PMT18-01405 City of Menifee Permit No.: PMT18-01405
29714 HAUN RD.
99 CV_ �!.' MENIFEE,CA 92586 Type: Residential Addition
MENIFEE Date Issued: 0 312 912 01 8
PERMIT
Site Address: 30272 RUSTLER WAY, MENIFEE, CA Parcel Number: 358-510-004
92584 Construction Cost: $2,750.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 12'x 16'SOLID ALUMAWOOD PATIO COVER WITH 1 FAN,2 LIGHTS
Work:
Owner Contractor
JULIE PICONKE PSLQ INC
30272 RUSTLER WAY 18890 SEATON AVE
MENIFEE, CA 92584 #206
Applicant Phone:9517954260
JOSH HERRICK License Number:919885
PSLQ INC DBA GREENBEE
1BB90 SEATON AVE
PERRIS,CA 92570
Fee Description gyl Amount($1
Receptacle, Switch, Outlet&Fixture 3 126.00
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 6.30
$300.96
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 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 I am exempt from licensure under the Contractor's State License Law for
Professions Code and Ty license is in full force and effect, the following reason:
License Class_ B License No. '1 By my signature below i acknowledge that,except
g p y personal residence
Expires ,_Signature in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legallysell a structure that i
have built as an owner-builder if it has not been constmcted 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 forworker's 7044 of the Business and Professions Code,is available upon request when
compensation,issued by the Director of Industrial Relations as provided for
by Section 3700 ofthe Labor Code,for the performance of work for which this application is submitted or at the following website:
this permit is issued. wwmIeeinfo.ca eov/calaw.html.
Policy# Date
01 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 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
numberare: application and the information I have provided is correct.I agree to comply
Carrier Vv!? with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy If u5o3oa5a Expires - 2-� enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred
dollars($100)or less Date
PROPERTY OWNER OR AUTHORIZED AGENT
o I certifythat in the performance of the work for which this permit is issued, C��5q0 Z
I shall not emolovany persons in any manner so as to become subject to the CITY BUSINESS LICENSE#_
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 forthwlt mply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILUR TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes 014-0
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($10D,000),IN WIII the intended use of the building by the applicant or future building
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South
IN SECTION 37060E THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)?See permitting checklist
forguidelines
CONSTRUCTION LENDING AGENCY oYes
dIvro-
I hereby affirm that under the penalty of perjury there is a construction WIII 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) 0 Yes
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 2SS05 and 25534 concerning
hazardous material re orting.checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Qy{s o No I
Business and Professions Code).Any city or county that requires a permit to
construct,alter,Improve,demolish or repair any structure,prior to its �= Date_ _
issuance,also requires the applicant for the permit to file a signed statement
PROPERTY OWNER 6R hUTROKIZED AGENT -T—
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
Business and Professions Code)or that he or she is exempt from licensure The EPA Renovation,Repair and Painting(RRPJ Rule requires contractors
and the basis for the alleged exemption.Any violation of Section 7031.5 by receiving compensation for most work that disturbs paint in a pre-1978
an Applicant for a permit subjects the applicant to a civil penalty of not more residence or childcare facility to be RRP-certified firms and comply with
than($500). required practices.This includes rental property owners and property
managers who do the paint-disturbing work themselves or through their
o 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 1-800-424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a
property who,through employees'or personal effort,builds or improves the n An EPA Lead-Safe Certified Renovator will be responsible for this project
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
completion,the Owner-Builder will have the burden of proving that it was Firm Certification No.:
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
01,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 Oil out the RRP
Acknowledgement.
Sosh�-r�-cCf�- Gl robe-2_.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION, MENIFEE
DATE: y PERMIT/PLAN CHECK NUMBER
PLANNING CASE NUMBER
TYPE: COMMERCIAL ¢ICRESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION C)DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUAREES
DESCRIPTION OF WORK t• 4, )✓ �q qo G! F, row e,— w rt1n 2 �f
PROJECTADDRESS _ 09 7al KU; 112T v�.I,Z ZIP 1-Z s y
—Cityof meniTee
ASSESSOR'S PARCEL NUMBER '�"j\�•mil.( LOT TRACT Quildinq Dept.
OWNER NAME Jv`\ CDFly p
ADDRESS q,,..Q fn, w, d 92-5,?; 7 C/
PHONE q5)-� 1y;5 EMAIL Received
APPLICANT NAME SnSI. �C,c� ,^P,B✓'� .
ADDRESS p
PHONE -nj09jy EMAIL
CONTRACTOR'S NAME W T`e.en OWNER BUILDER? 0 YES ENO
BUSINESS NAME (1 p
ADDRESS 2769to
PHONE 9 5)- Aw,0356 EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ 1Z 150 SQ FT ) R� L SQ FT y�
APPLICANT'S SIGNATURE - DATE 7�I
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: ' 'n CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE 11,`^I(��
INVOICETOTAL 3CO •Q5 GREEN SMIP
OWNER BUILDER VERIFIED OYES ';: NO DRIVERS LICENSE# NOTARIZED LETTER 0 YES O NO
City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777 .
G,n of
www.cityofinenifee.us
MENIFEE'
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Appr at of these plans s all not be construed to be a perriC r
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appro I of,any violation any provisions of the federal,star, or c
regul ons and ordinances This set of approved plans must kepi on the
(� johsi until completion.
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