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PMT15-01779 y City of Menifee Permit No.: PMT16-01779 29714 HAUN RD. Type: Residential Addition 4�CC_ FI../�k MENIFEE, CA 92586 MENIFEE Date Issued: 0 6/2 612 01 6 1 PERMIT Site Address: 29923 TIERRA SHORES LN, MENIFEE, Parcel Number: 340-500-056 ' CA 92584 Construction Cost: $4,114.00 Existing Use: 1 &2 Family Residence Proposed Use: Description of INSTALL 489 SO FT SOLID ALUMAWOOD PATIO COVER WITH 3 FANS, 1 FLOOD LIGHT Work: Owner Contractor RICKY BARAGAS GUTTERS N COVERS CONSTRUCTION INC 29923 TIERRA SHORES LANE 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, CA92508 Fee Description Qtty Amount Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 S a $293.00 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 building operations being carried on thereunder when in violation of the Building Code or of any other ordinance of City of Menifee.Except as otherwise slated,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.rpl 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 my license is N full e C�ffe Code:The Contractor's License Law does not apply to an owner of a property License Clas License No. who builds or improves thereon, and who contracts for the projects with a Expires Signature (�j ,�� 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 must have resided for at least one year prior to completion in Section 3ssu 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 of permit is issued. I 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 ❑ 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 Cade, for the performance of the work for which this submitted or at the following Web site:hftp:/Iw leginfo ca aav/calaw html. permit is issued.My workers'compensation insurance canter and policy number are: Carrier L Q) Property caner or Authorized Agent n Date Expires � Policy# S5�I3y / 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 state laws relating to building construction. I authorize representatives 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 identified propert forte inspection purposes. shall not emolov 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 Own or or Authorized Agent Dat Code, I shall forthwith comply with those provisions. �^I1t�� C�Applicant; City Business License —t-(z oCt(J A Z Date; 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 HANDLEA HAZARDOUS MATERIAL ORA DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL LABOR CODE, INTEREST,AND ATTORNEYS FEES ;'�N0 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 DYES 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 for the reasons)indicated below by the checkmark(s)I have placed ❑YES 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, \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 Stale License Law (Chapter9 (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 IJO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY a civil penalty of not more than($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING ❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL REPORTING. compensation,will do ( )all of or( ) porting of the work, and the structure is PROPERyyyY OVVV NER OR AUTHORIZED AGENT not intended or offered for sale.(Section 7044,apply andProfessions nee of a property Code; /� /�1��I The Contractor's State License Law does not a I to an owner of a ro ert X �' f { ` who, through employees' or personal effort, builds'or improves the property, 7 �— provided that the improvements are not intended or offered for sale. If,however, the building or improvement is sold within one year of completion, the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). & SAFETY PERMIT/PLAN CHECK APPLICATION Menifee DATE 06/25/2015 PERMIT/PLAN CHECK NUMBER 6j- Q TYPE: ❑COMMERCIAL ❑✓ RESIDENTIAL MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA [:]SIGN SUBTYPE: [-]ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑MECHANICAL ❑NEW ❑PLUMBING ❑RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK SOLID ALUM PATIO COVER WITH 3 FANS 1 FLOODLIGHT PROJECT ADDRESS 29923 TIERRA SHORES LANE MENIFEE CA 92584 ASSESSOR'S PARCEL NUMBER jQD— 60D-05(y LOT TRACT OWNER NAME RICKY BARAGAS ADDRESS 29923 TIERRA SHORES LANE MENIFEE CA 92584 PHONE (951)490-8247 EMAIL APPLICANT NAME KRISTY HENDRICKSON ADDRESS 19069 VAN BUREN BLVD#114 RIVERSIDE, CA 92508 PHONE (951)672-8022 EMAIL CONTRACTOR'S NAME GUTTERS N COVERS OWNER BUILDER? ❑YES❑✓ NO BUSINESS NAME GUTTERS N COVERS ADDRESS 19069 VAN BUREN BLVD#114 RIVERSIDE, CA 92508 PHONE (951)672-8022 EMAIL CONTRACTOR'S STATE LIC NUMBER 945962 LICENSE CLASSIFICATION B VALUATION$ $4.114.00 SO FT 489 L SQ FT APPLICANT'S SIGNATURE DATE CITYSTAFF USE ONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER. BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE PAID AMOUNT AMOUNT 6ZASC-'CASH %CHECK# C%CREDITCARD VISA/MC PLAN CHECK FEES PAID AMOUNT :;CASH CCHECK# C CREDIT CARD VISA/MC OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER C% YES C) NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586951-672-6777 www.cityafinemfee.us Inspection Request Line 951-246-6213 C1t U7 � 9 fi O c i � � �. D (,A CS1 � p L9 9 9 ACK (vCA ' � Iy! yqry ggNI7� p fr City of Menif2e 13uilding & Safety Dept. �J WL062015 CITY OF MENIFEE Received BUILDING AND SAFETY DEPARTMENT PLAN APPROVAL REVI -7 ko DATE "Approval of these plans shall not be construed to be a permit for,or an approval of,any violation of any provisions of the federal,state or city regulations and ordinances. This set of approved plans must be kept on the jobsite until completion, 15J f I— J£ 17 I I I � FI�� u �� 1