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PMT15-00895 i City of Menifee Permit No.: PMT15-00895 29714 HAUN RD, Type: Residential Addition �IBi MENIFEE, CA 92586 MENIFEE Date Issued: 04/09/2015 0 j B s PERMIT Site Address: 25924 BETH DR, MENIFEE, CA 92584 Parcel Number: 358-233-002 a Construction Cost: $12,000.00 Existing Use: 1 &2 Family Residence Proposed Use: Description of INSTALL 20'x 5T SOLID ALUMAWOOD PATIO COVER WITH 3 FANS, 4 POST LIGHTS, 2 LIGHT Work: STRIPS Owner Contractor BERTINE PINCKNEY A A A QUALITY RAIN GUTTERS INC 25924 BETH DRIVE 1268 TRENTON AVENUE MENIFEE, CA 92584 CORONA, CA 92880 Applicant Phone: 9517344729 PHILLIP GREEN License Number: 728413 A A A QUALITY RAIN GUTTERS INC 1268 TRENTON AVENUE CORONA, CA 92880 Fee Description Qtyt Amount($) e ptaCle,Swifc�'Qut et"$tF' 're � a�; `�,�� 5 c�-^'°�"� � ,. g •Q:. Building Permit Issuance 1 27.00 Inspections not specified 20 20.00 SMIP RESIDENTIAL 1 y 2.00 $319.00 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_Sidg_Permit_Template.rpt Page 1 of 1 S JI f City Of Menifee LICENSED DECLARATION I 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 II Professions Code and my licenseis in full force and effect. D _.cf Code:The Contractor's License Law does not apply to an owner of a property I License Class 'License _ who builds or improves thereon, and who contracts for the projects with a y, Expires Ignature /'•--^y-- licensed contractor(s)pursuant to the Contractors State License Law), WORKERS'COMPENSATION DECLARATION ❑ I am exempt from licensors under the Contractors'State License Law for the ❑ I hereby affirm under penalty of perjury one of the following declarations: fallowing 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 must have resided for at least one year prior to completion of Section 3 of the Labor Code, for the performance of work for which this Improvements covered b this permit, I cannot legally sell a structure that I have Policy# permit is issued. built as an owner-building 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 '. I have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application Is action 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:bttp://www.leginfo.ca.cov/calaw.hfml. permit is issued.My workers'compensation Insurance carrier and policy number are: Carrier S'�'/•k? /ti-2I tCi'>a.�t / Property Owner or ut orized Agent Date Expires Policy# 241.6 Gt.�GlG�l � Name of Agent Phone# ❑ By my Signature below, I certify to each of the following: I am the property 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 slate laws relating to building construction.1 authorize representatives of this city or county to enter the above- El I certify that in the performance of the work for which this permit is issued,I identified property for the 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 1 should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall foorrtt ith comply with those provisions. Property Owner or Authorized Agent Date Date; r ! %.1s Applicant; " City Business License# WARM 'G: FAILURE TO SECURES ORt'(ERS' HAZARDOUS MATERIAL DECLARATION COMP ATION COVERAGE ISUNLAWFUL, 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, DYES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL LABOR CODE, INTEREST,..AND ATTORNEYS FEES p•I40 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 3097 Civil Code) WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE Lender's Name AYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION Lender's Address ^NO FROM THE SOUTH COAST AIR QUALITY MANAGEMENT L�' 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: T L L�," /a Q� r License Law for the reason(s)indicated below by the checkmark(s)I have placed AYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY next to the applicable items) (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, "NO 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 []YES 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 to fr{N0 UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY a civil penalty of not more than($500).) j CODE, SECTION 25505, 25533 AND 25534 CONCERNING ❑ I, as owner of the property, or my employees with wages as their sale HAZARDOUS MATERIAL REPORT ING. compensation,will do ( )all of or( ) porting of the work, and the structure is PROPERTY��777VVNER OR AUTHORIZ�ITAGENT not intended or offered for sale.(Section 7044,Business and Professions Code; f p �, /'� // The Contractor's State License Law does not apply to an owner of a property X (+ T"r-- -„ / who, through employees' or personal effort, builds or improves the property, 1' 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). BUILDING & SAFETY • APPLICATION Y .-4l �..,Menifee DATE —1 q PERMIT/PLAN CHECK NUMBER TYPE: []COMMERCIAL []RESIDENTIAL MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA []SIGN SUBTYPE: []ADDITION []ALTERATION []DEMOLITION []ELECTRICAL ❑MECHANICAL ❑NEW ❑PLUMBING ❑RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK Ze 2s4- t 2 PROJECTADDRESS Z 2. „Q 4 .SI ASSESSOR'S PARCEL NUMBER LOT TRACT enitee OWNER NAME l v City of atety Dept. ADDRESS 2 " / PHONE �'Y-S'�� —Olpf Ct EMAIL APPLICANT NAME Received ADDRESS 5'ya -�,DLA—i( PHONE/ 3p EMAIL CONTRACTOR'S NAME OWNERBUILDER? ❑YE NO BUSINESS NAME ADDRESS -S- /ru PHONE 1 ps i Z?3 y—<,"-/;�7j� EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION $ moon SOFT 2d1'-5? f_ Itop4— LSQFT APPLICANT'S SIGNATURE DATE FIRSTAFFUSEONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIFE GREEN SMIP p�� INVOICE PAID AMOUNT AMOUNT .' CASH %'CHECK# 'OCREDITCARD VISA/MC PLAN CHECK FEES PAID AMOUNT !�- CASH 0 CHECK# O CREDITCARD VISA/MC OWNER BUILDER VERIFIED ',)YES ;% NO DL NUMBER NOTARIZED LETTER O YES 5 NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityofmenife.e.us Inspection Request Line 951-246-6213 is rA. I , l a U K W city of Menifee 'c— O Building & Safety Dept. APR 0 9 2015 Received LEDGER & TRACK -4 V / INSPECTION REQUIRED a CITY OF MENIFEE ��, �,y hT9 + Fd�s �Z1,` „ ,n cv � BUILDING AND SAFETY DEPART WENT Z, T- $ yA 6-q6-4 PLAN APPROVAL � h�u 5� qvq,,zs-� REVIEWED BY DA "Approval ofthese#ans shall not be construed to be a pgftitil approval of,any violation of any provisions of the federal,state or city regulations and ordinances. This set of approved plans a ust be kept on fhe jobsite until completion. r i o � �J �rne P /vGkNey a S9a�f �j�t! sT /to / P'4 til w h r �� tau c� Yd s's G