PMT18-04038 City of Menifee Permit No.: PMT18-04038
29714 HAUN RD.Il
k MENIFEE, CA 92586 Type: Residential Addition
MENIFEE MENIFEE Date Issued: 08/15/2018
PERMIT
Site Address: 27680 BROOKSHIRE CIR,MENIFEE, CA Parcel Number: 336-462-015
92585 Construction Cost: $3,950.00
Existing Use: 1 &2 Family Residence Proposed use:
Description of INSTALL ATTACHED 12'X 23'SOLID ALUMAWOOD PATIO COVER PATIO W/ELECTRICAL,2 FANS,
Work: 2 OUTLETS
Owner Contractor
MICHAEL GARCIA PSLQ INC
27680 BROOKSHIRE CIR 18890 SEATON AVE
MENIFEE, CA 92585 #206
Applicant Phone: 9517954260
JOSH HERRICK License Number:919885
PSLQ INC
18890 SEATON AVE
PERRIS,CA 92570
Fee Description QtV Amount t51
Receptacle, Switch,Outlet&Fixture 4 131.00
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 6.55
$306.20
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_Permtt_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 l am under provisions of with a licensed contractor(s)pursuant to the Contactors State License law).
Chapter9(commencing with section 7000)of Division 3 of the Business and O l am exempt from Iicensure under the Contactors State License Law for
Professions Cade and m license is in full force and effecL /t the fallowing reason:
License Class License No. By mysignature below l acknowledge that,except formy personal residence
Expires _1q _Signature in which l must have resided for at least one year priarte 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
❑I hereby affirm under penalty of perjury one of the following declarations:I licensed contactors.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 fallowing website:
by Section 3700 of the Labor Code,for the performance of work for which www.IeRinfD.m.goy/caIaw.htmI.permit is issued.
Pollcyl$ Date
O I have and will maintain workers 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 l certify to each of the fallowing:I am the property
this permit is issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this
numberare: application and the information I have provided is currect.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
Pollcyq u5010952- Expires 1—1 2-1 enter the above identified property for inspection purposes.
(This section need not to be completed Is the permit H for one-hundred
dollars($100)or less Orate
PROPERTY OWNER OR AUTHORIZED AGENT
O I certify that In the performance of the work for which this permit Is issued, 2��rI ?
Ishallnotemolov any persons In any manner so as to become subject to the CITY BUSINESS LICENSE It d"'�(�i,J
worker's compensation laws of California,and agree that if l should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shall fortliv;) r mply with those provisions. Will the applicant or future building occupant handle hazardous material or
Applicant I!/ Date mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILUR TO SECURE WORKER'S COMPENSATION COVERAGE IS oYes 049n
UNLAWFUL,AND SHALL SUBJECF 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 occupant requires permit for construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management hecoDistrict(SCtionor odiee permittfro checklist
IN SECTION 3705 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air ines
Qua
CONSTRUCTION LENDING AGENCY oYes d<
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1090 feet ofthe
lending agency for the performance of the work which this permit is issued outerboundary ofaschool?
(Section 3097 Civil Code) O Yes rZ a
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that l am exempt from the permitting checklist l 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 item(s)(Section 70315 hazardous material re lord
Business and Professions Code).Any city or county that requires a permit to o� ONo _
Date_
construct,also alter,improve, applicantemolish for
heperminy ofilestructure,signetsta PROPERTY OWN R R U ORRED AGENT
issuance,also requires the applicant forthe permit to file a signed statement
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 700D)of Division 3 ofthe 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 or childcare faculty to be RRP-cettified firms and comply with
than
Applicant fora permit subjects the applicant too civil penalty of not more required practices.This includes rental property owners and property
than 1$500J. managers who do the paint-disturbing work themselves or through their
❑I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Rensvatian Program visit:
compensation,will do()all of or( )portion of the work,and the structure is www.eoa.eov/lead or contact the National Lead Information Centerat
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 OAn 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 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:
D 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractoes 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.
bosh t CJ'_- � bp�-
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION � MENIFEE
DATE: PERMIT/PLAN CHECK NUMBER
PLANNING CASE NUMBER
TYPE: O COMMERCIAL SC'RESIDENTIAL 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 ;pI o C.o✓[C V Z '�ll,�
PROJECTADDRESS T'�j �:� ZIP Z�pS
ASSESSOR'S PARCEL NUMBER _ t;i5 ( 44A-01 LOT ail TRACT C7-
OWNER NAME IIVI ; j
ADDRESS OL
PHONE a05 -03-1agg EMAIL
APPLICANT NAME J, -p
ADDRESS /� Q
PHONE 9 �' �'�-qQp EMAIL
CONTRACTOR'S NAME Q7MInL OWNER BUILDER? O YES XNO
BUSINESS NAME I1 nn n
ADDRESS S914 1�4-r'tu l�.l}� 47 •P gZ$
PHONE q5(--F3y-0T5b Q EMAIL
CONTRACTOR'S STATE LIC NUMBER q 4 LICENSE CLASSIFICATION
VALUATION$ -3 950 SQ FT KY5`1 L SQ FT 93
r
APPLICANT'S SIGNATURE DATEI
OTYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
If
INVOICETOTAL . ) GREEN I SMIP '
OWNER BUILDER VERIFIED 0 YES O No DRIVERS LICENSE 8 NOTARIZED LETTER O YES O NO
City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
G rr o0
www.cityofinenifee.us _�e
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