PMT18-00840 City of Menifee Permit No.: PMT18-00840
29714 HAUN RD. Type: Residential Addition
1iACCELAt> MENIFEE, CA 92586
o"""-"s SA—, MENIFEE Date Issued:
02/2612018
PERMIT
Site Address: 29233 FALL RIVER LN, MENIFEE, CA Parcel Number: 364-290-001
92584 Construction Cost: $3,620.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL ATTACHED 12'X 30'SOLID ALUMAWOOD PATIO COVER WlELECTRICAL 2 FANS
Work:
Owner Contractor
LORRAINE VALES PSLQ INC
29233 FALL RIVER LN 18890 SEATON AVE
MENIFEE, CA 92584 #206
Applicant Phone:9517954260
JOSH HERRICK License Number:919885
PSLQ INC
18890 SEATON AVE
PERRIS, CA 92570
Fee Description PY Amount 1E1
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
$296.70
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 building operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise slated,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 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 D I am exempt from Iicensure under the Contractors State License Law for
Professions Code and M license is in full force and effect. //tt the following reason:
License Class, -tom License No. �5
By my signature below I acknowledge that,except formy personal residence
Expires,�SSignature In which l musthaveresided for at least one year priurto completion of
improvements covered by this permit.I cannot legallysell 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 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 370D of the Labor Code,for the performance of work for whichsy.leeinfo.aa.eov/calaw html.
this permit is issued.
Policy# Date
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 o 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 l�lv� with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Polity# ►�S o3oa 52- Expires ,—I Z—�9_ 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
o I certify that in the performance of the work for which this permit is issued, ^�5��
Ishallnotemolov any persons In any manner so as to become subject to the CITY BUSINESS LICENSE# �L
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 forthwit mplywith those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date a l,� ,J1� mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURFITO SECURE WORKER'S COMPENSATION COVERAGE 15 o Yes 0<0
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 odi
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(SCAQMDr mpermitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY oYes
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1009 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
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that l 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 re orting.
checkmark(s)I have placed next to the applicable item(s)(Section 70315 rzYtf o No _ 2 1 /�
Business and Professions Code).Any city or county that requires a permit to Date vI�(���
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWN R R U ORREDAGENT /
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(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 Iicensure receiving compensation far most work that disturbs paint lnapre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or compensation
nforfacili most
beork that disubspaiified firms nIcomre-197ply h
than
n($50 ).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
o 1,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 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. o No EPA Lead-Safe Certified Firm is required for this project bemuse:
o 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 Oil out the RRP
Acknowledgement
ka—�cC-k—— G t2zhv_2
C APPLICATION
Menifee
DATE: PERMIT/PLAN CHECK NUMBERYrM 6-bog
Ltc
PLANNING CASE NUMBER
TYPE: O COMMERCIAL XRESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION XELECTRICAL O MECHANICAL
O NEW O`P-LUMBING O RE-ROOF NUMBER OF SQUARES n
DESCRIPTION OF WORK C 1-'�F Snll fVtMA C�,/2f 2'� V i
&�kn , /
PROJECTADDRESS AE3 V:J �yjw- LAY! ZIP
ASSESSOR'S PARCEL NUMBER ao� l LOT 1Q TRACT
OWNERNAME Lbrm,%ne
ADDRESS - a.pit -
PHONE 6q- EMAIL
APPLICANT NAME C�1
ADDRESS /�[
PHONE '15)376-10M EMAIL
CONTRACTOR'S NAME a7 OWNER BUILDER? O YES,h'40
BUSINESS NAME ((1� �^�'' (�
ADDRESS Q 1 r�1y V �l i q ZS of
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER 2mJ LICENSE CLASSIFICATION
VALUATION$ 3 LlJ-e� SO FT 3bo L SO FT Q
APPLICANT'S SIGNATURE DATE Z
CITY STAFF USE ONLY -JML
'
DEPARTMENT DISTRIBUTION CITY OF 0::,2 F�E,6U-$INESS LICENSE NUMBER
ACCEPTE ��/�/� GJ•(TJ rVT
BUILDING PLANNING ENGINEERING FIRE
PERMIT FEE O GREEN SMIP Imo„•
PLAN CHECK FEE I INVOICE TOTAL ��Q
OWNER BUILDER VERIFIED. OYES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Deportment 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityof,menifee.us
0
0
w
O N
1 e e�i
I I
I (1) (D IN
I
I I
I I
V
O vn
n° MO
O Z to
1U M V,
O
01 A o G Z^
m M 'O {/,
CL v o A m Y )
0 00 ~ O O O N r Va
o " o c
nIn D o 0
D c m s, 'n
� Z � =r m m
W = D " m c Z D Cl
m * T y
r A 0 3 n. m C) D
G 0 ,s _ l
° - rn 7C
? 01 r
^ oz. < n v
O i m m
n Z T
o< s m v
a a` v s
o. W p Z Z
� T
v ;,
r- Cl) -F
a - m
_ a x
T D -m CD
�• T1 W n
O_ a N 'C f•r m ..�
.v Q g
G C m qo
o�
r a CD
D N a D 0 ti o0 CD
,
Z Z N < CD
m �D d CD
m w m
sv
w ' '
n r-
D
r _ gFI , COPY
o` w r 70
x
Lnn 7o D
C Z
m m
M <
w
z N NI H3AlH llVJ
OM
A 0
PmTm' oo 8qb