PMT18-03243 City of Menifee Permit No.: PMT18-03243
29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Addition
MENIFEE MENIFEE Date Issued: 06/2712018
PERMIT
Site Address: 26333 LILAC VIEW CIR, MENIFEE, CA Parcel Number: 360-671-041
92584 Construction Cost: $2,000.00
Existing use: 1 &2 Family Residence Proposed use:
Description of INSTALL ALUMWOOD PATIO COVER 10 X 22 WITH ONE FAN.
Work:
Owner Contractor
MARY HAGINSKY KMPATIOCOVERS.COM INC
26333 LILAC VIEW CIRCLE 19495 OAKVIEW LANE
MENIFEE, CA 92584 LAKE ELSINORE, CA 92530
Applicant Phone:9098386779
KMPATIOCOVERS.COM INC License Number:954365
19495 OAKVIEW LANE
LAKE ELSINORE, CA 92530
Phone: 9098386779
Fee Description ON Amount($1
Receptacle, Switch,Outlet&Fixture 1 116.00
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 5.80
$290.45
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_Permil_Templale.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 ❑I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the fallowing reason:
License Class License No. y3L-5
By my signature below I acknowledge that,except formy personal residence
Expires II T1 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 legally sell a structure that I
have built as an owner-builder if it has not been constructed in its entirety by
a 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 of the Labor Code,for the performance of work for which this application is submitted Drat the fallowing websile:
this permit is issued. ww%-,.Ieginfo.ga.gov/calaw.himi.
Polity 4 Date
a 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 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 with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy R Expires enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred
dollars($1001 or less Date
PROPERTY OWNER OR AUTHORIZED AGENT
certlfy that in the performance of the work for which this permit is issued,
I shall not emalov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE 0
worker's compensation laws of California,and agree that if I should become
subject to the worker's compensation provisions of Section 3700 of the Labor HAZARDOUS MATERIAL DECLARATION
Code,I shall tprthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant l Date 15—7,c-I mixture containing a hazardous material equal to or greater that the
amounts specified an the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS a Yes IQ,11(a
UNLAWFUL,AND SHALL SUBIECF AN EMPLOYER TO CRIMINAL PENALTIES
Will the intended use of the building by the applicant or future building
ANDCIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South
- INSECTION 3TO60E-THE LABOR CODE,INTEREST,'AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)?See permitting checklist
forguidelines
CONSTRUCTION LENDING AGENCY aYes 1240
1 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?on
(Section 3097 Civil Code) a Yes o
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 next to the applicable itemis)(Section 7031.5 hazardo�us �aterial reporting.
Business and Professions Code).Any city or county that requires a permit to oyes W.
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 OR AUTHORIZED AGENT
that he a 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(RRP)Rule requires contractors
and the basis for the alleged exemption.Any violation of Section 7032.5 by receiving compensation for most work that disturbs paint In a pre-1978
an Applicant fora permit subjects the applicant to a civil penalty of not more residence or childcare facility to be RRP-cartifred firms and comply with
than($5G0), required practices.This includes rental property owners and property
managers who do the paint-disturbing work themselves or through their
❑I,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( I 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-EDO-424-LEAD(5323).
Code;The Contractor's State Ucense taw does not apply to an owner of a
property who,through employees'or personal effort,builds or Improves the D An EPA Lead-Safe Certified Renovator will he 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. 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 Contractor's 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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE
DATE: —Z7-2a PERMIT/PLAN CHECK NUMBER
GRADING/ PLANNING CASE NUMBER/OTHER RELATED CASES
TYPE: O COMMERCIAL c`fKLSIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES `) L.G
DESCRIPTION OF WORK
UV(e�
OCCUPANCY GROUP CONSTRUCTION TYPE SPRINKLERS OYES ONO
PROJECTADDRESS Crr_,, ��` P C-. ) ZIP
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME
ADDRESS Zla' G
PHONE C(�( - Z)�_z,�[,jy� EMAIL Building Dept.
APPLICANT NAME ,L Gam. Sr- W6(/Cv N vU+ UN Z 1 2018
ADDRESS J I. -Z• G�-
PHONE IgO,�j <j53<� ['7`7�1 EMAIL Received
CONTRACTOR'S NAME Wl Govv\OWNER BUILDER? 0
BUSINESS NAME
ADDRESS gyp{' \L �•�
PHONE _ G(o%- EMAIL
CONTRACTOR'S STATE LIC NUMBER CJ s y,��oS— LICENSE CLASSIFICATION
VALUATION$ &XIf-11 SQ FT L SQ FT / C/
APPLICANT'S SIGNATURE DATE
OTYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING EN I EERING FIRE b TiV).
INVOICE TOTAL G EN SMIP
OWNER BUILDER VERIFIED OYES 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.cityofinenifee.us
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