PMT15-00859 City of Menifee Permit No.: PMTIS-00869
29714 HAUN RD.
%�CCE 1? MENIFEE, CA 92586 Type: Residential Addition
MENIFEE Date Issued: 04/06/2015
PERMIT
Site Address: 28539 PLANTAIN WAY, MENIFEE, CA Parcel Number: 333490-032
92584 Construction Cost: $2,450.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 288 SO FT SOLID ALUMAWOOD PATIO COVER WIHT ELECTRICAL 1 FAN
Work:
Owner Contractor
CYNTHIA DAUM GUTTERS N COVERS CONSTRUCTION INC
28539 PLANTAIN ST 19069 VAN BUERN BOULEVARD#114
MENIFEE, CA 92584 RIVERSIDE, CA 92508
Applicant Phone: 9516728022
KRISTY HENDRICKSON License Number: 945962
GUTTERS N COVERS CONSTRUCTION INC
19069 VAN BUERN BOULEVARD#114
RIVERSIDE, CA 92508
Fee Description GQyt Amount
"Receptacle Swttch Outlet&1F06-OvM7
Building Permit Issuance 1 27.00 _
DecklPatio non standard r x t + 1 " s 133�0''
GREEN FEE 1 1.00�
-$IP RESIDENTIAL rpyxra sx 'k 1
'��_..
$278.00
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 Templale.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION
hereby affirm under penalty or perjury that I am licensed under provisions of ❑ I, as owner of the property an exclusively contracting with licensed
Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professions
Professions Code ino my license is in full force`nd effect. Code:The Contractor's License Law does not apply to an owner of a property
License Cls License Nq. r who builds or improves thereon, and who contracts for the projects with a
Expires Signature-. �!1GV - licensed contractor(s)pursuant to the Contractors Stale License Law).
WORKERS'COMPENSATION DECLARATION
❑ I am exempt from licensure under the Contractors'Stale License Law for the
❑ I hereby affirm under penalty of perjury one of the following declarations: following reason:
I have and will maintain a certificate of consent of self-insure for workers' By my signature below I acknowledge that, except for my personal residence in
compensation,issued by the Director of Industrial Relations as provided for by which I must have resided for at least one year prior to completion of
Section 3700 of the Labor Code, for the performance of work for which this improvements covered by this permit, cannot legally sell a structure that have
permit is issued. built as an owner-building if it has not been constructed in its entirety by licensed
Policy# contractors. I understand that a copy of the applicable law, Section 7044 of the
❑ 1 have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is
section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:htto'llwww leginfo ca oovlcalaw htm1.
permit is issued.My workers'compensation insurance carrier and policy number are:
Q Property Owner or Authorized Agent
Carrier _LL
Date
Expires 7� �i� Policy# &)c l on;�9
❑ By my Signature below, I certify to each of the following: I am the property
Name of Agent Phone# owner or authorized to act on the property owner's behalf. I have read this
(This section need not be completed if the permit is for application and the information I have provided is correct. I agree to comply
one-hundred dollars($100)or less) 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.
❑ I certify that y the performance of the work for which this permit is issued, identified grope y for ie inspection purposes. ---
shall not employ any persons in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers'compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions. Property O ner or Authorized Agent Dat
Date; C7/ rJJ�� Applicant; City Business License# ��;5,�.7_� .
WARNING: FAILURE TO SECURE WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDING
($100,000), IN ADDITION TO THE COST OF COMPENSATION, AYES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES NO EQUAL. TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS
I hereby affirm that under the penalty of perjury there is a construction lending INFORMATION GUIDE?
agency for the performance of the work which this permit is issued (Section WILL THE INTENDED USE OF THE BUILDING BY THE
3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE
Lender's Name ❑YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
Lender's Address FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
, O DISTRICT(SCAQMD) SEE PERMITTING CHECKLIST FOR
OWNER BUILDER DECLARATIONS
�" GUIDE LINES
I hereby affirm under penalty of perjury that I am exempt from the Contractor's PRINT NAME:
License Law for the reason(s)indicated below by the checkmark(s)I have placed DYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable item(s) (Section 7031.5. Business and Professions Code: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A
Any city or county that requires a permit to construct, alter, improve, demolish, SCHOOL? -
or repair any structure, prior to its 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 License Law (Chapter 9 (commencing with I HAVE READ THE HAZARDOUS MATERIAL
Section 7000)of Division 3 of the Business and Professions Code)or that he or AYES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from licensure and the basis for the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREMENTS
violation of Section 7031.5 by any Applicant for a permit subjects the applicant toq'ti0 UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) `` CODE, SECTION 25505, 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL REPORTING.
compensation, will do ( ) all of or ( ) porting of the work, and the structure is PROPERT WN R OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code; ,d� p
The Contractor's State License Law does not apply to an owner of a property X_ in Cf//1 C,%'C.x/e
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale, If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
CITY OF MEl®YFJl E PLCK No: P it N m OY� i, m
29714 Haun Road Dat
e:
fe:
Menifee, CA 92586 (.D /S
Phone: (951)672-6777 Amount: Amount,
Fax:(951)679-3843 Ck#: Ck#:
Building Combination Permit I
To Be Completed By Applicant
Legal Description: -ao 55 Planning Case: F: L: Rt: R:
Propedy,A gc�� ` - fJ Assessor's Parcel Number. ��
V IJ r 3- 4�10 D
Projectlierent Name: Unit#: Floor#:
Name: '1 Phone No. Feet No.
OwnerProy Address: �- .—j�- Unit Number Zip Code
artEmail Address:
Name: P.e o• ( /C ' Fax No.)
Applicant Address:. Rair-en Io ti i U Unit Number Zip Code
Email Address:
Name:
tAcr-') ti ooycr, F 1!5I-w `�S rl
Contractor Address:
1 u>q 't�_ ' , J �`�i� city �.AV ISM zip �a 5-
ontractor's Gity qg ass _tegl l0. Contractor's t to lif 'a License No.
' ,`` �. I. _ Classification:
Number of Squares:
Square Footage
Description of Work 11 l i , yt/1 b u I � Cost of Work$
S JI I I
Applicant's Signature
. .. Date:
To Iffia Completed By City Staff Only
Indicate As R-Received or N/A-Not Applicable
5 Completes sets of fully dimonsloned,drawn to sale plans which include: 1 set of documents which include
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Goo Tech/Soils Report(on cd only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8 Y:x 11)
❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Structural Calculations
❑ Single Line diagram for elec.services over 400 AMP
❑ floor Plan ❑ Structural Framing Plan&Detatls ❑ Shoring Plan I ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration' Addition" MeansJMethods
Work Type: Repair' Retrofit' Revision to Existing Permit' Required? YES NO
Proposed Building Use(s): Existing Building Use(s):
#Buildings: #Units: #Stories: Will the Building Have a Basement?
Y of N
Bldg.Code Occupancy Group Indicate Indicate if YES or NO Indicate all Geo-tech. Haz.Zone
At Project Construction Sprinkleretl that apply: Coastal Zone
Completion:
Type(s): C of o YES or NC Noise Zone
Required? Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board Landmark Comm. Planning Comm.Zoning Administrator
Fee Exempt: City Project Elec-Vehicle Charger Landmark Seismic Retrofit special case:umg.
Otfid.lA royal
Expedite Project(s): Child Care City Project Green Building Landmark Affordable Hausing
For Staff Use Only
Building/Safety Permit Specialist I City Planning I Civil Engineering I EPWpA-Admin Transportation Mgm,. I Rent Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
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