKESHORE DR#G161
LAKE ELSINORE,CA 92530
Fee Description OQt Amount($1
Receptacle, Switch, Outlet&Fixture 10 161.00
Building Permit Issuance 1 27.00
Deck/Patio, non-standard 1 133.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 2.00
General Plan Maintenance Fee-Building 1 6.65
General Plan Maintenance Fee-Electrical 1 8.05
$338.70
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_Pennit 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 Levi).
Chapter9(commencing with section 7000)of Division 3 of the Business and o 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 Class � License N By my signature below I acknowledge that,except for my personal residence
Expires Signatur — 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 DEC RATION _ have built as an owner-builder if it has not been constructed in its entirety by
❑I hereby affirm under penalty of p ry one ofth lowing declaration:) licensed contractors.I understand that a copy of the applicable law,Section
have and will maintain a certificat�o"f 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 f9J9 website:
by Section 3700 of the Labor Code,for the performance of work for which www.lesinfo.c . e aw.htmi. n
this permit is issued. ,l
po have
Date
I have and will maintain workers compensation insurance,as required by PROP ORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which O By m gnature below I certify to each of the following:I am the property
this permit is issued.My workers comp os`ation insurance carrier and policy oww+ r or authorized to act on the property owners behalf.I have read this
number are: I I application and the information I have provided is correct.I agree to comply
1� �.r—�/)►\ with all applicable city and county 9�0dinances and state laws relating to
Carder building construction.I author'zeepresentatives of this city of county to
Policy# U Expires enter[ 5t ?entifi roperty ' spection purposes.
(This section need not to be completed is the permit is for one-hundred Date /V! /J
dollars($100)or less PROP THORIZED AG ENT
o I certify that in the performance of the work for which his permit is issued,
I shall not employ any persons in any manner sqasrfo besphe subject to the CITY BUSINESS LICENSE It
workers compensation laws of California, rfd if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers coo pensation �sfons f- ection 3700 of the Labor
Code,Ishall fo ithW h riiiply wit osep v'ions. Will the applicant or future building occupant handle hazardous material ora
Applisa �� Date mixture containing a hazardous material equal to or greater that the
amounts ecified on the Hazardous Materials Information Guide?
WA NG:FAILUR TE O S E WORKER'S COMPENSATION COVERAGE IS O Yes pr o
UNLAW�LAND 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)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelii es
CONSTRUCTION LENDING AGENCY O Yes [fNo
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 bou9�dary of a school?
(Section 3097 Civil Code) Dyes oMo
OWNER BUILDER DECLARATIONS I have re d 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
Contractors License Law for the reason(s)indicated below by the California Health al Safety Code,Section 2 and 534 concerning
hazard s material repo
checkmark(s)I have placed next to the applicable items)(Section 7031.5 Oyes
Business and Professions Code).Any city or county that requires a permit to reporting. / Date
construct,alter,Improve,demolish or repair any structure,prior to Its PROPERTY E O AUTHO IZED 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 OVATION REPAIR AND PAINTING fRRPI
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the he 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
o 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 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a D 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. O No EPA Lead-Safe Certified Firm is required for this project bemuse:
O 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.
APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK
r;.
Menifee
DATE Z PERMIT/PLAN CHECK NUMBER
TYPE: 000MMERCIAL (VRESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW 11O PLUMBING� O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK b ILIc�-► II(� �' SG v Lo(/-VS
c D Go—
PROIECTADDRESS
ASSESSOR'S PARCEL NUMBER 7QLi - IC6111 - (�O\ LOT TRACT Building $ Safety )ept.
OWNER NAME�[ S` Vv— h Ca-L-- JUN 2 2 2017
ADDRESS v0 VV 2 C vim,
PHONE 109 312 7 IL EMAIL i W� t4Z +L' yh-q�� �-�ti
APPLICANT NAME
ADDRESS
PHONE (` EMAIL "
CONTRACTOR'S NAME S `(� �^1 -7� OWNER BUILDER? OYES O
BUSINESS NAME A
ADDRESS lL 1 L4 0 (� 51L,o qz-5.3b
[^'
PHONE 'PCID Z2( 4'(< EMAIL
CONTRACTOR'S STATE LIC NUMBER 530 '(? LICENSE CLASSIFICATION 0/
VALUATION$ /fl ,D O0 SQ FT L SQ FT
APPLICANT'S SIGNATURE �� DATE
DEPARTMENT DISTRIBUTION C. CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT O
AMOUNT ' CASH O CHECK# 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0 CHECK 4 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES 0 NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department29714 Noun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
LEDGER '& TRACK
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City of Menlfee
CI Y OF MENIFEE Building & Safety Dept.
B ILDING AND SAFETY DEPARTMENT JUN 2 2 2017
p ROVAL
Received r
REVIEWE 1 ~
DATE
*Approval of these plans shall not be const ued to be a permit for,or an
approval of,any violation of any provisions �ioe federal,state or city
regulations and ordinances. This set of DEPARTMENT
r ed plans must be kept on the
jobsite until completion.