PMT17-03580 City of Menifee Permit No.: PMT17-03580
29714 HAUN RD.
�CCEL/-> MENIFEE, CA 92586 Type: Residential Addition
MENIFEE Date Issued: 10/06/2017
PERMIT
Site Address: 27875 WILD SAGE CT, MENIFEE, CA Parcel Number: 336-370-045
92585 Construction Cost: $6,700.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 16 X 29 LATTICE ALUMAWOOD PATIO COVER WITH ELECTRICAL-2 FANS
Work:
Owner Contractor
ANN KIRCHGEESSNER TRADER DAN'S INC
27875 WILD SAGE COURT 840 S ROCHESTER AVE STE C
MENIFEE, CA 92584 ONTARIO, CA 91761
Applicant phone: 9093900555
DON DAUGHENBAUGH License Number: 517575
TRADER DAN'S INC
840 S ROCHESTER AVE STE C
ONTARIO, CA 91761
Fee Description Amount 1E1
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 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 wort(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_BIdg_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 I am under provisions of
Chapter!)(commencing with section 7DD0)of Division 3 of the Business and o 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 B License No. 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 prior to completion of
Improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATI have built as an owner-builder if it has not been constructed in its entirety by
❑I hereby affirm under penally 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
wvrry leginlo_caglr-alaw.nrn.I,
this permit is issued.
Policy 9 Date
❑�ve and will maintain workers compensai on insurance,as required by PR_9PERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which ❑By my signature below I certify to each of the following:I am the property
this permit is issued.My worker's compensation insurance caffler and policy owner or authorized to act on the property owner's behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
Carrier J'Z'� with all applicable city and county ordinances and state laws relating to
building constFbet. n.I authorize representatives of this city or county to
Policy g(a We Expires I. J e o e id Gf rty for inspection purposes
(This section need not to be completed is the permit is for one-hundred Date
dollars($1DO)or less p IZED AGENT
❑I certfy that m the performance of the work for which this permit is issued, O i{C/ 33
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE g ✓
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's c9maelLsation pmvisions of Section 3700 of the Labor
Code,I shalffowt t o pl i� a provisions. Will the applicant or future building occupant handle hazardous material or a
Applica Date �J r/ mixture contamp i hazardous material equal to or greater that the
amounts spec "led onthe Hazardous Materials Information Guide?
WARNI RE TO ECU ORf S COMPENSATION COVERAGE 6 O Yes oJVo
UNLAWFUL,AND SUBJECF AN EMPLOYER 70 CRIMINAL PENALTIES Will the intended use of the building 6y 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 SECFION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidel' s
CONSTRUCTION LENDING AGENCY D Yes No
I hereby affirm that under the penalty of perjury there is a construction Will the pro,posed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer to dary of a school?
(Section 3097 Civil Codel ❑Yes 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
California Health&Safety C
e,--*QzAPr 25505 and 25534 concerning
Contractor's Ucense Law for the reason(s)indicated below by the haz3tdpus ma erial re 'ng
checkmark(s)I have placed next to the applicable item(s)(Section 70315 ,d- o No /rj
Business and Professions Code).Any city or county that requires a permit[o /", _ D to b
construct,after,improve,.demolish or repair any structure,prior to Its PROPERTY OWNER O UTHO IZE
Issuance,also requires the applicant for the permt.t 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 MRPI
License Law(Chapter 9(commencing with Section 70D0)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 70315 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. Roy/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 ❑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. ❑No EPA Lead-Safe Certified Firm is required for this project because:
❑I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code: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.
APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK
'Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL ESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION "DEMOLITION O ELECTRICAL - MECHANICAL
O NEW O PLUMBING ORE-ROOF
APPLICATION NAME 1 �/ ''�9
DESCRIPTION OF WORK I b // 2�' ja f�/G2 /w,a,w a ,j eeto �
PROIECTADDRESS ;1797S- �Al T C'
ASSESSOR'S PARCEL NUMBER "J ,/�Q •?j�J{.! •' /'�� LOT � J TRACT =Po 05
OWNER NAME Am) i`/`Lt� }�(r
ADDRESS Z7 0775_ wl i c,'1L
PHONE 5-1- 6 ! -214q U EMAIL
APPLICANT NAME OVt
ADDRESS 126 1 -
PHONE C l�l )®- O EMAIL
CONTRACTOR'S NAME ,r OWNER BUILDER? ;;YES
BUSINESS NAME
ADDRESS 2q Q -01K Ll f
PHONE rq > q�- ocs5 EMAIL Pj
CONTRACTOR'S STATE LIC NUMBER �,j LICENSE CLASSIFICATION
VALUATION$ ,6 70D U 6 L SQ FT
APPLICANT'S SIGNATURE DATE �®
ClTYSMg _ 0my
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE SMIP I ' GREEN I' l/
INVOICE /fir �I'� PAID AMOUNT
AMOUNT Off- I•J o O CASH €3 CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0CASH OCHECK# 4CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO LICENSE NUMBER NOTARIZED LETTER G YES O NO
City at Menifee
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 925861y6pd &Matety Dept.
www.cityofmenifee.us Inspection Request Line 951-246-6213 OCT 0 6 261?
Received
LEDGER & TRACK
OWNER INSPECTION REQUIRED
i�.t V�
ADDRESS 2 'j -
CM( ZIP ONE Ci' b 27Q(P
LOT NO. TRACT APN
CONTRACTOR / � I—
ROOMS N' COVERS PROPOSED ADDITION(S) �� LTS
840 S ROCHESTER AVE#C
ONTARIO, CA 91761 x 2-q &bb'U a&aMTd
LIC. B-517575 �J
909-390-0555
WORK COMP `
ICW GROUP v
WSA5000386-07
EXP6/14/2015
44r
I�
4- q °(�CITY OF MENIFEE
BUILDING AND SAFETY DEP
PLAN APPROVAL
Oim
REVIEWED BY
DATE
'Approval of these plats shall not be construed to ea permit for,or an CI y of Manlfeo
approval of,any r btion of any provisions of the 3u g A Safety Dept.
regulations and ordinances. This set of approved plays must be kept on the
jobsite until completion. STREET OCT AF 2017
Received