PMT17-03659 City of Menifee Permit No.: PMT17-03659
29714 HAUN RD. Type: Residential Addition
'ACML/-> MENIFEE,CA 92586
a-1 sm.. MENIFEE Date Issued: 1011212017
PERMIT
Site Address: 25385 ROCKING HORSE CT, MENIFEE, Parcel Number: 358-541-008
CA 92584 Construction Cost: $3,871.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 12'x 17'SOLID ALUMAWOOD PATIO COVER WITH 1 FAN AND 12'x 11,SOLID
Work: ALUMAWOOD PATIO COVER, NO ELECTRICAL
Owner Contractor
SUSAN RYAN SOUTHERN CALIFORNIA PATIOS
25385 ROCKING HORSE COURT 1787 PAMONA DR#B
MENIFEE,CA 92584 CORONA, CA 92880
Applicant Phone: 9098161288
ANDREW POULLATH License Number: 948536
SOUTHERN CALIFORNIA PATIOS
1787 PAMONA DR#B
CORONA,CA 92880
Fee Description QQrt Amount($1
Receptacle, Switch, Outlet& Fixture 1 116.00
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 5.80
$290.45
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
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CITY OF MENIFEE
LICENSED DECLARATION propertywho builds or improves thereon,and who contram for the prulem
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 70011)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. S By my signature below l acknowledge that,except for my personal residence
Exp��
f� ,�-Y O 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 1
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 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,.lezinfa.ca.eov/calaw.html.
this permit is issued.
Policy# Date
K I have and will maintain workers compensation Insurance,as required by PROPERTY 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 workers compensation insurance carrier 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
Carrier 1 TF�f`-- 'r LN\ with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives ofthis city or county to
Policy# a(ZS-Z. Expires_ � S b' I 'U enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred
dollars($100)or less Date
PROPERTY OWNER OR AUTHORIZED AGENT
o 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#
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 ofthe Labor
Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date mixture containing a hazardous material equal to or greater that the
amounts s ecified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o 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 Dtstrict constSCtionor modification
permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes `I(No
I 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 b undary of a school?
(Section 3097 Civil Code) ❑Yes NNo
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 1 understand my requirements under the State of
Contractors 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 hazardous material reporting.
$)(Section 7031.5 //
Business and Professions Code).Any city or county that requires a permit to N Date
construct,alter,improve,demolish or repair any structure,prior to its �Rt�pE OWNER OR Al1TH IZED 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 IRRP)
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she Is exempt from licensure The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
receiving compensation for most work that disturbs paint in a pre-1978
and the casts for the alleged exemption.Any ntoto a ci 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 dull 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 ofthe 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 ofthe work,and the structure Is www.epa.eov/lead or contact the National Lead information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-BOD-424-LEAD(5323).
Code;The Contractors 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. ❑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 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
BUILDIN & SAFETY PERMIT/PLAN
1 APPLICATION
• f1 . _
CRy of ►,erliRfee
IdIng& Safety nnni
PERMIT/PLAN CHECK NUMBER
TYPE: C;COMMERCIAL * ESIDENTIAL 0 MULTI-FAMILY O MOBILE HOME O POOL/SPA OSIGN
SUBTYPE: .. ADDITION O ALTERATION O DEMOUTION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING 0 RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WO V {lam s 'Z I ZX
ol ,(c,,\ C�Je�I- 1 . L� r/ 1��a�1
PROJECTADDRESS dS -585 �e.�+do. NotV Coat OMA4&p ellSX9
ASSESSOR'S PARCEL NUMBER �y� Al . (bR LOT TRACT
OWNER NAME 7Ue ( M
ADDRESS `L.S3 S M�{SQ1`I' M�i,./I.YYc,C CA ZSu
PHONE ( -9 o EMAIL
APPLICANT NAME Pn&tAIV oaa c^ ,.Le O
ADDRESS �~/ 7� D� x,fp„�" f��j /,c�glo. e� {�f.,
PHONE `719- Spa`-Z3a� EMAIL Amlxx. ect+ib5
CONTRACTOR'S NAME_04111. +� OWNER BUILDER? YES NO
BUSINESSNAME
ADDRESS yp, 1'7g-/ I��Q
PHONE CF/1� !(� `'�. �5 EMAIL
CONTRACTOR'S STATE LICNUMBER SS S3C� LICENSE CLASSIFICATION
VALUATION$ 3.97( S FT L SO FT
J
APPLICANT'S SIGNATURE DATE (oj/-�L// 7
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE ACCEPTED BY:
PERMIT FEE O. rD SMIP GREEN 1�
PLAN CHECK FEE INVOICE TOTAL
OWNER BUILDER VERIFIED 0YES 0 NO DRIVERS LICENSE# _ `NOTARIZED LETTER <% YES 0 NO
LEDGER & TRACK
SLP- P-ujO'A ASPECTION REQUIRED
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x _ Poi pujjdjity of Menifoa
✓t I 9 $ Safety D pk
CQil.a j 5� OCT I 20fi
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CITY OF MENIFEE
BUILDING AND SAFETY DEPARTMENT r
PLAN APPROVAL
RELl1VI�EW D BY nn
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'Approval of these plans shall not be construed to be 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 t e
jobsite until completion.
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