PMT17-03057 City of Menifee Permit No.: PMT17-03057
29714 HAUN RD.
(ACCEL/17. MENIFEE,CA 92586 Type: Residential Addition
r.R...,.-K.:s.u.Y. MENIFEE Date Issued:
08/29/2017
PERMIT
Site Address: 25774 ROUNDUP CIR, MENIFEE, CA Parcel Number: 358-510-007
92684 Construction Cost: $6,900.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 840 SF SOLID ALUMAWOOD PATIO COVER WITH 3 FANS,4 POST LIGHTS
Work:
Owner Contractor
CARLOS FLORES KONTIKI CONSTRUCTION
25774 ROUNDUP CIRCLE 31060 HIDDEN LAKE RD
MENIFEE,CA 92584 MURRIETA, CA 92563
Applicant Phone:9097172457
EPELI MAFUA License Number:782009
KONTIKI CONSTRUCTION
31060 HIDDEN LAKE RD
MURRIETA, CA 92563
Fee Description ON Amount IE)
Receptacle, Switch, Outlet&Fixture 7 146.00
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 7.30
$321.95
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 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
I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full form and effect. ( the following reason:
License Class i License No. -7,Nz-00�` By my signature below I acknowledge that,except for my personal residence
Expires Signature 4a 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 1
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 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.IeRinfo_ca.Rov/caIaw.htm1.permit is issued.
Policy q Date
❑I have and will maintain workers compensaton 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 workers compensation Insurance carder and policy owner or authorized to act on the property owners behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
` with all applicable city and county ordinances and state laws relating to
Carrier CC building construction.I authorize representatives of this city or county to
Policy q 926 RJCJc� 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
❑I certify that in the performance of the work for which this permit is issued,
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE 9
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 empty with those provisions. WIII the applicant or future building occupant handle hazardous material or a
Applicant Date a' 17 mixture containing a hazardous material equal to or greater that the
/ amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECUR ORKER'S COMPENSATION OVERAG L5 ❑Yes ❑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)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes ❑No
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 boundary of a school?
(Section 3097 Civil Code) ❑Yes ❑No
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 hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 DYps ❑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(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($500). managers who do the paint-disturbing work themselves or through their
❑I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.eoa.gov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code,The Contractors State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible forthis project
property who,through employees or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. o No EPA Lead-Safe Certified Firm is required forthisproject because:
❑I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
APPLICATION& SAFETY PERMIT/PLAN CHECK
,Menifee
DATE 17 PERMIT/PLAN CHECK NUMBER W vi
-U f�j
TYPE: O COMMERCIAL C RESIDENTIAL O MULTI-FAMILY 0 MOBILE HOME O POOL/SPA OSIGN
SUBTYPE: O ADDITION u'ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
PROJECTADDRESS 2577 of U l <�Tk M \ (2. ':fz4�
ASSESSOR'S PARCEL NUMBER , �� ( � LOT TRACT
OWNER NAME
City of Menife
Opf.
ADDRESS
PHONE EMAIL APPLICANT NAME Receivp
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME ` OWNER BUILDER? 0 YES CA
BUSINESS NAME v(
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER 73j2C�o� LICENSE CLASSIFICATION
VALUATION$ C2 1 EGG SQ FT L-t L SQ FT
APPLICANT'S SIGNATURE DATE �-'
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I - SMIP 1
INVOICE
AMOUNTZQ�_ q,,�5 PAID AMOUNT 1, 15 OCASH QCHECKR OCREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT OCASH OCHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER YES ^ NO
City of Menifee &Wdinc&Safety Depertment 29714 Houn Rd. Menife_=, '_4 92586 951-672-6777
www.cityofineni;ee.us Inspection Request Line 951-246-621
I I I I I
City of Menitee
LEDGER & TRACKED f3uiidAus 2 s 2ot�ing & Safety t. n
C�ION REQUIRED � i rnn
I
Receiver' � C�
b
I � I
I
�r.
_f
JJi i e •
yl
Qi -I - I ti 1 � t • ��'\
1 !-
!-J—I --
I.
—EtTY,-oEr-M�f NfFf!F UIC 4113F �MD� E ETY DEPARTMENT
_
I I _
LA_ '
— --I - I�E�IEWE(� �
---- - - DATE
I
I �
PPr64 fthesepidn,snr 1 be construed tobe.&permit f 4oran
— III— —I----�--- pk$ul proValoff any 61adcut of an --ovlslons of the federal,state or city
_ _ _ - j
rationsland�rrdinances Ths , t of approved plans must be kept on the
f
bsrt I e until completion. —
II
I
_ I _