PMT17-02996 City of Menifee Permit No.: PMT17-02996
29714 HAUN RD.
't—ACCELA-j MENIFEE, CA 92586 Type: Residential Addition
MENIFEE Date Issued: 0 812 312 01 7
PERMIT
Site Address: 28879 SKYLARK ST, MENIFEE, CA 92584 Parcel Number: 333-631-026
Construction Cost: $6,750.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL SOLID 549 SQ FT ALUMAWOOD PATIO COVER W/ELECTRICAL 2 FANS, 7 LIGHTS, 1
Work: OUTLET
Owner Contractor
DIANE BRACCO PSLQ INC
28879 SKYLARK ST 28910 RANCHO CALIFORNIA RD
MENIFEE, CA 92584 #206
Applicant Phone: 9517954260
LOIS MONTINI License Number. 919885
PSLQ INC
28910 RANCHO CALIFORNIA RD
#206
TEMECULA, CA 92590
Fee Description 01tr Amount fEi
Receptacle, Switch,Outlet&Fixture 10 161.00
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 8.05
$337.70
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 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 ❑ I am exempt from licensure under the Contractors'Slate License Law for the
1 hereby affirm under penalty or perjury that I am licensed under provisions of following reason:
Chapter 9(commencing with section 7000)of Division 3 of the Business and By my signature below I acknowledge that,except for my personal residence in
Professions-Code and"license is in full force and eff, - n (j, - which I must have resided for at least one year prior to completion of
License Class Lice s D. Y rj improvements covered by this permit, I cannot legally sell a structure that I have
Expires _ ignature built as an owner-building if it has not been constructed in its entirety by licensed
1 contractors. I understand that a copy of the applicable law,Section 7044 of the
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application is
submitted or at the following Web site:
❑ I hereby affirm under penalty of perjury one of the following declarations: htio://www.leainfo.ca.Dov/calawhtml.
I have and will maintain a certificate of consent of self-insure for workers'
compensation,issued by the Director of Industrial Relations as provided for by Date
Section 3700 of the Labor Code, for the performance of work for which this
permit is issued. Property Owner or Authorized Agent
Policy# ❑ By my Signature below, I certify to each of the following: I am the property
❑ 1 have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read this
section 3700 of the Labor Code, for the performance of the work for which this application and the information I have provided is coned. I agree to comply
permit is issued.My workers'compensation insurance carrier and policy number are: with all applicable city and county ordinances and slate laws relating to building
construction.1 authorize representatives of this city or county to enter the above-
Carder 1 06161
z� identified property for the inspection purposes.
Policy# W 0i/a06161 Expires_a/ / (p '/ - Date
q3 Property Owner or Authorized Agent
(This section need not be completed if the permit is for City Business License# p6403
one-hundred dollars($100)or less)
❑ 1 certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not employ any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or a
workers'compensation laws of California, and agree that if I should become mixture containing a azardous material equal to or greater that the
subject to the coo Irs'compensation provisions of Section 3700 of the Labor amounts spec speolfied on the Hazardous Materials Information Guide?
Code,I shall o w comply I those provisions. // •�/i DYES
Applic t; ate; -l-G I Will the intended use of the building by the applicant or future building
occupant require a rmit far the construction or modification from South
WARNING: FAILURE TO SECURE WORKERS' Coast Air Quali anagement District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guideli
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES ❑NO
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the propo ii id g r modified facility be within 1000 feet of the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of o01?
LABOR CODE, INTEREST,AND ATTORNEYS FEES OYES NO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist.I unda land my requirements under the State of
agency for the performance of the work which this permit is issued(Section California Health a Code,Section 25505 and 25534 concerning
3097 Civil Code) hazardous nal reporting.
OWNER BUILDER DECLARAT16NS ❑Y --7
1 hereby affirmunder penalty of perjury that I am exempt from the Contractor's Date
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OWNER OR ALI 'ORIZED AGENT
next to the applicable item(s)(Section 7031.5.Business and Professions Code:
Any city or county that requires a permit to construct,alter, improve,demolish, EPA RENOVATION.REPAIR AND PAINTING(RRP)
or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a pigned statement that he or she is licensed pursuant to the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
provisions of the Contractor's State License Law(Chapter 9 (commencing With receiving compensation for most work that disturbs paint in a pre-1978
Section 7000)of Division 3 of the Business and Professions Code)or that he or residence or childcare facility to be RRP-certified firms and comply with
she is exempt from licensure and the basis for the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than($500).) employees.For more information about EPA's Renovation Program visit:
www.epa.govAead or contact the National Lead Information Center at
❑ I, owner of the property, or my employees with wages the
their sole 1-800-424-LEAD(5323).
compensation,owill re ( )all . or( )porting 13 the work,and the structure; G VV_01
not intended or offered for sale.(Section 7044,Business and Professions Code; l7l 1�'�
The Contractor's State License Law does not apply to an owner of a property ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
who, through employees'or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however, Certified Firm Name:
the building or improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that it was not built or improved for the Finn Certification No.:
purpose of sale).
❑ I, as owner of the property an exclusively contracting with licensed No EPA Lead-Safe Certified Firm is required for this project because:
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's License Law does not apply to an owner of a property
who builds or improves.thereon, and who contracts for the projects with a
r vim '
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Awl
DATE 08/21/2017 PERMIT/PLAN CHECK NUMBER O
TYPE: El COMMERCIAL QRESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME POOL/SPA []SIGN
SUBTYPE: []ADDITION [—]ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑MECHANICAL
❑NEW ❑PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Attached solid Alumawood patio cover,with electrical(2 fans,7lights, 1 outlet)
PROJECT ADDRESS 28879 Skylark St 2/ ,, 1
ASSESSOR'S PARCEL NUMBER ?y 3 - (n'3�' o.�lllAr :J�Y TRACT lr^J
PROPERTY OWNER'S NAME Diane Bracco
ADDRESS 28879 Skylark St.Menifee,CA 92584
PHONE (714)309-3266 EMAIL
APPLICANT NAME
ADDRESS
PHONE q 33 q--171,EMAIL
CONTRACTOR'S NAME GreenBee OWNERBUILDER7 ❑YES ✓❑NO
BUSINESS NAME
ADDRESS 28910 Rancho California Rd,Temecula, CA 92590
PHONE (951)234-0356 EMAIL
CONTRACTOR'S STATE LIC NUMBER 919885 LICENSE CLASSIFICATION B
VALUATION$ $6,750.00 SO FT 549sgft L SQ FT 48.5
X"tUiAPPLICANT'S SIGNATURE J DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN ' SMIP
INVOICE Sr PAID AMOUNT
AMOUNT ✓�•� OCASH QCHECK# C>CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH %CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES G NO DLNUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6 77 7
www.cityofinenifee.us Inspection Request Line 951-246-6213
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