PMT17-02738 City of Menifee Permit No.: PMT17-02738
29714 HAUN RD. Type: Residential Addition
<��CCELAI7. MENIFEE, CA 92586
MENIFEE Date Issued:
08/03/2017
PERMIT
Site Address: 29683 TIERRA SHORES LN, MENIFEE, Parcel Number: 340-470-008
CA Construction Cost: $3,550.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL ALUMAWOOD PATIO COVER WITH ELECTRICAL 1 FAN,2 LIGHTS AND 1 OUTLET 394 SQ
Work: FT
Owner Contractor
TAYLOR HEIDE WILLIAM SIMS
29683 TIERRA SHORES 34450 WALTHAM PL
MENIFEE, CA 92584 WINCHESTER, CA 92596
Applicant Phone: 9512164220
WILLIAMS SIMS License Number:845983
WILLIAM SIMS
34450 WALTHAM PL
WINCHESTER, CA 92596
Fee Description Ool( Amount f$1
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 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 Pernit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property wh%buitor improves thereon,and who contracts for the projects
with a lice tractors)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of wt�g
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I1 pt frotsklicensure under the Contractoes State License Law for
Professions Cod and my license is in full force and effect. GS1e W owing rw-
License Class - 1 Li ns N CA '1'1
/R J�\ y my n�ure below 4wledge that,except for my personal residence
Expires . 1 g Signature / 0 in must ha ed for at least one year prior to completion of
i - improvements bythispermit.l cannot legally sell astructurethatI
WORKER'S COMPENSATION DECLARATION have bui wner-builder if it has not been constructed in its entirety by
❑I hereby affirm under penalty of perjury one of the following declarations:I license ractors.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 this permit is issued. www.leeinfo.ca.¢ov/calaw.html.
/y
Policy# i/ G (�2 y t sT�N Date
PROPERTY OWNER OR AUTHORIZED AGENT
have and will maintain worker's compensation insurance,as required by
ection 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 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
,t / / with all applicable city and county ordinances and state laws relating to
Carrier lM, ✓� /� /� "/ �� building construction.I authorize representatives of this city or county to
Policy# Expires t 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 emolov any persons in any manners �s to become subject to the CITY BUSINESS LICENSE#
worker's compensation laws f California, agree that if I should become HAZARDOUS MATERIAL DECLARATION
ubjectto the orker's c nation pr islo of Section 3700 of the Labor
Code,I shall h ith y wit a pr isions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date elp�! miztuntsmaininga hazardous material
Mateualrials
to Information
ationr[hat the
amounts clfied on the Hazardous Materials Information Guide?
WARNI : L ECU W k 'S COMPENSATION COVERAGE IS ❑Yes No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant
t e In ended use pe
of the building by construction
applicant or future building
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR oocupantrequire Manin
agpermiement
enor thetrict( CAQM )?modification
See permining c South
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. oast Air O Iity Management District(SCAQMp)1 See permitting checklist
fguid li es
CONSTRUCTION LENDING AGENCY Yes No
I hereby affirm that under the penalty of perjury there is a construction ill th car posed building or modified facility be within 3000 feet of the
lending agency for the performance of the work which this permit is issued uter boundary of a school?
(Section 3097 Civil Code) Yes Ao
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Infor atio Guide and the SCAQMD
p ing cV
rstand my quire ents under the State of
I hereby affirm under penalty of perjury that I am exempt from the alifo i Hafeode,Se ion25 5and 25534 concerning
Contractors License Law for the reason(s)indicated below by the rdo s gcheckmark(s)I have placed next to the applicable items)(Section 7031.S esBusiness and Professions Code).Any city or county that requires a permit toDate
construct,alter,improve,demolish or repair any structure,prior to itsp PERTYHOR D A ENT
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(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-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.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 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. ❑No EPA Lead-Safe Certified Firm is required for this 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 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.
BUILDING & SAFETY • APPLICATION
n.
� Men ifee
DATE PERMIT/PLAN CHECK NUMBER PM- n-u2-j ✓.b
TYPE: O COMMERCIAL XRESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES �1
DESCRIPTION OF WORK (/ ,q V
PROJECT ADDRESS 6
ASSESSOR'S PARCEL NUMBER 3411-�IOOn�' LOT TRACT
OWNER NAME
ADDRESS ry P% t1
PHONE �j f �jo (,�){ [7�s�� EMAIL
APPLICANT NAME
ADDRESS ` / f
PHONE �,j_` �_� 6 �� EMAIL
CONTRACTOR'S NAME OWNER BUILDER? O YES O NO
BUSINESS NAME
ADDRESS S
PHONE EMAIL G�
CONTRACTOR'S STATE LIC NUMBER LICENSE SSIFICATION
VALUATION$ "' FT L SQ FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I' SMIP
INVOICE �O� PAIDAMOUNT
AMOUNT O CASH OCHECK# ��CREDIT CARD 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 ^f unnife
Bullding & Safety 68Pt.
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-62.jG 0 3 20V
Received
REQUIRED
PERMIT NO.
SITE PLAN
NAMEYLO:. ...11 : : : PHONE ( / �ti� '•/� 9 �- '
SITE ADDRESS 24Cf 6 ` 'I'J 1:t22,Q 9646f7 �-
ASSESSORS PARCEL NUMBER
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