PMT18-05308 City of Menifee Permit No.: PMT18-05308
29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Addition
MENWEE MENIFEE Date Issued: 11/01/2018
PERMIT
Site Address: 27758 ADAMS AVE, MENIFEE, CA 92585 Parcel Number: 329-202-021
Construction Cost: $4,000.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 13'x 25'CARPORT ATTACHED THRU FLASHING
Work:
Owner Contractor
FG PROPERTIES
2069 S JANETTE LANE
PLACENTIA, CA 92870
Applicant License Number:
FG PROPERTIES
2069 S JANETTE LANE
PLACENTIA, CA 92870
Phone: 7142329691
Fee Description Qty Amount($)
Building Permit Issuance 1 27.00
Deck/Patio, standard 1 83.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 1.00
General Plan Maintenance Fee-Building 1 4.15
$116.15
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 ❑I 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 License No. By my signature below I acknowledge that,except for my personal residence
Expires Signature in which I must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell 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 contractors.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 following website:
by Section 3700 of the Labor Code,for the performance of work for which
this permit is issued.
www.le info.ca. calaw.htm I,.
Policy# Date ( /— / •— /�Z—
OPERTY
❑I have and will maintain worker's compensation insurance,as required by OWNERR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which ❑By my signature below I certify to each of the following:I am the property
this permit is issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
with all applicable city and county ordinances and state laws relating to
Carrier building construction.I authorize representatives of this city or county to
Policy# Expires enter the above identified pro erty for inspection purposes.
(This section need not to be completed is the permit is for one-hundred �� Date
dollars($100)or less R N PERTY OW R A THORIZED AGENT
❑I certify that in the performance of the work for which this permit is issued,
I shall not employ 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 shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
Applicant Date amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes �(No
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 DOLLARS($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 guidelines
CONSTRUCTION LENDING AGENCY ❑Yes �,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 is issued outer boundary of a school?
(Section 3097 Civil Code) ❑Yes XNo
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
Contractor's License Law for the reason(s)indicated below by the hazardous material reporting. _
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oyes o /
Business and Professions Code).Any city or county that requires a permit to h Date I l ( D
construct,alter,improve,demolish or repair any structure,prior to its PROPE TY WNER OR H RIZED 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 Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRP)
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
❑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.epa.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 ❑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. ❑No EPA Lead-Safe Certified Firm is required for this project because:
❑I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,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.
AV AW
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENNFEE
DATE: PERMIT/PLAN CHECK NUMBER n�5
GRADING PLANNING CASE NUMBER OTHER RELATED CASES
TYPE: COMMERCIAL C RESIDENTIAL C MULTI-FAMILY .1. MOBILE HOME
SUBTYPE: ADDITION ALTERATION DEMOLITION C ELECTRICAL C' MECHANICABuilding Dept.
N EW PLUMBING RE-ROOF NUMBER OF SQUARES V 2018
DESCRIPTION OF WORK
OCCUPANCY GROUP CONSTRUCTION TYPE SPRINKLERS YES N 0
ASSESSOR'S PARCEL NUMBER -2 2 OL — 0 7/ —5LOT // 3 TRACT
APPLICANT NAME Tuq&)
CONTRACTOR'S NAME OWNER BUILDER? XYES NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
APPLICANT'S SIGNATURE a--- /D DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION 7ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
INVOICE TOTAL GREEN SMIP
YES C' NO
OWNER BUILDER VERIFIED YES C" NO DRIVERS LICENSE# NOTARIZED LETTER
City ofWienifee Building & Safety Department | 29714HaunRd.. K8enifee [A92SB6 (9S1)6T2'6777
ORIGINAL&2 COPIES REQUIRED WITH THE PERMIT APPLICATION
Existing
LOT PLOT PLAN AND PARK INFORMATION
Existing Structure Existing
Structure I Structure A) Park Name
Homeowner Name 6 -x
Homeo er Addres MetS
Corner Marker City of Menifee Corner Marker City MtoZip ��j r• ''
Building Dept.
/ B) Design Information:
n �Q Home Amperage: Pedestal Amperage:
......._...............................__......_ .. Q u._�_-Z.QJA---._---.---.---.--•--- _ ____...—_ _....._........._._._._..—�_.-...__._ Home Voltage: Pedestal Voltage:
Home Roof Load: PSF
e distances to all lot lines Roof Load for locality: PSF
eceivei�
C) Is the park located in a snow area requiring 30 lb or greater roof
f3 r loading? YES IK NO
CHECK ONE BOX D) The lot line corners at the front and rear are clearly and permanently
marked pursuant to Title 25 of the California Code of Regulations, "
Home above Grade '�{'r7�;xC+�
Sections 1]04 or 2104 in the following manner:
CITY 0 ME IFEE qw �c�' O
BUILDt G AND SAFETY D PAI- I Grade
NOTE: Each lot line corner shall be clearly and permanently marked
PLAN PP OVAL lC� riot to installation and inspection.
Existing
Stricture Existing
,` Structure STATEMENT OF RESPONSIBILITY
REVIEWED BY FACTURE�AgW (ORIGINAL SIGNATURE REQUIRED)
As the park owner or operator,or as his or her authorized
'Approval f these plans shall not be cons ed to be a Permit for,Oran = representative,I hereby certify that the information provided on
this plot plan relative to the location of the manufactured horne,
approval ,any v' lation s-any st of V the plans be kept on the all related accessory structure locations and separations and the
regulat'to and orioanees.Thi88etOfa P�+ park and homeowner information is true,accurate and
jobsite u til Com It'tion. complete. Lot corners have been identified as in item D above
..__.............._...-.____.._.........._..._._... ___._-...._.—_.._.__....._....__......_..-......._.........
..__.__.__�.._.._�..__ ��
Corner .�� STREET �\ Corner Signature of Park Owner,Operator,or Manager
Marker Marker
I� State of California
Z� ' 8 Department of Housing and Community Development
Width and length of lot: J V x � �J 0 Width and length of home S 0 x ,� Division of Codes and Standar§
`� lO ns aCCeptable 0r�
1. Draw any proposed structure(s)and existing structures on the diagram above at the approximate location
and identify the type of structures(e.g.deck,awning,etc). Indicate the distance from the lot line to the p.i rnU issuanC i
proposed structure. Also indicate the length and width of the structure.
2. Indicate the exact distances from structures on adjacent lots if located within 10(ten)feet of your lot line. Northern Area Office Southpiii)�,treaj0tce ��1
3. Enter length&width of the manufactured home(including eaves)and length&width of lot. 9342 Tech Center Drive,Suite 550 3737 ia"fu St.Sit AUo
a. No vegetation is allowed under the manufactured home or habitable accessory structure. Lot must be Sacramento,CA 95826 Riverside„fin�z5ol .
C r c.:.. :.,
properly graded to ensure that water cannot accumulate beneath the manufactured home.
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