PMT18-01571 City of Menifee Permit No.: PMT18-01571
29714 HAUN RD.
�Ap A_> MENIFEE,CA 92586 Type: Residential Addition
MENIFEE Date Issued: 04/03/2018
PERMIT
Site Address: 30128 PEBBLE BEACH DR, MENIFEE, Parcel Number: 336-144-015
CA 92586 Construction Cost: $4,500.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 14'x 22'SOLID ALUMAWOOD PATIO COVER, NO ELECTRICAL
Work:
Owner Contractor
JOHN WAGY TRADER DAN'S INC
30128 PEBBLE BEACH DRIVE 840 S ROCHESTER AVE STE C
MENIFEE,CA 92586 ONTARIO, CA 91761
Applicant Phone:9093900555
DON DAUGHENBAUGH License Number:517575
TRADER DAN'S INC
840 S ROCHESTER AVE STE C
ONTARIO,CA 91761
Fee Description Qtv Amount ISI
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
$168.66
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 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[!censure under the Contractor's State License Law for
Professions Code a my license is in full force and effect the fallowing reason:
License ClaWSgnathrm
License No. 5 �7 By my signature below I acknowledge that,except for my personal residence
Expires in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLA p improvements covered by this permit.[cannot legally sell a structure that I
have built as an owner-builder if it has not been constructed in its entirety by
D 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.le0rdo.ca.gow/calaw.htmi.
Policy If Date
ailave 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 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 1—L� with all applicable cityand county ordinances and statelaws relating to
�L �i / building constructs u rize representatives of this city or county to
Policy# �SiTS�(�3O Expires v �y e't e i emir dprope for inspection purpos S. r
(This section need not to be completed Is the permit is for one-hundred ( G7 l g
dollars($100)or less Date
PROPERTY OWNER OR AUTHORIZED AGENT
o I certify that In the performance of the work for which this permit is issued,
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
workers 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 shaB.ferth 00 y with t rovisions. � ��..�� rr������ 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
'f lI amounts spec on the Hazardous Materials Information Guide?
WARNING. RE T -REWO R'S COMPENSATION[OVERAGE IS o Yes FIX"
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or fatu,a 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 37060FTHE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelin
CONSTRUCTION LENDING AGENCY O Ye 3140
i
I hereby affirm that under the penalty of perjury there is a construction Will the propose uilding or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer bounce of school?
(Section 3097 Civil Code) ❑Yes o
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
1 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 ,rhia�d.rdous maieriaFrep mg.
Business and Professions Code).Any city or county that requires a permit to s °No
construct,alter,improve,demolish or repair any structure,prior to its Date J
issuance,also requires the applicant for the permit to file a signed statement PROPERTY OW R O D AGENT
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 Ilcensure receiving compensation for most work that disturbs pant in a pre-1978
and the basis for the alleged exemption.Any violation Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with
than
Applicant for a permit subjects the applicant to a civilit 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 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 1-80D-424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an ownerof a O
property who,through employees'or personal effort,builds or improves the 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 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 Contractors 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.
tiLLtAJ / i1t Il�Y1FAIVs[JI✓/I .-.��'�M,�...r� w_ .1/_�
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE
DATE: / ( PERMIT/PLAN CHECK NUMBER - 1
PLANNING CASE NUMBER
TYPE: O COMMERCIAL -01RESIDENTIAL O MULTI-FAMILY MOBILE HOME O POOL/SPA OSIGN
SUBTYPE: OADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
16 NEW O PLUMBING '0 RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK I� 2 Z I d1I!/ A1UVvi&\wood
PROJECTADDRESS 3O� Z 0 �-Z 'e- --Q,�S(iVc ZIP
ASSESSOR'S PARCEL NUMBER S LOT TRACT Buildinci Dept
OWNER NAME J / A
ADDRESS 301n � �vt Q�vQ
PHONE 151-21 - g333 EMAIL eceiV
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACiOR'S NAME ZQ6M JU I OWNER BUILDER? O YES Q N6
BUSINESS NAME `l'`"' /I�
ADDRESS q{ ,) lJC.wI-� �tJ— /f' Y2 /lti rft- 61176
PHONE yi'-3gd-t)S-3- EMAIL
CONTRACTOR'S STATE
-LLII'C NUMBER �� S t LICENSE CLASSIFICATION 9
VALUATION$ 7 (/ SSO, -✓FT ,4 L SO FT
:L�7 _APPLICANT'S SIGNATURE DATE /71
OTYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
INVOICETOTAL GREEN SMIP %
OWNER BUILDER VERIFIED C YES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92S86 (951)672-6777
www.cityofinenifee.us
enIIP•B:
i1
OWNERoh
ADDRESS ,IZ • nh
CITY ZIPcj�& PHONE
LOT NO. *TRACT AR
CONTRACTOR
ROOMS N' COVERS PROPOSED ADDITION(S)
840 S R #C ONTARIOIO, CA CA 91761
LIC. B-517575
909-390-0555
WORK COMP
ICW GROUP
WSA5000386-07
EXP6/14/2018
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