PMT15-01017 i
City of Menifee Permit No.: PMT15-01017
.��+�•''' �^ 29714 HAUN RD. Type: Residential Addition
'>'iC.rfi.E-L—/X>: MENIFEE,CA 92586
easy""mob MENIFEE Date Issued: 04/21/2015
PERMIT
Site Address: 27864 WHITTINGTON RD, MENIFEE, CA Parcel Number: 336-490-025
92584 Construction Cost: $8,000.00
Existing use: 1 &2 Family Residence Proposed use:
Description of INSTALL 17'x 40' SOLID ALUMAWOOD PATIO COVER WITH 3 FANS
Work:
Owner Contractor
ROBERT HORN CLASSIC ALUMAWOOD COVERS
27864 WHITTINGTON ROAD 39450 BONAIRE WAY
MENIFEE, CA 92584 MURRIETA, CA 92563
Applicant Phone: 9512942804
DAVID ABEEL License Number: 986793
CLASSIC ALUMAWOOD COVERS
39450 BONAIRE WAY
MURRIETA, CA 92563
Phone: 9516748533
Fee Description OQt r Amount f$1
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
$289.00
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_Templatesiot Page 1 of 1
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
Professions Code and my license is infull-farce-and-effect. Code: roc or a oe o 0
License Class F7 L�' Cicens No. 6793 an owner or a F57MT7—
who builds or improves thereon, and who contracts for the projects with a
Expires /�-/J _ Signatu licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ I am exempt from licensure under the Contractors'State 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 acknowledge that, except for my personal residence in
compensation,issued by the Director of Industrial Relations as provided for which I must have resided for at least one year prior to completion of
Section 370E of the Labor Code, for the performance of work for which thisis improvements covered by this permit, I cannot legally sell a structure that I 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 370E of the Labor Code, for the performance of the work for which this submitted or at the following Web site:http'//www.leginfo.ca.gov/calaw,htm],
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier Property Owner or Authorized Agent Date
Expires Policy#
Name of Agent Phone# ❑ By my Signature below, I certify to each of the following: I am the property
owner or authorized to act an 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-
certify that in the performance of the work for which this permit is issued, I identified property for the inspection purposes,
hall 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 property Owner or Authorized Agent Date
Date;
Code, I shall forthwith comply with those provi ions.�� /
ff-- Zl �6—Applicant; /d y ` City Business License#
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, OYES OCCUPANT HANDLE AHAZARDOUS MATERIAL ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES ONO 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 OYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
Lender's Address FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
ONO 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 EYES 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 OYES 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 ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE, SECTION 25505, 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL REPORTING.
compensation, will do ( ) all of or ( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale, If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
PERMIT/PLANBUILDING & SAFETY APPLICATION
.*Menifee
-� Menifee
DATE - ZI - I S� PERMIT/PLAN CHECK NUMBER
TYPE: C% COMMERCIAL RESIDENTIAL t:i MULTI-FAMILY C) MOBILE HOME C:% POOL/SPA O SIGN
SUBTYPE: ADDITION C ALTERATION C>DEMOLITION C; ELECTRICAL " MECHANICAL
O NEW + PLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK / 5 GL t61)144 W&0,0 e&O P-1 k7 3
e+4
p ULAO 1 X 11,
11 /
PROJECTADDRESS Z `7 D 6I W A c4t i of 7-tr.,J
ASSESSOR'S PARCEL NUMBER 2�-990-� LOT T�'uTCity of Menifee
OWNER NAME OYI /` ��0./I
ADDRESS z 7 8 t�6 y C0 + I.l.1 t�(, _�o/j
PHONE �72_ EMAIL Received
APPLICANT NAME U) j) LTCCL
ADDRESS zS Lr/'Z
PHONE 98q-7Jz -g36 9 EMAIL
CONTRACTOR'S NAME R Aj L),S 0,*/ o ^oLkkqph OWNER BUILDER? C'YES VNO
BUSINESS NAME Lf tt �, ('C C J ✓t'L,1-0Y LZ O tJ /f e
ADDRESS 3FY5_0 60A)ALAC W0� e 25-6 7
/'
PHONE 3T/- C7y-853.T EMAIL Ca,'SficAI-04A.W000 (ZOO C.^Y (tc-Ac4co
CONTRACTOR'S STATE LIC NUMBER 9867 7",O LICENSE CLASSIFICATION p -Ltf
VALUATION$ p Orb- r SQ FT 8 C) L SQ FT
APPLICANT'S SIGNATURE DATE N
LCITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT C)CASH <`CHECKH <.:CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 01 CASH C)CHECK H Cam'CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED %YES > NO DL NUMBER NOTARIZED LETTER C% YES Ct NO
City of Menifee Building& Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.Lis Inspection Request Line 951-246-6213
Owner: Contactor:
Robert &Deborah Horn Classic Alumawood Covers
27864 Whittington 39450 Bonaire vwf y �}-
Menifee CA 92584 Temecula CA. 92563
(7D
951 672-3633 951 674-8533 CAS
)
City of Menifee
Building & Safety Dept,
2s APR 2 1 2015
_—_ — Rocei�ed
CITY OF M NIFEE LEDGER TRACK r
BUILDING ND SAFETY DEPARTMENT INSPECTION REQUIRE
PLAN APPF OVAL
rr � O
REVIEWED BY 5 1
sold >
`Approval of these Tans shall not be con trued to be a permit for,or an Cow er i
approval of,any vio ation of any provisio is of the federal,state or city
regulations and ord nances. This set of a proved plans must be kept on the
johsite until comple ion.
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