PMT17-02685 City of Menifee Permit No.: PMT17-02685
29714 HAUN RD.
'!>CCFL/�' MENIFEE, CA 92586 Type: Residential Addition
MENIFEE Date Issued:
08/01/2017
PERMIT
Site Address: 30363 BLUME CIR, MENIFEE,CA 92584 Parcel Number: 360-073-011
Construction Cost: $5,700.00
Existing use: 1 &2 Family Residence Proposed use:
Description of INSTALL 12'x 34'SOLID ALUMAWOOD PATIO COVER WITH 2 FANS,3 LED LIGHTS
Work:
Owner Contractor
HENRY HIDALGO T F MEADOR CONSTRUCTION
30363 BLUME CIRCLE 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 Div Amount(E1
Receptacle, Switch, Outlet&Fixture 5 136.00
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 6.80
$311.45
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_Permk_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 perjurythat 1 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 Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class 8 Ucen No. (o3 9 O S 7 By my signature below I acknowledge that,except for my personal residence
Expires 4 '.�O Signature 6 K2� in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I
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 fallowing 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.lepinfo.ca.gov/calaw.htmi.permit is issued.
Policy# Date
Yl have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Cade;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 worker's compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this
number are: l� application and the information I have provided is correct.I agree to comply
Carrier t I'\IJ 3.5 3 41 IS with all applicable city and county ordinances and state laws relating to
Kt� � 7 buildingconstruction.Iauthorizerepresentativesofthiscityorcountyto
Policy# Expires 7130 ./ 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 certify that in the performance of the work for which this permit is issued,
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,I shall ��cal[�fy/ggr'ppRRIIIy with t revisions. Will the applicant or future building occupant handle hazardous material or a
Applicant `� '/ Date a 17 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
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or D)modification from South
IN SECHON 3706.OF THE.LABOR CODE,INTEREST,.AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)7 See permitting checklist
for guidelines - - - - - - - - - - -- -
CONSTRUCTION LENDING AGENCY O 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
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the
California
Contractor hazzardou
s License Law for the reason(s)indicated below by the Health al Safety Code,Section 25505 and 25534 concerning
hazardous material reporting.
checkmark(s)I have placed next to the applicable items)(Section 7031.5 pYes ❑No
Business and Professions Code).Any city or county that requires a permitto Date
construct,alter,improve,demolish or repairany structure,priorto Its PROPERTY OWNER OR 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 Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRPI
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 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.eoa.Rov/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 Contractor's State License Law does not apply to an ownerof 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 itwas
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
❑1,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
4Ei
Menifee
DATE It PERMIT/PLAN CHECK NUMBER -
TYPE: O COMMERCIAL OESIDENTIAL 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 ':L h 5T0t(I 0 5P O )l, V\ Uri
PROJECT ADDRESS 3 r,3 (� 3 lJ V VAC- C I Y'C L
ASSESSOR'S PARCEL NUMBER oWO�27 d LOT TRACT Safety Safety De 1.
OWNER NAME ,�I ( !� AUG 1 a !
ADDRESS dL SalV�e, / `�hL%Fce- C 'l V
PHONE 1 - '2 2d ' Z 10``5 EMAIL
APPLICANT NAME Ow r
ADDRESS [�� PJ Q�C �� w j 1 ��%'v�-off C� _ca' ZJ 6,e]
PHONE q S '-�O 37"CD EMAIL
CONTRACTOR'S NAME 'V Fe G`��"�- C wk-sfi OWNER BUILDER? O YES NO
BUSINESS NAME S CK W\
ADDRESS P C9 e5CP
��77
PHONE -l5 �"- �37-� 1 0 EMAIL (Vol ;�
CONTRACTOR'S STATE LIC NUMBER G3_ry 0 9 7 LICENSE CLASSIFICATION (V / 1 .>
VALUATION$ 700 SO FT -I O { L SO FT
APPLICANT'S SIGNATURE DATE S I
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIPINVOICE (-
3N�t5 PAID AMOUNT LAS
AMOUNT
O CASH O CHECK IT CO CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT I 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 Deportment 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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City of Menifee
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*App vat of these Plan! shall not be construed to be a permit for,or a
appro al of,any violatio k
St be n the
k of any provisions of the federal,state city
regula ions and ordina es.This set of approV�leans mu
jobsi until completio O��°tU