PMT17-02943 City of Menifee Permit No.: PMT17-02943
29714 HAUN RD.
<A-CCEL/ MENIFEE,CA 92586 Type: Residential Addition
MENIFEE Date Issued: 0 910112 01 7
PERMIT
Site Address: 28752 PARK TRAIL WAY,MENIFEE,CA Parcel Number: 333-680-036
92584 Construction Cost: $5,500.00
Existing Use: 1 &2 Family Residence Proposed use:
Description of CONSTRUCT 12'X 14'CUSTOM PATIO COVER W/ELECTRICAL
Work:
Owner Contractor
TAMARA DYER
28752 PARK TRAIL WAY
MENIFEE, CA 92584
Applicant License Number:
TAMARA DYER
28752 PARK TRAIL WAY
MENIFEE,CA 92584
Phone: 9518583654
Fee Description Q�t Amount($1
Receptacle, Switch, Outlet&Fixture 7 146.00
Building Permit Issuance 1 27.00
Deck/Patio,non-standard 1 133.00
Inspections not specified 129 129.07
Additional Plan Review Building 129 129.07
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 1.00
General Plan Maintenance Fee-Building 1 6.65
$672.79
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 1 am under provisions of
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 License No. 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 prior to completion of
improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATION 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 3ROPERTY
th Business �,1°-:.^ lions Code,is available upon request when
compensation,issued by the Director of Industrial Relations as provided for1' align' s5 ubm' ed o t fallo7Date
website:
by Section 3700 of the Labor Code,for the performance of work for whichf , ON c I
this permit is issued. ✓7
Policy# '� �' L
OWNER OR AUTHO Z AGENT
❑I have and will maintain workers campensa lion insurance,as required by
section 3700 of the Labor Code,for the performance of the work for which o By my signature below ce . 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 nd the information I have provided is correct.I agree to comply
licable ' county ordinances and state laws relating to
Carrier 3PROPERPolicy# Expire(This section need not to be completed is the permit is for one-hundreddollars($100)or lessDate /�l
TY OWNER OR AUTyO.ZED AGENT
o I certify that In the performance of the work for which this permit is issued,
I shall not emolov 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 workers compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
Applicant Date amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes o 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 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)7 See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes ❑No
I hereby affirm that under the penalty of perjury there Is a construction Will the proposed building or modified facility he 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 0 No
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
Contractors License Law for the reasons)indicated below by the California Health al Safety Cade,Section 25505 and 25534 concerning
hazardous material reporting.
checkmark(s)I have placed next to the applicable Items)(Section 7031.5 oyes o No
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 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 Contractors State EPA RENOVATION,REPAIR AND PAINTING fRRPI
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 fora 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
01,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.eov/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 thatthe 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:
❑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.
& SAFETY PERM IT/PLAN CHECK APPLICATION
Menifee
DATE �_I PERMIT/PLAN CHECK NUMBER fl/gIrl— OALH?
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
t�NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK \A,p w eleC. �2't ILA
PROJECTADDRESS ,�,
ASSESSOR'S PARCEL NU BER ��3(oS'G ID— LOT T.,OV TRACT
OWNER
ADDRESSp��3pt�.
PHONE �/I Q�p� (p EMAIL 7Z>Yi: P+I'0j `Y Co�) Qo/ Love,
APPLICANT NAME
ADDRESS YAP Q`Sa/bo%e
PHONE �95/> �, ��(oS"7 EMAIL
rZ
CONTRACTOR'S NAME OWNER BUILDER? ES O NO
BUSINESS NAME
ADDRESS 1�,' L,� 73,
PHONE � � IS �' 1 EMAIL
I
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ �j SQ L SO FT
APPLICANT'S SIGNATURE 17711 A
1� ATE
DEPARTMENT DISTRIBUTION rI CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN 11 SMIP
INVOICE �/� PAID AMOUNT
AMOUNT �✓ OCASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH 0CHECK# O 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 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinemfiee.us Inspection Request Line 951-246-6213