PMT18-02427 City of Menifee Permit No.: PMT18-02427
29714 HAUN RD.
'I�CCF6A MENIFEE,CA 92586 Type: Residential Addition
MENIFEE Date Issued: 0511712018
PERMIT
Site Address: 27982 HIDE AWAY CT, MENIFEE,CA Parcel Number: 333-370-042
92585 Construction Cost: $5,600.00
Existing use: 1 &2 Family Residence Proposed use:
Description of INSTALL 12'x 47'SOLID ALUMAWOOD PATIO COVER, NO ELECTRICAL
Work:
Owner Contractor
JUAN&ANGELICA MARCELINO PRIME BUILDERS
27982 HIDE AWAY COURT 16596 CITRUS VIEW CIRCLE
MENIFEE, CA 92585. RIVERSIDE,CA 92504
Applicant Phone:9517808624
CAITLIN CALI License Number: 795780
PRIME BUILDERS
16596 CITRUS VIEW CIRCLE
RIVERSIDE, CA 92504
Fee Description Oft Amount
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 700D)of Division 3 of the Business and O I am exempt from Iicensure under the Contractor's State License Law for
Professions Code
Qee and my license is in full force and effect. t},,, the following reason:
License Class 61 U nsye No. "/"I 570 D By my signature below 1 acknowledge that,except for my personal residence
Expires .J�-j1'�Signature &-nc&sn c2r:i in which l must have resided for at least one year prior to 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
m ❑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 37GO of the Labor Code,for the performance of work far which this permit Is issued. www.1eginfo.ca.gov/calaw.htm1.
/n1
Polity# FLA 00 r�b�7(Do d I Date
o I 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 D 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 aI�re: application and the information I have provided is correct I agree to comply
Carrier W IA s n Qmkirnt,1h4e with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# L A"03 /n�1 Expires ��','.<,—`�(p 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,
i shall not emolov any 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 I rthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date_ -t - Ik mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 o Yes a 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($100,000),IN ion occupant require a permit for the construct or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SC ion or See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes ❑No
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit Is issued outer boundary of a school?
(Section 3097 Civil Code) ❑Yes ❑No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractor's License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed nett to the applicable item hazardous material reporting.$)(Section 7031.5 oyes D No
Business and Professions Cade).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 Contractor's 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 Iicensure 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 car childcare facility to be RRP-certified firms and comply with
than
Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property
than($S00). managers who do the paint-disturbing work themselves or through their
01,as owner of the property,or my employee with wages as their sale 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-BOD-424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a n 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
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. D 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 Contractor's 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 �p MENIFEE
DATE; PERMIT/PLAN CHECK NUMBER
PLANNING CASE NUMBER
TYPE: O COMMERCIAL $RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA OSIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O P//L��U��M��BBIpING O RE-ROOF NUMBER OF SQUARES //��n�T,, II
DESCRIPTION OF WORK I t✓U Vci{' L LVI.I
PROJECTADDRESS a:)ggg, 0lak I.tAA/GU1 lJl . ZIP a�5 bJ
ASSESSOR'S PARCEL NUMBER �3 3 I?i2o0 I-s' LOT �� TRACT 5 0 7
Q
OWNERNAME II /
ADDRESS C� Building Dept.
PHONE "I J 'LL11 A EMAIL
APPLICANT NAME I l l
611
ADDRESS 4Ly� 'ft (j CdA In td Ci)Ybnae Recelvelu
PHONE Q�I "/()�' ,�,2j ��j EMAIL
CONTRACTOR'S NAME j ,� i I e OWNER BUILDER? OYESPONO
BUSINESS NAME &NU /
ADDRESS CIAVJAS `,/ O t I �d4 L
PHONE �S��- �'�(0�-% EMAIL DaVA 6 � x. P1
CONTRACTOR'S STATE LIC NUMBER �N 5?�y LICENSE CLASSIFICATION I,:J
VALUATION$ 5,Cn o D(/ (n,^,SnnQ••FT S(p L SQ FT
�' 1 11
APPLICANT'S SIGNATURE ( - b/ DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
INVOICE TOTAL GREEN SMIP
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
City of Menifee Building &Safety Department 129714 Haun Rd., Menifee,CA 92586 (951)672-6777
www.cityofmenifee.us
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City of Menifee
Building Dept.
Prime Builders MAY 17 2018
The Home Improvement Specialists
Received
16596 Citrus View Cir
Riverside, CA 92504
(951)780-8624
I hereby authorize the following person(s)to act on my behalf in obtaining permits from
the Building Department and to sign permit applications for me. I am properly registered
and/or licensed by the city and/or state of California.
I assume full responsibility under the law for permits taken by persons authorized to act
on my behalf.
Persons authorized to sign permits and their signatures:
Caitlin Cali / to �r;2�i ,G ( , il ,20 I
Company Name: Prime Builders By:
Bernhardt Brenner
State License Number: B1-795780 Owner
�se� a.-�c>titd
i
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.
State of California Riverside
County of )
On February 20, 2018 before me, Charlene D. Simmons Notary Public
(insert name and title of the officer)
personally appeared Bernhardt Brenner
who proved to me on the basis of satisfactory evidence to be the person(s-rwhose nam I are--
subscribed to the within instrument and acknowled ed to me thal�Ashelth�y executed the same in
( i E!s eNthetrauthorized capacity(ieq, and that bifhWhedtheit signature(syon the instrument the
person(sj or the entity upon behalf of which the person(e)-scted, 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. CHARLENE D. SIMMONS
COMM. #2184111
¢'wee N0TAHVPUBUGCALIFORNIA m
RIVERSIOI COUNTY
WITNESS my hand and official seal. Mr Comm EKDOesMarch8,2O2r
- (Seal)
Signature Seal