PMT17-02365 City of Menifee Permit No.: PMT17-02365
29714 HAUN RD.
�CCEL/-> MENIFEE, CA 92586 Type: Residential Addition
MENIFEE Date Issued:
07/1012017
PERMIT
Site Address: 29241 SHIPWRIGHT DR, MENIFEE, CA Parcel Number: 333430-006
92585 Construction Cost: $5,800.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 9'X 44'ALUMAWOOD PATIO COVER,W/ELECTRICAL 4 FANS, REQUIRES 4 FOOTINGS
Work:
Owner Contractor
VINNY GOUNDAR T F MEADOR CONSTRUCTION
29241 SHIPWRIGHT DR 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 Oft Amount f51
Receptacle, Switch, Outlet&Fixture 4 131.00
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 6.55
$306.20
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_Bidg Pemiit_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 contractor(s)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 Contractors State License Law for
Professions Code andmy license is in full farce and effect. the following reason:
License Class License o. By my signature below I acknowledge that,except for my personal residence
Expires Signat 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 DECLARATI have built as an owner-builder if it has not been constructed in Its entirety by
❑I hereby affirm under penalty of perj ry 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 Cade,for the performance of work for which www.leginfo.ca.gov/calaw.htmi.permit is issued.
Policy# Date
❑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
Carrier with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# 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 1I��I�////' ���-
Kh!
ertify that in the performance of the work for which this permit is issued,
all not emolov any persons in any manner so as to become subject to the CITY BU51NE55 LICENSE N �,/ 1_
kern compensation laws of California,and agree at if I should become HAZARDOUS MATERIAL DECLARATION
subject to t ore compensation P1,591ons o ection 3700 of the Labor
Code,I sh forth w1 co ly wit se rovisi s. Will the applicant or future building occupant handle hazardous material or a
Applica t Date mixture containinga hazardous material equal to or greater that the
amountsyspenfied an the Hazardous Materials Information Guide?
WARNING: U TO SECURE WORKER'S COMPENSATIO COVERAGE 15 ❑Yes p�lvo F -
UNLAWFU4 SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL ES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South
- - IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)7 See permitting checklist
for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes g�rvo
1 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 ad 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 California H ction 25505 d 25534 concerning
Contractors License Law for the reason(s)indicated below by the hazardo materia e?pV
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Dyes
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 O OR AUTHORIZE 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 RENO ION 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-certlfied 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
❑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.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 Contractors State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovatorwill 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 forthe purpose of sale. ❑No EPA Lead-Safe Certified Firm is required forthis 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.
APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK
Menifee
DATE U 11-7 PERMIT/PLAN CHECK NUMBER 1 'O
TYPE: O COMMERCIAL 4RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
-
DESCRIPTION OF WORK =tt9tol ( y 1 t ctth a eU /PV`
W aN 5 & 1i -9009-fv\ S
PROJEcTADDRESS 212- �0\hIc D1�
ASSESSOR'S PARCEL NUMBER 3 / — �1' '0140T TRACT
OWNERNAME �/1Y�Y� I,SOVv.O�Y
ADDRESS Sav°�e
PHONE a 51 --^37 9 -(oO-3 11 1 EMAIL
APPLICANT NAME 1 ('V6A / le �b" ej`� I f
ADDRESS Po �� �� WI/ l ot,-LC- ee+ g25rQ
5
PHONE EMAIL
CONTRACTOR'S NAME t--�e��-O''- 6' K OWNER BUILDER? O YES 60
BUSINESS NAME
ADDRESS S 4m
PHONE q EMAIL
CONTRACTOR'S STATE LIC NUMBER C'3 1 0 7 "' LICENSE CLASSIFICATION
ov
VALUATION$ f15 Sao SQ FT 3 /to L SQ FT ^7
APPLICANT'S SIGNATURE DATE /a 1
DEPARTMENT DISTRIBUTION �' CITY OF�F�US LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAIDAMOUNT
AMOUNT � O CASH O CHECK# OCREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZEDLETTER 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
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038ln03H NQIAa dSNI
A9VH1 'P N39033
CITY OF MENIFEE
y..� BUILDING AND SAFETY D ARTMENT
07 �REVIEWED BY-,,_. _
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'Approval of these plans sh,dli nut he cv..; naeo to oe a ermit for,or an
Lad rq L W y\e_r' approval of,any violation of any prowsion of the federa state or city
\ regulations and ordinances. This set of apl roved plans m t be kept on the
60`,tea z� jobsite until completion,
a5 i - 379 - Goa
City of nifee
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