PMT17-02688 City of Menifee Permit No.: PMT17-02688
29714 HAUN RD.
�A\CCEL,A7. MENIFEE,CA 92586 Type: Residential Addition
MENIFEE Date Issued: 08/01/2017
PERMIT
Site Address: 27786 PANORAMA HILLS DR, MENIFEE, Parcel Number: 340-360-009
CA 92584 Construction Cost: $3,000.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL ALUMAWOOD SOLID 11 X 13 &LATTICE 11 X 22 WITH 1 FAN
Work:
Owner Contractor
MIKE DEROUIN KMPATIOCOVERS.COM INC
27786 PANORAMA HILLS 19495 OAKVIEW LANE
MENIFEE, CA 92584 LAKE ELSINORE,CA 92530
Applicant Phone: 9098386779
KENT MURVINE License Number:954365
KMPATIOCOVERS.COM INC
19495 OAKVIEW LANE
LAKE ELSINORE,CA 92530
Fee Description QQt Amount IEl
Receptacle,Switch, Outlet&Fixture 1 116.00
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 5.80
$290.45
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_Pemit 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).
Chapter!)(commencingwith section 7000)of Division 3 of the Business and in 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 Claass�) License No. 5.5 LIB By my signature below I acknowledge that,except for my personal residence
C�Expires� )!X< Signature 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 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 Code,for the performance of work for which www.Ieginfo.ca.gov/caIaw.htmI.permit is issued.
Policy p Date
❑I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,forthe 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 owner's 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 s 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
KKcertlfy that in the performance of the work for which this permit is Issued,
s not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE p
workers 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 hwith complywith those provisions. Will the applicant or futum�VYPQ cul ant handle hazardous material or a
Applicant Date - '-�7 mixture containing a hazardousr' to or greatertha[the
amounts specified on the Hazardous ai* ation Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes No , • q/z/s r1'Qept
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES V!7 pp'2
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN Will the lntended:use of the building DY y e licant or future building
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant requir&per or the construe modification from South
Coast Air Quality Mana nstrict(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES - F�� �. - --- ---.—
- forgdidelines- h3 �
CONSTRUCTION LENDING AGENCY 0 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 IN
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 al Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)Indicated below by the
hazardous material rep
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 o ting.
2�es ❑No (' r 1
Business and Professions Code).Any city or County that requires a permit to _ Date tS /1 7
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED AGE T
issuance,also requires the applicant for the permitto file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRP1
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
an Applicant for a permit subjects the applicant to a civil penalty of not more residence ra childcare facility a 6e rental
-repined firms and comply with
than($500). required practices.This includes rental property owners and property
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-BOD-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 forthis 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:
o 1,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 PERM IT/PLAN CHECK APPLICATION
IN
Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL )� RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA C SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES 7mp CC
DESCRIPTION OF WORK Yl ' \l 1 x 1 } Zz
w
PROJECT ADDRESS 77
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME �iI( 0
ADDRESS //z 77 55L ,�1
PHONE I'j] 760 pG"Zo EMAIL
APPLICANT NAME
ADDRESS ej4jc4
PHONE 162 453CS 6771 EMAIL
CONTRACTOR'S NAME K.Vv� �,a-�o Go vc.c v-. OWNER BUILDER? O YES NO
BUSINESS NAME
ADDRESS L L 1/\
PHONE < 6Q :!�a R' G775 EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ SO FT L SO FT
APPLICANT'S SIGNATURE 11r — DATE— fz- l -17
DEPARTMENT DISTRIBUTION I • CITY OF MENIFEE BUSOESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I • SMIP 3St/S^J
INVOICE
AMOUNT —`�J �[��• ().LM PAIDAMOUNT
O CASH OCHECK# OCREDIT CORD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH %CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 HOUn Rd. Menifee, CA 92585 951-672-6j�j Df Menifee
www.cityofinenifee.us Inspection Request Line 951-246-6213 Building&Satety Dept.
AUG 01 2017
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F�A VA L.EOGER t+ TRAGIC
P"'NEGTIQN REQUIRED
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ury OF MENIFEE
BUILDING AND SAFETY DEPARTMEN
PLAN APPRVAL -
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REVEti1 L , B • •
DATE
'Approval of these plans shall not be construed to be a permit for,or an
approval of,any violation of any provisions of the federal,state or ity
regulations and ordinances. This set of approved plans must be k t on the 0
jobsite until completion.
'OC`
City f Menifee
Building & Safety Dept.
AUG01 2017
Pleceived