PMT18-03878 City of Menifee Permit No.: PMT18-03878
y 29714 HAUN RD.
i/ MENIFEE, CA 92586 Type: Residential Addition
MENIFEE MENIFEE Date Issued: 0 8/0 612 01 8
PERMIT
Site Address: 26747 OPALESCENT, MENIFEE, CA Parcel Number: 360-810-016
92584 Construction Cost: $3,600.00
Existing use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 12 X 30 SOLID ALUMWOOD PATIO COVER WITH 1 FAN
Work:
Owner Contractor
SAM STILL PSLQ INC
26747 OPALESCENT 18890 SEATON AVE
MENIFEE,CA 92584 #206
Applicant Phone:9517954260
PSLQ INC License Number:919885
18890 SEATON AVE
PERRIS, CA92570
Fee Description Qtv Amount fSl
Receptacle, Switch,Outlet&Fixture 1 116.00
Building Permit Issuance 1 27.00
DecklPatio, 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_Permit_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ [am exempt from ltcensure under the ContradoW State License Law for the
I hereby affirm under penalty 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 eff n (l. which I must have resided for at least one year prior to completion of
License Class Lice s o. Y rj improvements covered by this permll,I cannot IegaIV sell a structure that I have
Expires — — ignature t built as an owner-building if it has not been constructed in its entirety by licensed
v contractors. I 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 applirallon Is
submitted or at the following Web site:
and❑ I he affirmunder penalty of perjury one the following rlaretions: hOoJ/www.lecinfo.ca.aov/calaw.html.
I have and willllmaintain a certificate of consentt fo
of self-Insure for wodters'
compensation,issued by the Director of Industrial Relatl provided for by Date
Section 3700 of the Labor Code,for the performance of work for which this
permit is issued. Property Owner arAulhorized Agent
Policy# ❑ By my Signature below,I cedify to each of the following: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 (his 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 state laws relating to building
construction.I authorize representatives of this city or county to enter the above-
Carrier T� / identified property for the inspection purposes.
Policy# � 01 h9/y/D60/ Expires 2 / l(j ID Dale
Property Owner orAuthorized Agent
(This section need not be camp el t3edYthe permit Is for City Business License# M6 4O3
one-hundred dollars($100)or less)
❑ 1 certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not emolov 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 wo t rs'compensation provisions of Section 3700 of the Labor amounts specrett the Hazardous Materials Information Guide?
Code,I shall o w h comply itir those provisions. / �/ DYES M1460
Apple t et -f f ! /� Will the intended use of the building by the applicant or future building
occupant require a rmil for the construction or modification from South
WARNING: FAILURE TO SECURE WORKERS' CoastAir Quali anagement District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guideli
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 propo it rd ng r modified facility be within 1000 feet ofthe outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of ool?
LABOR CODE,INTEREST,AND ATTORNEYS FEES DYES NO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm that under the penalty of perjury there is a cons(ruction lending permitting checklist.I un�de stend my requirements under the State of
agency for the performance of the work which this permit is issued(Section California Health B.Saftity Code,Section 25505 and 25534 conceming
3097 Civil Code) hazardous diat�al reporting.
OWNER BUILDER DECLARATIONS ❑Y _ --7
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date
License Law for the reason(s)indicated below by the checkmatk(s)I have placed PROPERTY OWNER OR AU 4OR(zw AGENT
next to the applicable item(s)(Section 7031.5.Business and Professions Code: EPA RENOVATION.REPAIR AND PAINTING fRRPI
Any city or county that requires a permit to construct,alter,improve,demolish,
or repair any structure,prior to its issuance, also requires the applicant for the
permit to rile a stgned 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 Stale License Law(Chapter 9(commencing with receiving compensation for most work that disturbs paint in apre-1978
Section 7000)of Division 3 of the Business and Professions Code)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'
www.epa.govllead or contact the National Lead Information Center at
❑ I, as owner of the property, or my employees with wages as their sole 1-800-424-LEAD(5323).
compensation,will do( )all of or( )porting of the work,and the structure Is /'1_CIS_„
not Intended or offered for sale.(Section 7044,Business and Professions Code: k I�-�
The Contractor's 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 of 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 properly 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 MENIFEE
AM
DATE: PERMIT/PLAN CHECK NUMBER t III V J O
GRADING/PLANNING CASE NUMBER/OTHER RELATED CASES
TYPE: O COMMERCIAL (MtVSIDENTIAL O MULTI-FAMILY O MOBILE HOME -- POOL/SPA O SIGN
SUBTYPE: C I ADDITION O ALTERATION O DEMOLITION 0-SCECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK t Q (_, ID
OCCUPANCY GROUP CONSTRUCTION TYPE SPRINKLERS O YES O-NU-
PROJECTADDRESS AL0TV7� � 1 ZIP `� 7'
ASSESSOR'S PARCEL NUMBER '/ U V ' n 10 • LOT TRACT
OWNER NAME LL
ADDRESS —
c
PHONE a j- q_5 EMAIL Building Dept.
p �
APPLICANT NAME //� /z lo-rl/o �AUG�� U 6 2018
ADDRESS � J4 L a
PHONE '„1 - SD -� EMAIL
CONTRACTOR'S NAME L OWNER BUILDER? O YES CtW
BUSINESS NAME n �9�
ADDRESS �7y) '7JD A^)0T/ [J L r L L b 924 917)
PHONE R�/ - � - /� rjj EMAILC Kul
CONTRACTOR'S STATE LIC NUMBER 9/ D gJ LICENSE CLASSIFICATION AJ
VALUATION$ IDd SO FT d l0 L SO FT
APPLICANT'S SIGNATURE DATE 8�
s - _
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGI ££RING FIRE
INVOICE TOTAL ( GREEN 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.cityofmenifee.us
NIF
O m
M. x
� rt
N
Z O _ "vIFFF 70
C m ✓JR�V44 T y®
m
r-F S �O/1 AaProial:r r "a
0 pprovnG/com Ptnihle�dU�'oeaqax,tl iars
.lQ��) O tiona. „O C cosu<�to . .D e pon �F
is of
re
—h . - o
r
3 N rt "kaA1
0)7
40
s C N
W
rr Q I
O I IN
I I
-- --- -------- -- -j
N O
Q
T Q
N N
M N (D
D Z N
Z rn -4 o
T V
n O (D
o DN N
2 0 W H
m N D
W m y City of Menifee
00— h Z -4 Building Dept.
Ul
w p AUG 0 6 2018
V �
� G
A 7
n Receive
Perri 1• n � '1 �`