PMT17-04438 City of Menifee Permit No.: PMT17-04438
29714 HAUN RD.
�l-�CCELh� MENIFEE, CA 92586 Type: Residential Addition
MENIFEE Date Issued:
1 211 5/2 01 7
PERMIT
Site Address: 28707 MIDDLEBROUGH CT, MENIFEE, Parcel Number: 336-500-010
CA 92584 Construction Cost: $7,000.00
Existing Use: 1 &2 Family Residence Proposed use:
Description of INSTALL SOLID 990 SO FT ALUMAWOOD PATIO COVER W/ELECTRICAL 4 FANS
Work:
Owner Contractor
CHERYL ELLIS CREATIVE SCAPES
28707 MIDDLEBROUGH CT 4937 WAYSIDE ROAD
MENIFEE,CA 92584 CHRISTIANA, TN 37037
Applicant Phone:9515323031
JOE BARNARD License Number:811984
CREATIVE SCAPES
4937 WAYSIDE ROAD
CHRISTIANA, CA 37037
Fee Description Otty. Amount ISI
Receptacle, Switch,Outlet&Fixture 4 131.00
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 6.55
$306.20
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 butliding 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_Pennit 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 o 1 am exempt from Iicensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class C- X-2 License No.
(14 Fit/ By my signature below I acknowledge that,except for my personal residence
Expires 31_I Signature lt6'r-x 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 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 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 wv,w.IeRinfo.ca.gov/caIaw.htmI.permit is Issued. w
Polity# Date
o l have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which a 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
with all applicable city and county ordinances and state laws relating to
Carrier 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 AG ENT 'l
'fl certify that in the performance of the work for which this permit is issued, iy11ry'y14
II shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# 040C
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,I shall f hwittcompl r ith those provisions. c/ Will the applicant orfuture building occupant handle hazardous material or a
Applicant Date Sf-31-1 b mixture containing a hazardous material equal to or greater that the
amounts s ecified on the Hazardous Materials Information Guide?
WARNING:ill LURE TO SECURE WORKER'S COMPENSATION COVERAGE IS D Yes PNO
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[ODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY o Yes ciio
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 boundary of a school?
(Section 3097 Civil Code) a Yes ro
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
Contractor's 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(s)(Section 7031.5 hazardous ma ial reporting.
Qf4o
Business and Professions Code).Any city or county that requires a permit to oYes
Date /�,'s I�
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OVJJ a,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 Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRPI
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($SOD). managers who do the paint-disturbing work themselves or through their
o 1,as owner of the property,or my employee with wages astheirsole 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.eov/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. D No EPA Lead-Safe Certified Firm is required for this project because:
a 1,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.
APPLICATION& SAFETY PERMIT/PLAN CHECK
Menifee
DATE: ia-f S PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION ECTRICAL O MECHANICAL
O NEW O PLUMBING ORE-ROOF NUMBER SQUARES-
DESCRIPTION DESCRIPTION OF WORK / /D ZIA
PROJECTADDRESS OHO / D� (�IlG('OC/•Q �/C(Jr,YLj ZIP
ASSESSOR'S PARCEL NUMBER '� -10 LOT 10 TRACT o� p1a.3
OWNERNAME nC�er� L /JpFLLIS / �/'
ADDRESS 9L? i0-7 ,.�t'or le PlzcV h (!—
PHONE `7Dy —&C 0 -9J7J EMAIL
APPLICANT NAME
ADDRESS
PHONE �j7--30-3 EMAIL
CONTRACTOR'S NAME vC S rlI OWNER BUILDER? OYES O
BUSINESS NAME
ADDRESS
PHONE �J,��:�3 y�3d f / EMAIL —7
CONTRACTOR'S STATE LIC NUMBER (�j(GJ�Lr Q p LICENSE CLASSIFICATION C'Z 7
VALUATION$ SOD SQ FT f 70- L SQ FT /''�
APPLICANT'S SIGNATURE DATE 1-2 _JS` /
LITYSTAFFUS ONLY,_ V_
DEPARTMENT DISTRIBUTION CITYOF�pENIFEE BU IC ENUMBER
BUILDING PLANNING ENGINEERING FIRE ACCEPTED BYE �/ F \LIl'1
PERMIT FEE SMIP GREEN
PLAN CHECK FEE INVOICE TOTAL
OWNER BUILDER VERIFIED OYES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Noun Rd. Menifee, CA 92S86 9S1-672-6777
www.cityofmenifee.us
City of Menife:e
4 r-of,EH, ,2, .f RACK 5 Building Dept.
INSPECTIO REQUIRED' DEC t
Received
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BUILDING AND SAFETY DEPARTMENT
PLAN APi R'.`VAL
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al:n iot be construed to ba a jarm it for,or an
P.of any provisions of the federal,state or city r
ns and :es. This set of approved plans must be kept on the
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