PMT18-04190 City of Menifee Permit No.: PMT18-04190
29714 HAUN RD. Type: Residential Addition
iB MENIFEE,CA 92586
MENIFEE MENIFEE Date Issued: 08/24/2018
PERMIT
Site Address: 29523 MOUNT BACHELOR WAY, Parcel Number: 338-251—WO
MENIFEE,CA 92586 Construction Cost: $4,125.00
Existing Use: 1 &2 Family Residence Proposed use:
Description of INSTALL 15 X 25 SOLID NEWPORT ALUMAWOOD PATIO COVER-NO ELECTRIC
Work:
Owner Contractor
KIM SAYRE PSLQ INC
29523 MOUNT BACHELOR WAY 18890 SEATON AVE
MENIFEE, CA 92586 #206
Applicant Phone:9517954260
PSLQ INC License Number:919885
18890 SEATON AVE
PERRIS, CA 92570
Phone:9517954260
Fee Description L1yt Amount 151
Building Permit Issuance 1 27.00
_ DecWPatio, non-standard 1 133.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 1.00
General Plan Maintenance Fee-Building 1 6.65
$168.66
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications orfrom 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 ❑ I am exempt from licensure under the Conlredois'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 alicense is in full force and effi which I must have resided for at least one year prior to completion of
License Class Lice s o. `�f 7 O improvements covered by this permit,I cannot legally sell a structure that I have
Eepires — — Ignature r built as an Owner-bullding if it has not been constructed In its entirety by licensed
I 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 application is
fo submitted or at the following Web site:
I I hereby affirm under penalty of perjury one the following rlaretions; httol/www.leoinfo.ca.aov/calaw.html.have and will maintain a certificate of consentt 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 or Authorized Agent
Policy# ❑ By my Signature below, I certify 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 this application and the information I have provided is correct. 1 agree to comply
permit is issued.My workers'compensation insurance carder 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 // identified property for the inspection purposes.
Policy# Expires (,D '/ Dale
C[..�� Property Owner orAuthorizedd Agent
(This section need not be eompletteedlifthe permit is for l City Business License# p '- qC)3
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 wo rs'compensation provisions of Section 3700 of the Labor amounts spec'i on the Hazardous Materials Information Guide?
Code,1 shall o w h comply ith those provisions. / �] I/_ DYES Q 0
Applica t: ate; A-7 / IICJ Will the intended use of the building by the applicant or future building
occupant require a 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 guide],
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 tiding r modified facility be within 1000 feet of the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of o01?
LABOR CODE,INTEREST,AND ATTORNEYS FEES DYES NO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAOMD
I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist.I undgg stand my requirements under the State of
agency for the performance of the work which this permit is issued(Section California Health BS,Sai€ty Code,Section 25505 and 25534 concerning
3097 Civil Code) hazardous diat€n`et reporting.
OWNER BUILDER DECLARATIONS DY ^-7
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date 42
License Law For the reason(s)indicated below by the checkmadc(s)I have placed PROPERTY OWNER ORALI �RIZED AGENT
next to the applicable ilem(s)(Section 7031.6.Business and Professions Code:
Any city or county that requires a permit to construct,alter,Improve,demolish, EPA RENOVATION,REPAIR AND PAINTING(RRP1
or repair any structure,prior to its issuance,also requires the applicant for the
permit to rite 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 Slate 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 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.govAead or contact the National Lead Information Center at
❑ 1, 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 rs-_-
„
not Intended or offered for sale.(Section 7044,Business and Professions Code; lam(, 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 Firm 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).
❑ 1, as owner of the property an exclusively contracting with licensed No EPA Lead-Safe Certified Finn is required for Nis 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
DATE: PERMIT/PLAN CHECK NUMBERvrr61,10
PLANNING CASE NUMBER
TYPE: O COMMERCIAL bRESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA 0 SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK
WORK rye D-j_1b
i[J GJ� ^ C ►�//
PROJECTADDRESS ags� 3 �O LW7 /,,ppSKY/ 7� '21P
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME J
ADDRESS alq
PHONE EMAIL CRY Of 4enifee
APPLICANT NAME z /j' /(J
ADDRESS L
PHONE �j 1 — 3 34 I I-7 (rjJC EMAIL Receivwi
CONTRACTOR'S NAME `I O __ �/� OWNER BUILDER? O YES 0•1d
BUSINESS NAME — /L-) 16E2� 4
ADDRESS
PHONE ! d^/ —• ^ (�3 [[ EMAIL
CONTRACTOR'S STATE LLI�ICL�NUMBER f 9 IS jj-. LICENSE CLASSIFICATION
VALUATION$ L11�.3 SO FT 37 S LSQ FT
APPLICANT'S SIGNATURE DATE,CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: h CITYOF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE Y
INVOICE TOTAL GREEN SMIP
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
MENIFEE
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