PMT18-04485 City of Menifee Permit No.: PMT18-04485
29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Addition
f4�E Iq1 E E E MENIFEE Date Issued: 09/14/2018
PERMIT
Site Address: 24355 TRAILBLAZER LN,MENIFEE, CA Parcel Number: 358-562-003
92584 Construction Cost: $11,000.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 10'X 20'ATTACHED EQUINOX ALUMWOOD PATIO COVER WITH 2 OUTLETS
Work:
Owner Contractor
MICHAEL PINTO TRADER DAN'S INC
24355 TRAILBLAZER LANE 840 S ROCHESTER AVE STE C
MENIFEE, CA 92584 ONTARIO, CA 91761
Applicant Phone:9093900555
TRADER DAN'S INC License Number:517575
840 S ROCHESTER AVE STE C
ONTARIO,CA 91761
Phone:9093900555
Fee Description Q1t r Amount!$1
Receptacle,Switch,Outlet& Fixture 2 121.00
Building Permit Issuance 1 27.00
Deck/Patio,non-standard 1 133.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 2.00
General Plan Maintenance Fee-Building 1 6.65
General Plan Maintenance Fee-Electrical 1 6.05
$296.70
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 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 7000)of Division 3 of the Business and o I am exempt from licensure under the Contractors State License Law for
Professions Code and.my license is in full force and effect. the following reason;
5 License Class License No. /7 S"7 5-- By my signature below I acknowledge that,except for my personal residence
Expires ILOSignature in which l must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell a structure that 1
WORKER'S COMPENSATION DECIA 0 have built as an owner-builder if it has not been constructed in its entirety by
D I 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 Code,is available upon request when
compensation,issued by the Director of Industrial Relations as provided for this application is submitted or at the following website:
by Section 3700 of the Labor Code,for the performance of work for which
this permit is issued. w ww.leginfo.ca.eav/calaw.html.
Policy N Date
ai'fiave 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 D By my signature below I certify to each of the following:I am the property
this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
Carrier L W with all applicable city and county ordinances and state laws relating to
�L 7 !� building construct --La i u nze representatives of this city or county to
Policy q �SiT SQd(JJ Expires v Z r the r entif a for inspection purposes..
(This section need not to be completed is the permit is for one-hundred Date L5�
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
o I certify that in the performance of the work for which this permit is issued,
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE If
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shap-f ,hwi cam y with t rovisions. Will the applicant or future building occupant handle hazardous material or a
S' mixture containing a hazardous material equal to or greater that the
Applicant Date amounts speci Ed on the Hazardous Materials Information Guide?
WARNING. RET RE-WO R'S COMPENSATION COVERAGE 15 ❑Yes o 0
UNLAWFUL,AND SHALL SUBJECT 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 00LLARS 1$100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidel�i,n��Y1�"�
CONSTRUCTION LENDING AGENCY o Yes r� o
7
I hereby affirm that under the penalty of perjury there is a construction Will the propose udding or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer baun of a school?
(Section 3097 Civil Code) o Yes o
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the California Health&Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the haz rdous materiatrep mg.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 /SYes o No
Business and Professions Code).Any city or county that requires a permit to Date 17 I
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OW R O B D AGENT
issuance,also requires the applicant for the 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 IRRPI
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 a pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with
an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
o 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( )ail of or( )portion of the work,and the structure is www.eoa.aov/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 Contractors State License Law does not apply to an owner of a D An 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:
o I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP role please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION , MENIFEE
DATE: PERMIT/PLAN CHECK NUMBER v
PLANNING CASE NUMBER
TYPE: O COMMERCIAL ',? ESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ITION O ALTERATION O DEMOLITION �CTRICAL O MECHANICAL
PAD O PLUMBING O IRE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK OI ,fj\lV1d vlj CUy .
PROJECTADDRESS /�( J2�J �V�I IL�G1Z�'� 4AI, ZIP
ASSESSOR'S PARCEL NUMBER .1qe-� \�� -Q`-/'"�' LOT TRACT
OWNER NAME ml�bcn-?i(
ADDRESS
PHONE 71q- 7�t�1—�� EMAIL
APPLICANT NAME VY
ADDRESS
PHONE p EMAIL
CONTRACTOR'S NAME 2�r/,M> I OWNER BUILDER? O YES ONO
BUSINESS NAME {7 �" "
ADDRESS LQ) _ V qr- �f..Q/ A4&- G41L40r7 c(1-7,�l
PHONE c oil'?GI 6 -U� EMAIL
CONTRACTOR'SSTATELICNUMBER ��7� 75 LICENSE CLASSIFICATION
VALUATION$ ( 'f 000 SO FT /,0 G L SO FT �/
APPLICANT'S SIGNATURE DATE / /O
� l
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: n CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE r
INVOICETOTAL q CRk#._V I 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
OWNER
ADDRESS 2�� 3.SS j rcAdbloz-er CN `
CITY miGo ZIP- PHONE 71y'2°I1-g38 — �^
LOT NO. TRACT 0=r25 APN '
CONTRACTOR
ROOMS N' COVERS PROPOSED ADDITION(S) 200 r -1
840 S ROCHESTER AVE #C
ONTARIO, CA 91761 l X ZU -e j vic)X q ltpo, Ij aoo d
LIC. B-517575
909-390-0555 P 141,0 (ovt r'•.
WORK COMP
ICW GROUP Elcc-t Z o�-HC,+S
WSA5000386-07
EXP6/14/2018
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City of Menifee
Building Dept.
SE_P 14 2018
Received
STREET