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PMT15-01882 i City of Menifee Permit No.: PMT15-01882 29714 HAUN RD. A MENIFEE, CA 92586 Type: Residential Addition s"�wkws MENIFEE Date Issued: 0710 612 01 5 PERMIT Site Address: 29075 SILVER STAR DR, MENIFEE, CA Parcel Number: 340-351-004 92584 Construction Cost: $1,750.00 i Existing Use: 1 &2 Family Residence Proposed Use: Description of INSTALL 8'x 25'SOLID PATIO COVER WITH 1 FAN Work: Owner Contractor ARMANDO RAHAMAN GUTTERS N COVERS CONSTRUCTION INC 29075 SILVER STAR DRIVE 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 Q_yt Amount 1$1 Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 $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_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 Code my license is in full forcce and effec Code:The Contractor's License Law does not apply to an owner of a property License Clas ��License No. �/�jr who builds or improves thereon, and who contracts for the projects with a Expires Signature ,'IIG; � -- licensed contractors)pursuant to the Contractors State License Law). WORKERS'COMPENSATION DECLARATION ❑ I am exempt from licensure under the Contractors'State License Law for the ❑ 1 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 3ssu 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 permit is issued. P Y P 9 Y 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 Code, for the performance of the work for which this submitted or at the following Web site:http7//mwm.leginfo.ca.gov/calaw.html. permit is issued.My workers'compensation insurance carrier and policy number are: Carrier A - C LAP Dale Expires 7 g I Policy# 75L007/a 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- 0 1 certify that in the performance of the work for which this permit is issued,I identified propert for a 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, r or Authorized Agent C Dat Code,I shall forthwith comply with those provisions. p ! �Z City Business License Date; /v//5 _ Applicant; lI (i(Zy'(,�1ti� 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 ORA DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE / MIXTURE CONTAINING A HAZARDOUS MATERIAL LABOR CODE, INTEREST,AND ATTORNEYS FEES i' 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 AYES 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 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 or repair any structure, prior to its issuance, also requires the applicant for the ' SCHOOL? 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 [DYES 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 NQ UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY a civil penalty of not more than (5500).) 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 PROPER Y 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 io an owner of a property X who, through employees' or personal effort, builds'or improves the property, V 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 : APPLICATION A Menifee DATE PERMIT/PLAN CHECK NUMBER TYPE: ".) COMMERCIAL " RESIDENTIAL O MULTI-FAMILY 0MOBILEHOME % POOL/SPA O SIGN SUBTYPE: ADDITION O ALTERATION O DEMOLITION O ELECTRICAL r' MECHANICAL O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK PROJECTADDRESS OM dV 00 ASSESSOR'S PARCEL NUMBER 2j�o','Z,6\-GUL{ LOT TRACT City o enl e OWNER NAME {r Building & Satet Dept. ADDRESS St IU 15 PHONE q5` -5311P-u3� EMAIL APPLICANT NAME i w ay, Received ADDRESS v/ # ' .e PHONE D151-1�1�--��2' EMAIL CONTRACTOR'S NAME 5 N OWNER BUILDER? OYES 0 BUSINESS NAME ADDRESS PHONE EMAIL CONTRACTOR'S STATE LIC NUMBER 045610- LICENSE CLASSIFICATION VALUATION $ -7SO SP FT 0 • L SQ FT (� APPLICANT'S SIGNATURE ATE 1 �CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE +� PAID AMOUNT AMOUNT d�$ i%CASH 0 CHECK# OCREDITCARD VISA/MC PLAN CHECK FEES PAID AMOUNT C' CASH :.'CHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED "YES 0 NO OIL NUMBER NOTARIZED LETTER O YES NO City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 LEDGER & TRACK � � � o G 11 1PEC t_y�, REQUIrEC,; 9 � A Ci y of Menifee Buildir g & Safety Dept. J1IL062015 ITY OF MENIFEE Received *W%IGND SAFETY DEPARTMENT PLAN APPROVAL REVIEWED BY D D TE }Approval of these plans shall note provisions the federate state or city approval of,any violation of any p regulations and ordinances. This set of approved plans must be kept 11 n the r 2S j bsite until completion. j t IS °— — Cj a ` r �2� Poo L