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PMT17-04568 City of Menifee Permit No.: PMT17-04568 29714 HAUN RD. 5 ACCELA? MENIFEE, CA 92586 Type: Residential Addition MENIFEE Date Issued: 12/28/2017 PERMIT Site Address: 28937 GOLDEN DAWN DR, MENIFEE, Parcel Number: 372-351-002 CA 92584 _ Construction Cost: $4,400.00 Existing use: 1 &2 Family Residence Proposed use: Description of INSTALL ONE 416 SO FT SOLID PATIO COVER WITH 2 CEILING FANS AND 4 POST LIGHTS Work: Owner Contractor TAHMINA MORSEHD KMPATIOCOVERS.COM INC 28937 GOLDEN DAWN DR 19495 OAKVIEW LANE MENIFEE, CA 92584 LAKE ELSINORE, CA 92530 Applicant - Phone:9098386779 ADAM MARVIN License Number:954365 KMPATIOCOVERS.COM INC 19495 OAKVIEW LANE LAKE ELSINORE, CA 92530 Fee Description Q�t Amount ISl Receptacle, Switch,Outlet&Fixture 6 141.00 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 $309.66 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 Men'rfee.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_Permk_Tempiate.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 ❑I am exempt from licensure under the Contractor's State License Law for Professions Code d my license is in full force and effect. the following reason:. License Class License Jo. 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 DECLARATION have built as an owner-builder if it has not been constructed in its entirety by in 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.gov/calaw.html. Polity It Date ❑I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT section 3700 of the Labor Code,forthe performance of the workforwhich o By my signature below I certify to each of the following:I am the property this permit is Issued.My worker's compensation Insurance carrier 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 with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy It 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)ar less PROPERTY OWNER OR AUTHORIZED AGENT �rtlfy 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 It 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 forth twith cart/7ply l with+those provisions. Will the applicant or future building occupant handle hazardous material or a Applicant �/e1�4 Tab DVAI) Date 1?6 mixture containing a hazardous material equal to or greater that the amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS in Yes a<o UNLAWFUL,AND SHALL SUBJECT AN EMPLOYERTO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($300,000),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 _------- forguidelines - CONSTRUCTION LENDING AGENCY ❑Yes saw 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) ❑Yes u.Ntr- OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm under penalty of perjurythat I am exempt from the permitting checklist.I 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 hazardous material reporting. checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 /] Business and Professions Code).Any city or county that requires a permit to Date r construct,alter,improve,demolish or repair any structure,priorto its PROPERTY OWNER 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 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($500). managers who do the paint-disturbing Work themselves or through their ❑I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit: compensation,will do( )all of or( )portion of the work,and the structure is www.eoa.eov/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-BOD-424-LEAD(5323). Code;The Contractor's State License Law does not apply to an owner of a ❑.An EPA Lead-Safe Certified Renovator will be responsible for this project property who,through employees'or personal effort,builds or improves the property provided that the Improvements are not Intended or offered for Certified Firm Name: sale.If,however,the building or improvement is sold within one year of Firm Certification No.: completion,the Owner-Builder will have the burden of proving that it was not built or Improved for the purpose of sale. o No EPA Lead-Safe Certified Firm is required for this project because: o I,as owner of the property am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractor's State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP Acknowledgement. J IT/PLAN& SAFETY PERM APPLICATION pvii[� .. Menifee DATE: I Z�Z g PERMIT/PLAN CHECK NUMBER " Q TYPE: O COMMERCIAL 8'r�ESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES DESCRIPTION OF WORK If /6 P 1oh-1 oqko Co vtr �4n J I PROIECTADDRESS Z$J37 60/0(N �4�.n /'j, ZIP 92J'13 ASSESSOR'S PARCEL NUMBER LOT TRACT OWNER NAME 1 A 4im n R off/h�l� /� ADDRESS -Z V37 Io�(� 1Jq Or. PHONE 95^I .3 7-7�/- Otto EMAIL `z APPLICANT NAME 4/4 " �Grvoim JJ /� A to coilA ADDRESS qqI / y9.r 041C V•,Plr 1A- tcke £/ n.f. o1Y 92 f'.1 O PHONE /o 9 �� b/�� 9 EMAIL -7+" CONTRACTOR'S NAME Cw[!y. CO/LI rc/�Q- OWNER BUILDER? C:YES CCHd@ BUSINESS NAME Q ADDRESS 4'_Vle LA -hd(!L- CA PHONE 9b9 b3o h 7�pp EMAIL CONTRACTOR'S STATE LLIC NUMBER 3 LICENSE CLASSIFICATION VALUATION$ ` yobA SQ.FT. LSO FT APPLICANT'S SIGNATURE DATE CITY.STAFF USE.ONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE ACCEPTED PERMIT FEE SMIP GREEN r 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 kaun Rd. Menifee, CA 92586 951-672-6777 www.cityofmenifee.us City of Menifee HOMEOWNER /"to r,c.I, Building Dept. CONTRACTOR Tahmina and Mobik-Morshed KMPatioCovers.com.lnc 19495 Oakview Lane 28937 Golden Dawn dr DEC l f; Lake Elsinore CA 92530 Menifee CA 92584 (951 )377-8120 (909)838-6779 O � License#954365 Scope of Work:Install Solid Insulat a 13'x32"(416 sq/ft). Cover will attach to O' single family home and existin concrete slab.Structure wi me ude 2 ceiling fans and 4 post lights. (L TRACK p W Oaf✓ ( ITY OF MENIFEE L0 UILDING AND SAFETY DEPARTMENT LL �41 LAN APPROVAL 0 nJ RE'VIEWED BY F;k l ? I ATE 2�93� *Appri ival of these plans shall not be construed t be a permit for, ran C"!d r n L) ' n approi al of,any violation of any provisions of the federal,state or ity 15 regula ions and ordinances. This set of approved lans must be ke t on th, w jobsit until completion. Y • I f � cot 1 9 f A h