PMT17-02994 City of Menifee Permit No.: PMT17-02994
29714 HAUN RD.
'ACCELA> MENIFEE,CA 92586 Type: Residential Addition
MENIFEE Date Issued: 08/23/2017
PERMIT
Site Address: 30583 BUCKBOARD LN, MENIFEE, CA Parcel Number: 358-451-003
92584 Construction Cost: $5,900.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 10'X 27', 15'X 23'SOLID ALUMAWOOD PATIO COVER,W/ELECTRICAL 1 FAN,2 SPOT
Work: LIGHTS
Owner Contractor
BRETT& KIM CHARLSON PATIO GUY ALUMAWOOD CONTRACTOR
30583 BUCKBOARD LN 41197 GOLDEN GATE CIR STE 108
MENIFEE,CA 92584 MURRIETA, CA 92562
Applicant Phone:9513330056
LOIS MONTINI License Number:872839
PATIO GUY ALUMAWOOD CONTRACTOR
41197 GOLDEN GATE CIR STE 108
MURRIETA, CA 92562
Fee Description gty Amount lEl
Receptacle, Switch. Outlet&Fixture 3 126.00
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 6.30
$300.95
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 slated,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
I herehy affirm under penalty of perjury that I am under provisions of with a licensed contractors)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑1 am exempt from licensure under the Contractor's State License Law for
Professions Code ar�s�(my license Is in full force and effe __ ^ the following reason:
License Clatss ,U Uce a- � t/aJ By my signature below l acknowledge that,except for my personal residence
Expires UJ' �7 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
o 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.le;zinfo.car.gov/calaw.html.permit is issued.
Policy# Date
❑I have and will maintain worker's 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 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: /� ,r application and the information I have provided is correct.I agree to comply
Carrier �2)6/2 /q J / with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# �'7"��-�� 7 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
of certify that in the performance of the work for which this permit is issued, iyf�l�L _
1 shall not em o
olov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# �J6 `44
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 fo lywi h comply with those provisions. Will the applicant or future building occupant handle hazardous material or
mixture containing a hazardous material equal to or greater Guide?
e
Applicant . Date amounts spec' Ed on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes t9 a
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 forguidelines
CONSTRUCTION LENDING AGENCY ❑Yes o
I hereby affirm that under the penalty of perjurythere 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 o -school?
(Section 3097 Civil Code) o Yes o
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.l understand my requirements under the State of
I hereby affirm under penalty of perjurythat I am exempt from the
Contractor's License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous ma, te�ial,repcarting.
Business and Professions Code).Any city or county that requires a permitto oyes o o�iY Ll� /��_
_��) �(�� Date
construct,alter,improve, applicantsh for hepermiany t to
a prior tsta 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 IRRP)
License Law(Chapter9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(ARP)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
o 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.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 Contractor's 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 project because:
0 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Cade: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.
�IVJWMt7SAFETY >
DATE PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL PRESIDENTIAL O MULTI-FAMILY O MOBILE HOME 0 POOL/SPA O SIGN
SUBTYPE: 7 ADDITION '�ALTERATION CIDEMOLITION C ELECTRICAL O MECHANICAL
O NEW O PLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
L 5
PROIECTADDRESS
ASSESSOR'S PARCEL NUMBER 35 p1 - �• ..7 LOT TRACT
OWNERNAME - k1M ,L,L
ADDRESS o tj J17
PHONE q,/ - A &9 - ; !j&l EMAIL
APPLICANT NAME
ADDRESS C.,
PHONE Q��- 3 3 y�J7 EMAIL
CONTRACTOR'S NAME OWNER BUILDER? O YES Via
BUSINESS NAME 4517
•-�
ADDRESS yI 1 97in
PHONE 9,s�- ,�3-LSO (� EMAIL AdQm @6j1UmgWp1) ' I`4' e bm
CONTRACTOR'S STATE LAIC NUMBER g9o� $ "/ LICENSE CLASSIFICATION
VALUATION$ .i / SQ.FT ! L SQ FT
APPLICANT'S SIGNATURE CJ '. DATE
DEPARTMENT DISTRIBUTION CITY OF MENIEEE BUSINESS UCENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I V SMIP I
INVOICE PAID AMOUNT
AMOUNT •� OCASH `'-CHECK# OCREDITCARD VISIVMC
PLAN CHECK FEES PAID AMOUNT •,-;CASH O CHECKN •✓CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
.,�, �3 �3 PDT II
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LEDGER & IRA K
INSPECTION REOU REU
rxi=p $G City of Menifee
Building & Safety Dept
AUG 2 3 2017
i Received �
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PLAN APPROVAL
REVIEWEDBY* 'r �
3 D ° DATE (D
'Approval of these plans shall not be construed tabe a permit for,or an
approval of,any violation of any provisions of the federal,state or city
regulations and ordinances. This set of approved plans must be kept on the
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