PMT18-01380 City of Menifee Permit No.: PMT18-01380
29714 HAUN RD.
'ACCELA—? MENIFEE, CA 92586 Type: Residential Addition
MENIFEE Date Issued:
03/27/201B
PERMIT
Site Address: 31853 ROUGE LN, MENIFEE, CA 92584 Parcel Number: 372-492-009
Construction Cost: $3.800.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 12 X 28 SOLID ATTACHED ALUMAWOOD PATIO COVER WITH 1 FAN&8 LIGHTS
Work:
Owner Contractor
DENVER GORSHA SUNSTATE LANDSCAPE INC
31853 ROUGLE LANE 9901 INDIANA AVE#102
MENIFEE, CA 92584 RIVERSIDE, CA 92503
Applicant Phone: 9517977000
SUNSTATE LANDSCAPE INC License Number:945375
9901 INDIANA AVE#102
RIVERSIDE,CA 92503
Phone:9517977000
Fee Description D_yt Amount 1$1
Receptacle, Switch, Outlet&Fixture 9 156.00
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 7.80
$332A6
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 carded 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 perjury that l 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 aIamexempt from licensure under the Contractors State License Law for
Professions Code and my license is in full farce and eff
ect the following reason:
License Clan G427 License la. /L .3 S By my signature below l acknowledge that,except for my personal residence
Expires /1-30-/Jr-Signature in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DEC ON improvements covered by this permit.I cannot legally sel a structure that
have built as an owner-builder if It has not been constructed In its entirely 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 workers 7044 of the Business and Professions Code,Is available upon request when
compensation,issued by the Director of Industrial Relations as providedfor this application is submitted or at the following website:
by Section 3700 of the Labor Cade,for the performance of work for which wvnv.leeinfo.ca.Rov/calaw.html.
this permit Is issued.
Policy if 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 o By my signature below l 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.l have read this
number are: application and the information I have provided is coned.I agree to comply
Carrier tat y7-t54--, NA%.y. L with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Poll cy#Z1JiVf iFbI7LWS Expires_ `]'-j _ 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
a I certify that in the performance of the work for which this permit Is issued,
Ishallnotemolov any persons in any manner so as to became subject to the CITY BUSINESS LICENSE#
workers compensation laws ol'Callfornia,and agree that If l should become HAZARDOUS MATERIAL DECLARATION
subject to the workers co pe ationprovisionsofSmtion3700ofthe Labor
Code,l shall forth 1 f th hose provisions. Will the applicant or future building occupant handle hazardous material or
Applicant Date 10-3/'17 mixture containing a hazardous material equal to or greater that the
amounts specified an the Hazardous Materials Information Guide?
WAR :FAILURETO SECUREWORKER'S COMPENSATION COVERAGE IS Dyes allo
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($160,000),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 forguidellnes
CONSTRUCTION LENDING AGENCY ❑Yes ONO
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 Cade) Dyes ONO
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalryoFperjury lhatlam exempt from the permitting checklist.I understand my requirements under the State of
California Health 8,Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable Item(s)(Section 7031S DYes a No
Business and Professions Code).Any city or County that requires a permit to Date
construct,alter,improve,demolish or repair any structure,prior to 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 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 literature receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Section 70315 by residence or childcare facility to be RRP-certified firms and comply with
an Applicant for a permit subjects the apptinnt 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 themselvesorthrough their
Ol,as ownerof the property,army employee with wages as theirsole 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.eav/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 Contractors State License Law does not apply to an owner of a oAn 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:
D 1,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 rill out the RRP
Acknowledgement.
�j.
SAFETY PERMIT/PLAN CHECK APPLICATION
DATE 3 Z] I r PERMIT/PLAN CHECK NUMBER f J
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION "ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O�PLUUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK I�Ixi-O f SjL10 AL14 A, Ivz o P14 T1-(7
W 0 oNi_ FAN r S
PROJECT ADDRESS ,3 /)3 P�OL{/J��=] L�''�/�j�
ASSESSOR'S PARCEL NUMBER �J '"1 V - m f LOT TRACtity Of Menifee
OWNER NAME D Z
Building Dept.
ADDRESS ,r= .+ MAR 2 7 2018
PHONE 7(oi7-S-03 b'(Gr7 ( EMAIL o
Reutilvivu
APPLICANT NAME S /( ' L
ADDRESS .rAlVi/{,S/ja vf- /
PHONE 9,s'/ - 74 7- 7LIr EMAIL
CONTRACTOR'S NAME _ `� /`_ = OWNER BUILDER? O YES 'A-d0
BUSINESS NAME S(�Nf I�} 1% LA.r/Y�S PL -r'.✓G.
ADDRESS O f
PHONE �'SI_747 _ 7,107 EMAIL
CONTRACTOR'S STATE LIC NUMBER GJ/_(,> �7s LICENSE CLASSIFICATION Q C,),
VALUATION$ 3 „SQFT 33k LSQFT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION I CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE 'yI. pglD AMOUNT O
AMOUNT ' 0CASH CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK It O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DL NUMBER NOTARIZED LETTER O YES NO