PMT17-02751 City of Menifee Permit No.: PMT17-02751
29714 HAUN RD. Type: Residential Addition
<A-CC11i MENIFEE, CA 92586
MENIFEE Date Issued: 0 810 412 01 7
PERMIT
Site Address: 29931 TWIN LAKES RD, MENIFEE, CA Parcel Number: 333591-013
92585 Construction Cost: $3,500.00
Existing use: 1 &2 Family Residence Proposed use:
Description of INSTALL ATTACHED SOLVALLIMWOOD PATIO COVER 336 SO FT.WITH 2 FANS
Work:
Owner Contractor
JOSH HERRICK PSLQ INC
29931 TWIN LAKES ROAD 28910 RANCHO CALIFORNIA RD
MENIFEE, CA 92585 #206
Applicant Phone:9517954260
MENIFEE, CA License Number.919885
Fee Description (�yl Amount($)
Receptacle, Switch, Outlet&Fixture 2 121.00
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 6.05
$295.70
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 peril 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 forthe 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 o I am exempt from licensure under the Contractors State License Law for
Professions Code and y license is in full force and effect. the following reason:
License Claasss Y License �/ -7 /1 �7 By my signature below I acknowledge that,except for my personal residence
Expires Signature in which I must have resided for at least one year pdorto completion of
improvements covered bythis permit.I cannot legallysell a structure that I
WORKER'S COMPENSATION DECLARATIO 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 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.leeinfo.ca.eov/calaw.html.
this permit is issued.
Policy#
Date
p4'6ave 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 o By my signature below 1 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.1 have read this
number are: application and the information I have provided is correct.I agree to comply
C A/ 1� with all applicable city and county ordinances and state laws relating to
Carrier /V building construction.l authorize representatives ofthhcity orcountyto
Policy# Y50 3 o'L 5'L 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
o I certify that In the performance of the work for which this permit is issued, z v�L
I shall not am Ploy any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#�,�
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workerskompensation provisions of Section 3700 of the Labor
Code,l shall fort zi mply with those Will the applicant or future building occupant handle hazardous material ora
-' 6. ` mixture containing a hazardous material equal to orgreater that the
Applicant Date amounts specified on the Hazardous Materials Information Guide?
WARNING:FAIL RE O SECURE WORKER'S COMPENSATION COVERAGE IS o Yes J;I10__
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 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 forguidelihes
CONSTRUCTION LENDING AGENCY oYes p74o
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 bound�a of a school?
(Section 3097 Civil Code) o Yes aa14"o
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 Health&Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the hazar us material r ortin
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 es o No
Business and Professions Code).Any city or county that requires a permitto Date
construct,alter,Improve,demolish or repair any structure,priorto its PROPERTY OWP(fffilk 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 IRRPI
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($500). managers who do the paint-disturbing work themselves or through their
❑1,as owner of the property,or my employee with wages as their sole employees.For more Information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.eoa.eoy/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-900-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a o An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or Improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. o No EPA Lead-Safe Certified Firm is required for this prolect because:
o 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE PERMIT/PLAN CHECK NUMBERFmTn—o--r1 D 1
TYPE: O COMMERCIAL jKRESIDENTIAL C MULTI-FAMILY O MOBILE HOME -- POOL/SPA O SIGN
SUBTYPE: O ADDITION ""ALTERATION O DEMOLITION :% ELECTRICAL O MECHANICAL
O NEW OPLUMBING )^ RE-ROOF-NUMBER OF SQUARES 7
DESCRIPTION OF WORK n i a , v
PROJECTADDRESS a9 7Gwn',
ASSESSOR'S PARCEL NUMBER ?33-'5 11 11 'o 13 LOT �� TRACT
OWNER NAME AM 6 d f
ADDRESS at ini CA
2S
PHONE qS�•2;$-S9go EMAIL
APPLICANT NAME p
ADDRESS ((]]rr p
PHONE '{7�����lO�y EMAIL
CONTRACTOR'S NAME OWNER BUILDER? O YES KENO
BUSINESS NAME
ADDRESS JO r.e�.. , ,� 97,50
PHONE 95�-a3yo3sb EMAIL
CONTRACTOR'S STATE LIC NUMBER 7/q$ZS LICENSE CLASSIFICATION
VALUATION$ 3500. SQ FT 3 3 & L SO FT a2 ,
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN " SMIP 1
INVOICE /aC PAID AMOUNT �.
AMOUNT � lJ OCASH 'CHECK# CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT C;CASH :.'CHECK# C CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6.777
Menifee
www.cityofin denifee.us Inspection Request Line 951-246-6213 BUIl ng&t Safety Dept.
AUG 0 4 2017
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