PMT18-01849 City of Menifee Permit No.: PMT18-01849
29714 HAUN RD. Type: Residential Addition
<;�CCEL,f MENIFEE, CA 92586
MENIFEE Date Issued: 04/24/2018
PERMIT
Site Address: 29843 ROCK ROSE CT, MENIFEE,CA Parcel Number: 340-403-019
92584 Construction Cost: $5,000.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL ATTACHED 560 SQ FT SOLID ALUMAWOOD PATIO COVER W/ELECTRICAL,2 FANS,4
Work: LIGHTS
Owner Contractor
ALEJO E MARINAS 12760 ANDRETTO ST
29843 ROCK ROSE CT MORENO VALLEY, CA 92553
MENIFEE, CA 92584
Applicant Phone:9518672081
EDUARDO SALAZAR License Number: 18-PEOP-00014
12760 ANDRETTO ST
MORENO VALLEY,CA 92553
Phone:9518672081
Fee Description Q-t( Amount($)
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
General Plan Maintenance Fee-Electrical 1 7.05
$316.70
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 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
with a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of y�
Chapter9(commencing with section 7000)of Division 3 of the Business and Jtogym-exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. 'the following reason:
License Class License No. 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
❑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. wtQ.le nfo.ca. ov calaw.html.
_ s /
Policy# Date `'
o I have and will maintain worker's compensation insurance,as required by RO RTY(} R OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which ❑By my gn�ure below I certify to each of the following:I am the property
this permit is issued.My workers compensation insurance carrier and policy owner orcadEhorized 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
bu'IdTg construction.I authorize representatives of this city or coun 'to
Policy# Expires ter t�e above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred / Date 7i
dollars($100)or less < P !DER OR AUTHORIZED AGENT
1
❑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 USINESS LICENSE#
worker's 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 forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
Applicant Date amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes ❑No
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 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 for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes ❑No
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 o No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
Contractors License Law for thea reason(s)indicated below by the
I hereby affirm under penalty perjury that I am exempt from 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 oyes ❑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(RRP)
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($SOD). 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.epa.gov/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 ❑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:
❑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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION w; Is, MENIFEE
DATE: - Z j PERMIT/PLAN CHECK NUMBER p�
PLANNING CASE NUMBER
TYPE: COMMERCIAL 0"RESIDENTIAL <:' MULTI-FAMILY MOBILE HOME POOL/SPA SIGN
SUBTYPE: ADDITION ALTERATION DEMOLITION ELECTRICAL MECHANICAL
NEW 0 PLUMBING 0 RE-ROOF NUMBER OF SQUARES /f
DESCRIPTION OF WORK
PROJECTADDRESS �� c1 ���GC� n G �� ZIP CZS
ASSESSOR'S PARCEL NUMBER! LOT TRACT
OWNER NAME - Buildinge
ADDRESS ? 14
PHONE EMAIL ewled
APPLICANT NAME � Q,,i�p S � i
ADDRESS I Z 7 6 tT l t'j GZS'�
PHONE EMAIL -•• J. l `lw�
CONTRACTOR'S NAME O NER BUILDER? A.- 'YES %NO
I
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ SQ FT ��7 L SQ FT
APPLICANT'S SIGNATURE i'�/� J DATE /I L
CITYSTAFF USE ONLY � A low
DEPARTMENT DISTRIBUTION ACCEPTED BY: CIT Y OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
INVOICE TOTAL .�Q GREEN SMIP ---
OWNER BUILDER VERIFIED YES NO DRIVERS LICENSE# NOTARIZED LETTER YES NO
City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
GvTy Op
www.cityofinenifee.us
MENIFEE
LEDGER, TRACK
INSPECTION REOURP, city of menifep-
Building DePI.
MENIFEE Received
f , I , AND SAFETY DEPAR. . J,T
`Lk APPROVAL
17 NE D BY
DATE
A these plans shall not be contbvWb be a, )r,or an
?P')L ;i any violation of any provisions d%fiedei city
Qs and ordinances. This set of approved plus
Sept
on the
ur-ifl completion.
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CALIFORNIA ALL— PURPOSE
OSE
CERTIFICATE OF ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies only the identity
of the individual who signed the document to which this certificate is attached,
and not the truthfulness, accuracy, or validity of that document. City of MenlEe
State of California } APR 2 4 2018
County of jzwexJ e- } Received
On MOY-0h N , 2O I k before me, Snuff Snyyl-e� r-afy,DL�� I\hu\-u ��Wg-
(Here insert name aficIttitle of the officer)
personally appeared fie. \O May-I nos ,
who proved to me on the basis of atisfactory evidence to be the person(s) whose
n me(s)Qare subscribed to the within instrument and acknowledged to me that
I she/they executed the same incp:f� her/their authorized capacity(ies), and that by
2/ch
her/their signature(s) on the Instrument the person(s), or the entity upon behalf of
the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that
the foregoing paragraph is true and correct.
SKYE JANAE CAMPOS
WITNESS my hand and official seal. C0MM.#2218211
Notary Public-California y
RIVERSIDE COUNTY
My Comm.&P.OCT.14.2021 io
2
otary ub Signature ' (Notary Public Seal)
0 �
ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM
This form complies with current California statutes regarding notary wording and,
DESCRIPTION OF THE ATTACHED DOCUMENT ifneeded,should be completed and attached to the doctmrent.Acbwowledgments
from other states may be completed for documents being sent to that state so long
Q _ as the wording does not require the California notary to violate California notary
/�1��h(�rt��C�
- \ ( Z`�/lr law.
(Title or description of attached document) • State and County information must be the State and County where the document
signer(s)personally appeared before the notary public for acknowledgment.
• Date of notarization must be the date that the signers)personally appeared which
(Title or description of attached document continued) must also be the same date the acknowledgment is completed.
The notary public must print his or her name as it appears within his or her
Number of Pages Document Dat J commission followed by a comma and then your title(notary public).
• Print the name(s) of document signer(s) who personally appear at the time of
notarization.
CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms(i.e.
he/she/they is/are)or circling the correct forms.Failure to correctly indicate this
❑ Individual (s) information may lead to rejection of document recording.
❑ Corporate Officer . The notary seal impression must be clear and photographically reproducible.
Impression must not cover text or lines. If seal impression smudges, re-seal if a
(Title) sufficient area permits,otherwise complete a different acknowledgment form.
El Partner(s) • Signature of the notary public must match the signature on file with the office of
the county clerk.
❑ Attorney-in-Fact Additional information is not required but could help to ensure this
❑ Trustee(s) acknowledgment is not misused or attached to a different document.
Other Indicate title or type of attached document,number of pages and date.
❑ Indicate the capacity claimed by the signer. If the claimed capacity is a
corporate officer,indicate the title(i.e.CEO,CFO,Secretary).
2015 Version www.NotaryClasses.com 800-873-9865 Securely attach this document to the signed document with a staple.
March 19, 2018
To Whom It May Concern:
I, Alejo Marinas residing at 29843 Rock Rose Ct. Menifee,
CA 92S84 is hereby authorizing Eduardo Salazar to obtain a
permit for my AlumaWood Patio cover. Thank you very much.
Sincerely Yours,
Alejo Marinas
See Attached Notarized
Document Dated �1- d/
. ,-rA IFORNIAI' DRIVER LICENSE --
DL 03352300,
GLASS C
C'xP 03/31/2019 END NONE- - -
l.rti MARINAS
- FN ALEJO E -
' 29843 ROCK ROSE CT
r 1; MENIFEE, CA 92584
DOB 03/31/1974
RSTR NONE --- --= 03311974
SEX _M HAIR_BLK EYES BLK
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DD o3io4/2014s35i8iBBFD/19 - "03104/2014
I
Carl Putnam P.E.
• 3441 Ivylink Place
Lynchburg,VA 24503
Carl Putnam, P.E.
City of Menifee
February 3, 2017 Building Dept.
Mike Adams
APR 2 4 2018
United Duralume Products, Inc.
350 S. Raymond Ave. Received
Fullerton, CA
Dear Mike:
I am the engineer of record for standard plan, United Duralume Patio Cover, Carport and
Commercial En-gineering. These plans have been approved under the 2015 IBC as ICC
Evaluation Service Report#2676. For these structures the 2016 CBC is identical to the
2015 IBC and it is acceptable to build structures within the scope of this plan under the 2016
CBC.
It is acceptable for copies of these plans to be used to obtain building permits. I can provide
an electronic version for comparison if desired.
Please contact me at(434)384-2514 or at carlputnam(o-)comcast.net if you require further
information.
Sincerely,
Carl Putnam, P.E.
SS�NA G
6, 1 9 /�
P. 301201
C I
TgTFOFCALL O�
JUN 09 2017
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