PMT17-02405 City of Menifee Permit No.: PMT17-02405
29714 HAUN RD. Type: Residential Addition
<A_CCEUA_ MENIFEE, CA 92586
MENIFEE Date Issued: 07/11/2017
PERMIT
Site Address: 29112 GUAVA ST, MENIFEE, CA 92584 Parcel Number: 333-631-016
Construction Cost: $6,175.00
Existing use: 1 &2 Family Residence Proposed use:
Description of INSTALL 480 SF SOLID ALUMAWOOD PATIO COVER WITH 2 FANS,6 LIGHTS, 1 OUTLET
Work:
Owner Contractor
DONALD FORBES PSLQ INC
29112 GUAVA STREET 28910 RANCHO CALIFORNIA RD
MENIFEE,CA 92584 #206
Applicant Phone: 9517954260
JOSH HERRICK License Number.919885
PSLQ INC DBA GREENBEE
28910 RANCHO CALIFORNIA RD
#206
TEMECULA, CA 92590
Fee Description Oft l Amount($1
Receptacle,Switch, Outlet&Fixture 9 156.00
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 7.80
$332.45
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 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.rpt 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 D I am exempt from licensure under the Contractor's State License Law for
Professions Code and y license is in full force and effect the following reason:
License Class�Q License h 1S 7 By my signature below I acknowledge that,except for my personal residence
Expires 1--SI-IA Signature in which l must have resided for at least one year prior to completion of
improvements covered byth(s permit I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATI07ff have built as an owner-builder if it has not been constructed in its entirety by
O 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 www.IeRinfo.ca.Roy/calaw.html.
this permit is issued.
Policy N Date
PROPERTY OWNER OR AUTHORIZED AGENT
p4ave and will maintain workers compensation insurance,as required by
section 3700 of the Labor Code,for the performance of the work for which o 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 coned.I agree to comply
CN C with all applicable city and county ordinances and state laws relating to
Carrier building construction.I authorize representatives of thb city or county to
Policy 9 t/512 5 o Z 5— 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($300)or less PROPERTY OWNER OR AUTHORIZED AGENT
o l certify that In the performance of the work for which this permit is issued, //rr Lr2
1 shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE g n�7 4ab—
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers ompens -on provisions of Section 3700 of the Labor
Code,I shall fortf omplywththose� Will the applicant or future building occupant handle hazardous material or
16. mixture containing a hazardous material equal to or greater that the
Applicant Date amounts specified on the Hazardous Materials Information Guide?
WARNING:FAIL RE O SECURE WORKER'S COMPENSATION COVERAGE Is o Yes
UNLAWFUL,AND SHALLSUBIECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building bythe applicant or future building
AND CIVILFINES UP TO ONE HUNDRED THOUSAND DOLLARS($10D,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 forgutdelines
CONSTRUCTION LENDING AGENCY aYes p4o
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 bounda of a school?
(Section 3097 Civil Code) D Yes
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQNID
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 and25534 concerning
Contractors License Law for the reason(s)indicated below by the hazapilous material r ortin .
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 es o No 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 OWF(CM 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 71100)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($500). managers who do the paint-disturbing work themselves or through their
a I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.ena.eoy/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a o An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or Improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. D No EPA Lead-Safe Certified Firm is required for this project because:
D I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
;Menifee
DATE V/I PERMIT/PLAN CHECK NUMBER
TYPE: []COMMERCIAL RESIDENTIAL MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑MECHANICAL
❑NEW ❑PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK e� ; ;>% "-j
QI2c�t :cq Z 6J), �
PROJECTADDRESS Z9 010
ASSESSOR'S PARCEL NUMBERS�(,Q fj1 - ��lQ LOT TRACT
PROPERTY OWNER'S NAME jt-e
ADDRESS ZSB City of Meety
AmP /I�
Dept-
PHONE /y��g- �Qy'� EMAIL
APPLICANT NAME -J 6 t :r
ADDRESS Received
p
PHONE 1/51-m- 94$�/ EMAIL
CONTRACTOR'S NAME 4prle°¢n 9 a.( OWNERBUILDER7 ❑YE NO
BUSINESS NAME /� J
ADDRESS Q ,,o,.n C n AI,' fin--Pam,./Q 7SM
PHONE 9S[-,7;y a35� pp EMAIL
CONTRACTOR'S STATE LIICC NUMBER LICENSE CLASSIFICATION
VALUATION$ T SQ FTC L SQ FT
APPLICANT'S SIGNATURE DATE f/ /
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN ' SMIP I
AMOUNTINVOICE -.7� P PAID AMOUNT r2 �2
.7 0CASH OCHECKH %CREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O 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
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