PMT18-04015 City of Menifee Permit No.: PMT18-04015
29714 HAUN RD. Type: Residential Addition
Q' G� MENIFEE, CA92586
MENIFEE MENIFEE Date Issued: 0 811 412 01 8
PERMIT
Site Address: 30252 COBURN CIR, MENIFEE,CA Parcel Number: 358-720-037
92584 Construction Cost: $6,500.00
Existing Use: 1 &2 Family Residence Proposed use:
Description of INSTALL 13'6"x 40'SOLID ALUMAWOOD PATIO COVER WITH 2 CEILING FANS, 6 LED LIGHTS,3
Work: POST LIGHTS, 2 SWITCHES
Owner Contractor
KEN STOLPA ANGEL'S PATIO COVERS&AWNINGS
30252 COBURN CIRCLE 225 SPARKLER LANE
MENIFEE,CA 92584 PERRIS, CA 92571
Applicant Phone:9514431659
ANGEL GONZALEZ License Number:900657
ANGEUS PATIO COVERS&AWNINGS
225 SPARKLER LANE
PERRIS, CA 92571
Fee Description Q1t r Amount ISl
Receptacle, Switch,Outlet&Fixture 13 176.00
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 8.80
$353AS
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 building 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 Permi[ 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 70001 of Division 3 of the Business and O l am 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 bc!z Lice se No. 170C) By my signature below I acknowledge that,except for my personal residence
Expires ?y/�. Signature in which l 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
D 1 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 workers 7044 of the Business and Professions Cade,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 or at the following website:
this permit is Issued. 1 J ynvw.leginfo.M.eov/calaw html.
Policy# �71 V V�n�r�l��� 2 Date-
0 1 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 forwhich �rruymy signature below l certify to each of the following:I am the property
this permits Issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property owner's beha If.I have read this
number arey:V1 r '- I application and the information l have provided'a correct.I agree to comply
Carrier_ 1 l 1 )d UV-e4- 01Q )eS with all applicable city and county ordinances and state laws relating to
-7cf building construction.I authorize representatives of this city or county to
Policy#� �11 UWG6� /O ires /-Z�'
5�— � P � enter he ahov identified pr ertyfor inspection purposes.
(This section need not to he completed is the permit is for one-hundred ov Date O� 2G p
dollars($10D)or less (J
PR TY OWNER OR AUTHORIZ AGENT
�rtlfy that in the performance of the work for which this perm([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 shal orthwi c mply with thus, a provision. Will the applicant or future building occupant handle hazardous material or a
Applicant �TKQrr�/ _Date f7 g mixture containing a harardous material equal to orgreaterthat the
amounts specified an the Hazardous Materials Information Guide?
WARNING:F LURE TO SECURE WOR ER'5 COMPENSATION COVERAGE IS 0 Yes !rNo
UNLAWFUL,AND SHALLSUBIECT AN EMPLOYERTO CRIMINAL PENALTIES Will the intended use of the building by the apFilicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ottupan[require a permit for the construction or rnu:dification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Duality Management the
t(SCtionor vdific.�nittino checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Airllnes
Qua
CONSTRUCTION LENDING AGENCY aYes zf'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 isissued outer boundary of a school?
(Section 3097 Civil Code) OYes a'No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCADMD
I hereby affirm under penalty of perjury that l 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 items)(Section 7031.5 hazardous matey (reporting.
Business and Professions Code).Any city or county that requires a permit to fifes 0 No —
construct,alter,improve,demolish or repair any structure,prior to its Date G�CJ
Issuance,also requires the applicant for the permit to file a signed statement PROPERTY OW ER OR AUTHORIZED T
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRPI
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 apre-1978
and the basis for the alleged exemption.Any violation of Section 70315 by residence or childcare facility to he RRP-certified bs poi and comply with
than
Applicant far a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property than($500). p p rty
managers who do the paint-disturbing work themselves or through their
0 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.eoa.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 Contractor's State License Law does not apply to an owner of a 0An EPA Lead-Safe Certified Renovator will he 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:
O I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7D44,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 �y MENIFEE
DATE: I W �} PERMIT/PLAN CHECK NUMBER \
PLANNING CASE NUMBER
TYPE: C COMMERCIAL RESIDENTIAL C MULTI-FAMILY C MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: C ADDIT ON C ALTERATION C DEMOLITION C ELECTRICAL O MECHANICAL
lyfAE,W, `O PLUMBING O RE-ROOF NUMBER OF SQUARES
//� n"
DESCRIPTION OF WORK 1�1f�.'¢Ict wrm pah d Lw' r {•�11�n�I a
"` lily l7 ' U Y� OC�LI 1"L�lfl
PROJECTADDRESS 35 WUYY , GLIC� ZIP
� CI
ASSESSOR'S PARCEL NUMB/ER fg -_j •02j-j LOT TRACT
•OWNER NAME --'vi \pot,
, Building Dept.
ADDRESS �d`_7/J� Cv 01j 'Y!Y1 IDU JAwI
PHONE ( � � - I ?)/� W EMAIL Received
APPLICANT NAM^E� 1 �JL/ G Ire i V G
ADDRESS [)t5 W n
PHONE —IZ'T17" EMAIL
Y CONTRACTOR'S NAME > - � re I OWNER BUILDER? YES O NO
BUSINESS NAME
ADDRESS ,, .e l {, ,�,1
PHONE � 55 94-b ._' 1L0}5q �EMAIL wv1q d �V l(.JU 'ccm
CONTRACTOR'S STATE LIC NUMBER �'IUV '1 LICENSE CLASSIFICATION
VALUATION$ Q�V SQ FT L SQ FT
APPLICANT'S SIGNATURE 40'i DATE (I
r _ ,
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
INVOICETOTAL GREEN `— SMIP I_
OWNER BUILDER VERIFIED OYES O NO DRIVERS LICENSE# NOTARIZEDLETTER O YES O NO
City of Menifee Building &Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
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www.cityofinenifee.us -
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Building Dept.
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(3\)PO` 51-)) ► LEDGER & TRACK
ASPECTION REQUIRED
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IL DING AND SAFETY DEPARTMENT
PLA PROVAL
REVIE ED B F� J
DATE
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'Approval o hese plans s I not be construed 6e a permit for,or an
approval of. ny violation of any provisions of the federal,state or city
regulations d ordinances. This set of approved plans must be kept on the
jobsite until completion.
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