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PMT17-03983 City of Menifee Permit No.: PMT17-03983 29714 HAUN RD. Type: Residential Addition ACCEL]A_ MENIFEE, CA 92586 MENIFEE Date Issued: 11/06/2017 PERMIT Site Address: 29316 GUAVA ST, MENIFEE,CA 92584 Parcel Number: 333-624-009 Construction Cost: $2,900.00 Existing Use: 1 &2 Family Residence Proposed use: Description of INSTALL 10'X 28 .SOLID ALUMAWOOD PATIO COVER W/ELECTRICAL 2 FANS Work: Owner Contractor DALE&KATHY NELSON T F MEADOR CONSTRUCTION 29316 GUAVA ST PO BOX 713 MENIFEE, CA 92584 WILDOMAR, CA 92595 Applicant Phone:9518376180 TOM MEADOR License Number:6390B7 T F MEADOR CONSTRUCTION PO BOX 713 WILDOMAR, CA 92595 Fee Description Oty Amount 1$) 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 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 perjurythat I am under provisions of with a licensed contractors)pursuant to the Contractors State License Law). Chapter9(commencing with section 7000)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 License o. l��'! �i By my signature below I acknowledge that,except for my personal residence Expires � L 30 Signature in which 1 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 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 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 ,A,sv,A,le inf ca. ov c law.html. this permit is issued.Policy M -?51 Date /7 o 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:(,(—p 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 1 building construction.I authorize representatives of this city or county to Policyk��5 39-/ S3�—/ S Expires C7 30 enter the a ove i t' ed prose 6r inspection purposes. (This section need notto be completed is the permit is for one-hundred Date ' lD dollars($100)or less PROPERTY OWN R OR AUTHORIZED AGENT o I certify that in the performance of the work for which this permit is issued, t17'1G+� I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE q 1J! 44 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 forthwi com I ithall forthwi com l ith thos�ovisions. Will the applicant or future building occupant handle hazardous material or a �� a mixture containing a hazardous material equal to or greater that the Applicant��Date amounts�sPf cified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE Is o Yes �Qdo 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 foorguid- es - CONSTRUCTION LENDING AGENCY ❑Yes 13 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 boppdary of a school? (Section 3097 Civil Code) ❑Yes o 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 Cade,Section 25505 and 25534 concerning Contractors License Law for the reason(s)indicated below by the checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 _hazardous material) eporting. Business and Professions Code).Any city or county that requires a permit to es ❑Nc ✓/ Date / (� construct,alter,improve,demolish or repair any structure,signets its PROPERTY OWNER R A ORIZED 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 IRRPI 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($SOO). 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.g_YLov/lead/lead or contact the National Lead Information Center at not Intended or offered for sale.(Section 70",Business and Professions 1-BOG-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. o 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. i • APPLICATION Menifee DATE: bi(17 PERMIT/PLAN CHECK NUMBER TYPE: O COMMERCIAL X RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: (ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O-NiE-W OPLUMBING ORE-ROOF NUMBER OF SQUARES DESCRIPTION OF WORK rI..YL t vI I OI /o 7( 2 Ivmrn✓ VIt t/ra (_oVr PROJECT ADDRESS 2p22rUC41/� st ^ ZIP �7259f 1- ASSESSOR'S PARCEL NUMBER J,IT,J� LOT �P 5 TRACT IASS0�� OWNER NAME 0-kc- A Z SD ADDRESS 51e, v"`lC_ PHONE c� 6l- 7333- '6119 EMAIL APPLICANT NAME t dot — ADDRESS PO 0 / W C , C/4- Cj 2s Q S PHONE 7- r 8' EMAIL CONTRACTOR'S NAME __r / -+g Ate- COKs-{'. OWNERBUILDER? OYES NO BUSINESS NAME -`- ADDRESS PHONE *EMAIL CONTRACTOR'S STATE LIC NUM$Eg (0 3 9 O g / �LICENSE CLASSIFICATION VALUATION$ a9 QO SO FT L SQ FT APPLICANT'S SIGNATURE DATE It 6 I/7 DEPARTMENT DISTRIBUTION ACCEPTED CITY OF MENIFEE BUSINESS UCQNSOUMBER Y:BUILDING PLANNING ENGINEERING P1Rf !� 601Ll�-4 PERMIT FEE 0 SMIP GREEN PLAN CHECK FEE • 1 INVOICE TOTAL OWNER BUILDER VERIFIED OYES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586951-672-6777 www.cityofinenifee.us LEDGER & IRACK a� ENP EC"TJ ON REQUIRED s 0- jo ee Building Dept. NOV U 6 2017 Received � a 3 `f51- 7733- 00"q 'a :2 (0 GvaVa St c{A j'2 5 8 C 50ILCIjNG AND S FE i Y NPARTMENT PLAN APPROV V W .�,. ,v ,n p.oveJ puss must be kepi on the joo;�:e u,wi completion, .�C1 ,L