PMT17-03937 City of Menifee Permit No.: PMT17-03937
29714 HAUN RD.
RCEL/t7i MENIFEE,CA 92586 Type: Residential Addition
MENIFEE Date Issued: 1 110112 01 7
PERMIT
Site Address: 30281 CORALIUM WAY, MENIFEE, CA Parcel Number: 360-810-043
92584 Construction Cost: . $3,100.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL SOLID ALUMWOOD PATIO COVER 14 x 28 W/ELECTRICAL-3 LIGHTS
Work:
Owner Contractor
CRAIG SHARON LGA CONTRACTING INC
30281 CORALIUM WAY P 0 BOX 28
MENIFEE,CA 92584 WILDOMAR,CA 92595
Applicant Phone:9512856545
LGA CONTRACTING INC License Number:973789
P 0 BOX 28
WILDOMAR, CA 92595
Phone:9512856545
Fee Description Qtv Amount(S1
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 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 Bidg_Permit Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts forthe projects
1 hereby affirm under penalty of perjurythat 1 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 ❑1 am exempt from licensure under the Contractor's State License Law for
Professions Code andmy license is in full force and effect. the following reason:
License Class C� �i License No. �.Z 3�b By my signature below I acknowledge that,except for my personal residence
Expires c9 I -D I I I a Signature in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DE[LARATIO improvements covered by this permit.I cannot legally sell a structure that I
have hull[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 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
this permit is issued. www.leginfo.ca.Rov/calaw.html.
Policy# Date
❑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 with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# 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
certlfy that in the performance of the work for which this permit is issued,
I shall not emolov 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 of the Labor
Code,I shall fo with comply with those provisions. 1 Will the applicant or future building occupant handle hazardous material or a
Applicant �. aC73✓ 1_t-2`f 0i yt0 Date\l— ,� mixture containing a hazardous material equal to or greater that the
t; amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 ❑Yes pi-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 "a
I hereby affirm that under the penalty of perjury there is a rttion Will the proposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work whi �`t'gif5r Issued outer boundary of a school?
(Section 3097 Civil Code) G �9 v� g7es o No
OWNER BUILDER DECLARATIONS QV" rto1� I have read the Hazardous Material Information Guide and the SCAQMD
(� 1 1• permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am ex�[Am the California Health&Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicate ow by the hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section �yj dyes ❑No
Business and Professions Code).Any city or county that req qit o — \
construct,alter,improve,demolish or repair any q its 1�`"�°f "'�"'et✓`o Date t
issuance,also requires the applicant for the pe signed statement PROPERTY OWNER OR AUTHORIZED AGENT
that he or she Is licensed pursuant to the provision of the Contractors State EPA RENOVATION,REPAIR AND PAINTING JRRPJ
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(5500).
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.epa.Rov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 70",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 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.
7
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE: PERMIT/PLAN CHECK NUMBER FIE I __U J
TYPE: O COMMERCIAL • RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA C SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
&NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK \
PROJECTADDRESS jC`�281 /��o\ kOrY\ UkJakI' 1 ZIP G �JR-IA
ASSESSOR'S PARCEL NUMBER '5(kVc•�(7 -04'C LOT T5 TRACT a? `CI v
OWNER NAME •,] , 1 ;p _._
ADDRESS •Z K: \ \ J M �1 -e•
PHONE gC31 . L'�?jC> _t 50 EMAIL
APPLICANTINAME L `✓el, � en
ADDRESS
PHONE � AIC_ �a R'S EMAIL
CONTRACTOR'S NAME V t pV' e Ua(-N C OWNER BUILDER? &YES 0 NO
BUSINESS NAME L—CA
ADDRESS s,
PHONE �'�� • 'a�}Fj- LOCjI-\�j EMAIL C MU 1 •L
CONTRACTOR'S STATE LIC NUMBER �• r-� LICENSECLASSIFICATION
VALUATION$ OO SO FT �jG C.. L SQ FT Y zppl
APPLICANT'S SIGNATURE DATE �^I
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CIS F MENIF BUSINESS U ENSE NUMBER
ACCEPTED BY: ✓'
BUILDING PLANNING ENGINEERING FIRE • I.
PERMIT FEE 3V�,J, SMIP GREEN
PLAN CHECK FEE INVOICE TOTAL
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER YES v NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951 enfte
Dept
www.cityofmenifee.us
NOV 0 1 2017
Received
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