PMT15-01414 i
City of Menifee Permit No.: PMT15-01414
29714 HAUN RD.
d9- CCIEL MENIFEE, CA 92586 Type: Residential Addition
W", MENIFEE Date Issued: 06/27/2015
1
PERMIT
Site Address: 27519 BOSTON DR, MENIFEE, CA 92586 Parcel Number: 335-273-025
Construction Cost: $2,040.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 255 SO FT SOLID ALUMAWOOD PATIO COVER**REVISED-ADD 70 SQ FT LATTICE PATIO
Work: COVER"*
Owner Contractor
MARK DAMAN GUTTERS N COVERS CONSTRUCTION INC
27519 BOSTON DR 19069 VAN BUERN BOULEVARD#114
MENIFEE, CA 92586 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 Qtv Amount
Deck/Patio, non-standard 1 133.00
D p c�t�InspecinrC'ard v � � � � � � ti
GREEN FEE 1 1.00
$183.00
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_Template.rpt 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 Codeld my license is in full forceter d_qffect. Code:The Contractor's License Law does not apply to an owner of a property
License Class \5 License No.�t _k0A_ who builds or improves thereon, and who contracts for the projects with a
Expires_ 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 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, I cannot legally sell a structure that I have
permit is issued.
Policy# built as an owner-building if it has not been constructed in its entirety by licensed
contractors. I understand that a copy of the applicable law, Section 7044 of the
.Rb I have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is
rsection 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:htto//www.Ieginfo.ca.qov/caIawhtmI.
permit is issued.My 1wo-`rkers'compensation insurance carrier and policy number are:
Carrier�CU7,'1 .�tU'�'^, Property wrier or Authorized Agent Date
Expires ::4n I lS Policy#S�C iy)� lw�
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 represent es of this city or county to enter the above-
0 1 certify that in the performance of the work for which this permit is issued,I identifie )rap the inspection p oses.
shall not employ any persons in any manner so as to become subject to the --�--! J
workers' compensation laws of California, and agree that if I should become �_1(./ry 20 S
subject to the workers'compensation provisions of Section 3700 of the Labor Prope uthorized Agent Date
Code, I shall forthwith comply with those provisions.
Date; Applican, ��City Business License# b i CJIv
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, []YES 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 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 NO FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
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 forthe 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: �J BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF
Any city or county that requires a permit to construct, alter, improve, demolish, C O 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 VYES 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
El1, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL DEPORTING.
compensation, will do ( )all of or( ) porting of the work, and the structure is PR PERT1f OWNER OR P�k}TiiB GENT
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
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).
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