PMT15-02013 i
i
City of Menifee Permit No.: PMT15-02013
29714 HAUN RD. Type: Residential Addition
g9kC .,A..` MENIFEE, CA 92586
MENIFEE Date Issued: 0 7/1 512 01 5
PERMIT
Site Address: 28414 CRESTWOOD ST, MENIFEE, CA Parcel Number: 333-320-013
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92585 Construction Cost: $14,400.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 170 SO FT ALUMAWOOD PATIO ROOM &280 SO FT SOLID ALUMAWOOD PATIO COVER
Work: W/ELECTRICAL 2 FANS, 1 LIGHT,4 PLUGS
Owner Contractor
JIM STUBBLEFIELD WEST COAST SIDING &TRIM
28414 CRESTWOOD ST 675 LACEY OAK DIRVE
MENIFEE, CA 92585 CORONA, CA 92881
Applicant Phone: 9517353379
DANIEL SULLIVAN License Number: 615917
WEST COAST SIDING&TRIM
675 LACEY OAK DIRVE
CORONA, CA 92881
Fee Description (Qtyt Amount I$1
� ece ace 'i -ut xtr-
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
$309.00
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 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 and my license is in full force and effect. Code:The Contractor's License Law does not apply to an owner of a property
License���C,,,la��_ss - License No. who builds or improves thereon, and who contracts for the projects with a
Expires Al— licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ lam 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 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
I have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is
se
section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:htti)'/lwww.leciinfo.m.gov/caiaw.html.
permit is issued.My workers'compensation insurance camier and policy number are:
Carrier Property Owner or Authorized Agent Date
Expires /I /js Policy# .Awl S5S2 7U
� Py 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 inf tion I have provided is correct. I agree to comply
one-hundred dollars($100)or less) with all,a plrcable city a county ordinances and state laws relating to building
construction.I authorize epresentatives of this city or county to enter the above-
1I^I certify that in the performance of the work for which this permit is issued,I identified property for th inspection purposes.
shall not emolov any persons in any manner so as to become subject to the - -
workers'compensation laws of California,,qd agree that if I should become /
subject to the workers'compensation proGisio s of Section 3700 of the Labor prop Owner or Authorized Agent ate
Code,I shall forthwith comply with those prov ions.
City Business License# O _561569
Date; j Applicant;
IV
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 HANDLE A HAZARDOUS MATERIAL OR A
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE nn 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 AYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
Lender's Address iNO 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 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, ( 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(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 TOE 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 LINO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE, SECTION-25505 255,13,AND 25534 CONCERNING
6a`I, as owner of the l�perty, or my employees with wages as their sole HAZARDOUS ATERIAL ffEP RTING.
compensation,will doe all of or( )porting of the work, and the structure is PROPERTY�O�VNER OR A'y�'rtHO ZED AGENT
not intended or offered or sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
I
& SAFETY PERM IT/PLAN
♦ APPLICATION
Menifee
DATE h PERMIT/PLAN CHECK NUMBER OpCQ'�
TYPE: t'COMMERCIAL * RESIDENTIAL " MULTI-FAMILY 0 MOBILE HOME POOL/SPA -:i SIGN
ILIBTYPE: ADDITION 0 ALTERATION (I DEMOLITION O ELECTRICAL 0 MECHANICAL
ati0 G NEW C PLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK I rn jAjIA } Q I I AfjwHw*J
t P( t ;Ll 1 46
PROIECTAD ZDRESS 11 C •2 5 gqWoaQ \
ASSESSOR'S PARCEL NUMBER �j33'J�CQ^Q�?j LOT TRACT 3bODa
OWNERNAME -,V 641� '�
ADDRESS "L d 11 (!y W,,V V,110; tl
PHONE q5 (- / EMAIL
APPLICANT NAME uitL
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME Wt F (,r)S� }(i N1 OWNER BUILDER? OYES t NO
BUSINESS NA/ME
ADDRESS "'
PHONE �S� �Uj�� ,y(� EMAIL
CONTRACTOR'S STATE LIC NUMBER (/)an LICENSE CLASSIFICATION PLt L I
VALUATION$ tq p� SO FT (n�� L SO FT
APPLICANT'S SIGNATURE "w� Z$� Y%T� (DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFE USINEESSS,LI_CENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP pL� OSS(o$
INVOICE PAID AMOUNT
AMOUNT • }' CASH C'CHECKft '•'. CREDIT CARD VISA/MC
P LAN CHECK FEES PAID AMOUNT CLASH C CHECKH i.%CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED DYES 0 NO DL NUMBER NOTARIZED LETTER :E,. YES C% NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92585 951-572-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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City of Menife `
Building & Safety Dept.
JUL 15 2015 4
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Received w
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CITY :' : `ENIFEE
BL))f. , \ND SAFETARTMENT
PLAN A - OVAL
REVIEWC..i
DATE
*Approval of tees:c is shall not be construed to be a permit for,or an
approval of,any viola,,- n of any provisions of the federal,state or city QIto
regulations and ordina. -:es. This set of pproved plans must be kept on the 1
jobsite until completion. � ----)
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Carl Putnam P.E.
3441 Ivylink Place
Lynchburg,VA 24503
Carl Putnam, P. E.
June 4, 2015 City of Menifee
Building & Safety Dept.
Heath Morgan 5 2015
Amerimax Exterior Home Products jUL 1
28921 US Hwy 74
Romoland, CA 92585 Received
Dear Heath:
My California PE registration was renewed in June 2015 and is currently valid u til 2017. All
previous documentation (plans, letters, calculations, etc.) that I approved Conti ue to be
valid under the conditions specified in those documents.
If you require further information please contact me at(434) 384-2514 or at
carlputnamacomcast net.
Sincerely,
Carl Putnam, P.E.
ENG11V
PUT/yq�FF
68139
13012017
CIVt
TEOFCA�1
UN 9 2015
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