PMT18-03591 City of Menifee Permit No.: PMT18-03691
29714 HAUN RD. Type: Residential Addition
MENIFEE, CA 92586
MENIFEE MENIFEE Date Issued: 07/1 912 0 1 8
PERMIT
Site Address: 27948 RIVER SHORE CT,MENIFEE, CA Parcel Number: 333-370-023
92585 Construction Cost: $5,050.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 9'x 55'SOLID ALUMAWOOD PATIO COVER WITH 3 FANS
Work:
Owner Contractor
RODJOHNSON PSLQINC
27948 RIVER SHORE COURT 18890 SEATON AVE
MENIFEE,CA 92585 #206
Applicant Phone:9517954260
LOIS MONTINI License Number:919885
PSLQ INC DBA GREENBEE
18890 SEATON AVE
PERRIS, CA 92570
Fee Description Qtv Amount(M
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
$300.95
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_Pennk_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ ]am exempt from licensure under the Conlractors'State License Law forthe
I hereby affirm under penally or perjury that I am licensed under provisions of following reason:
Chapter 9(commencing with section 7000)of Division 3 of the Business and By my signature below I acknowledge that,except for my personal residence in
Professions Code and license is in full force and eHeel n (y which I must have resided for at least one year prior to completion of
License Class Lice see//No. �? Y [j improvements covered by this permit,I cannot legally sell a structure that I have
Expires _ - ignature 11 built as an owner-building if it has not been constructed in its entirety by licensed
r ,contractors. 1 understand that a copy of the applicable law,Section 7044 of the
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application Is
submitted or at the following Web site:
❑ I hereby affirm under penalty of perjury one the following declarations* h0o://www.leciinfo.m.gov/calaw.html,
I have and will maintain a certificate of consentt fo work of self-insure for workers'
compensation,issued by the Director of Industrial Relations as provided for by Date
Section 3700 of the Labor Code, for the performance of work for which this
permit is issued. Property Owner orAulhorizedAgent
Policy# ❑ By my Signature below,I certify to each of the(ollowing:I am the property
❑ 1 have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read this
section 3700 of the Labor Code, for the performance of the work for which this application and the information I have provided is correct. I agree to comply
permit is Issued.My workers'compensation Insurance carrier and policy number are: with all applicable city and county ordinances and slate laws relating to building
CT construction.I authorize representatives of this dtyor county 10 enter the above-
Carrier o/ identified property for the Inspection purposes.
Policy# U)&/D7)9)6D/ Expires / /(? '/ Date
L,L Property Owner orAulhorizedAgent
(This section need not be comp)et3ed4f the permit is for City Business License# �—TO�
one-hundred dollars($100)or less)
❑ I certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not employ any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or a
workers compensation laws of California,and agree that If I should become mixture containing a azardous material equal to or greater that the
subject to the coo drs'compensation provisions of Section 3700 of the Labor amounts spec cell o the Hazardous Materials Information Guide?
Code,I shall o w h comply ilh those provisions. / •r/7 ❑YES
Applica k ete'--C-J�-li ! Will the intended use of the building by the applicant or future building
occupant requires permit for the construction or modification from South
WARNING: FAILURE TO SECURE WORKERS' Coast Air Quali anagement District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for gutdeit
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES ❑NO
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed fi rd ng rmodNed facility be within 1000 feet of the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of pot?
LABOR CODE,INTEREST,AND ATTORNEYS FEES DYES
NO
CONSTRUCTION LENDINGAGENCY 1 have read the Hazardous Material Information Guide and the SCAQMD
i hereby aRrm that under the penalty of perjury there is a construction lending permitting checklist.I undd9 stand my requirements under the Stale of
agency for the performance of the work which this permit Is issued(Section California Health F.Saf&y Code,Section 25505 and 25534 concerning
3097 Civil Code) hazardous diatEnral reporting.
OWNER BUILDER DECLARATIONS DY JPQ AI
- -7
I hereby affirm under penally of perjury that 1 am exempt from the Contractor's Date
License Law for the reason(s)Indicated below by the checkmark(s)I have placed PROPERTY OWNER ORAU bRiZEDAGENT
next to the applicable hem(s)(Section 7031.5.Business and Professions Code:
Any city or county that requires a permit to construct,alter,improve,demolish, EPA RENOVATION,REPAIR AND PAINTING(RRP)
or repair any structure,prior to Its issuance,also requires the applicant for the
permit to file a signed statement that he or she Is licensed pursuant to the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
provisions of the Contractor's State License Law(Chapter 9(commencing with receiving compensation for most work that disturbs paint in a pre-1978
Section 7000)of Division 3 of the Business and Professions Cade)or that he or residence or childcare facility to be RRP-certified firms and comply with
she is exempt from licensure and the basis for the alleged exemption.Any required practices.This includes rental property owners and property
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than($500).) employees.For more information about EPA's Renovation Program visit
❑ I, as owner of the roe www.epa.govnead or contact the National Lead Information Center at
property.rty, or my employees with wages the
their sole 1-800- LEAD-LEAD(5323).
compensation,will re ( )all . or( )porting of the work,and the structure e, /1 MR-Q_„
not Intended or offered for sale.(Section 7044,Business and Professions Code; � l7(, 1�^�
The Contractors Slate License Law does not apply to an owner of a property ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
who, through employees'or personal effort, builds or improves the property,
provided that the improvements are not Intended or offered for sale.If,however, Certified Finn Name:
the building or improvement is sold within one year or completion,the Owner-
Builder Will have the burden of proving that it was not built or improved for the Firm Certification No
purpose of sale).
❑ I, as owner of the property an exclusively contracting with licensed No EPA Lead-Safe Certified Firm is required for this project because:
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's License Law does not apply to an owner of a property
who builds or Improves-thereon, and who contracts for the projects with a
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION ME IFE r
DATE: — PERMIT/PLAN CHECK NUMBER V
GRADING/PLANNING CASE NUMBER/OTHER RELATED CASES
TYPE: O COMMERCIAL ESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA •O'SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION 'ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK
VI _` 5
OCCUPANCY GROUP CONSTRUCTION TYPE SPRINKLERS O YES tw; O-N
PROJECTADDRESS A77 !?L�(y IQ ) y �E}R J� ��� GTZIP J�
ASSESSOR'S PARCEL NUMBER 333-3'10"4�3 LOT TRACT
OWNER NAME 5R D A LD
ADDRESS go 13 L) - V lag
Z 1:� CI
tee
PHONE qQg ' 5-78'- AkD9� EMAIL Building peg t.
APPLICANT NAME 1 A) JUL 19
ADDRESS
PHONE R 6_7 - 3'Sg4 7 EMAIL Uctivect
CONTRACTOR'S NAME �C - -f-{'(_ OWNER BUILDER? O YES 0440!
BUSINESS NAME q —�
ADDRESS q
PHONE 9�'1 - ;k 3 y 9 EMAIL
CONTRACTOR'S STATE LIC NUMBER g�9 �Cj LICENSE CLASSIFICATION
VALUATION$ SQFT 2 5 L SQ FT
APPLICANT'S SIGNATURE DATE
OTYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: - 10 CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE t_r_d--?
INVOICETOTAL I
q GREEN _ SMIP I -
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.cityofinenifee.us � `/�
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