PMT15-02309 City of Menifee Permit No.: PMT15-02309
29714 HAUN RD,
Tt MENIFEE, CA 92586 Type: Residential Addition
MENIFEE Date Issued: 0 8/1 012 01 6
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1
PERMIT
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I
Site Address: 28387 INVERNESS CT, MENIFEE, CA Parcel Number: 340-110-017
92584 Construction Cost: $3,850.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 347 SQ FT SOLID ALUMAWOOD PATIO COVER W/ELECTRICAL 2 FANS
Work:
i
Owner Contractor
ANNE CORONA WEST COAST SIDING &TRIM
28387 INVERNESS CT 675 LACEY OAK DIRVE
MENIFEE, CA 92584 CORONA, CA 92881
Applicant Phone: 9517353379
DANIEL SULLIVAN License Number: 615917
WEST COAST SIDING &TRIM
675 LACEY OAK DIRVE
CORONA, CA 92881
Fee Description QQtr Amount l$1
c ichC�' e i u€:r 1-
Building Permit Issuance 1 27.00
GREEN FEE 1 1,00
CSiID��T�{1'
$283.00
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 thereunderwhen 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 Co 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 Class LicQ s No.l_J�njj who builds or improves thereon, and who contracts for the projects with a
Expires 4)411 Signature, licensed contractors)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 permit is issued. improvements covered by this permit, I cannot legally sell a structure that I have
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
4 I 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:htto://www.leoinfo.m.ciovlcalaw.html.
permit is issued.My wo ers'compensation insurance carrier and policy number are:
Carrier Property Owner or Authorized Agent Date
Expires ( ( Policy# 0OWI 12" 1?_&
TkBy 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 appli le city a d county ordinances and state laws relating to building
construct. uthoriz epresentatives of this city or county to enter he a6ove-
I certify that in the performance of the work for which this permit is issued, I identified p r rty for t inspection purposes.
shall 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 prov' s of ST
3700 of the Labor grope Owner or Authorized Agent Da e
Code,I shall to hwith comply with those ovi ins. m
C, City Business License#
Date; (� I/ Applicant;
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 ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES (�7�10 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 pYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address NO 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 DYES 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, Q NO SCHOOL?
or repair any structure, prior to its issuance, also requires the applicant for the t"
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 pYES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from Iioensure 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($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL I EPORI ING.
compensation, will do( )all of or( )porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
�� Lti6 Menifee
DATE d I S PERMIT/PLAN CHECK NUMBER
TYPE: % COMMERCIAL 4 RESIDENTIAL `) MULTI-FAMILY 'D MOBILE HOME (:; POOL/SPA C)SIGN
SUBTYPE: C)ADDITION ALTERATION 0 DEMOLITION 0 ELECTRICAL <, MECHANICAL
NEW ","' PLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK i Xj
,r
PROJECTADDRESS Vv 5 � C
ASSESSOR'S PARCEL NUMBER —5qC — It()—dI, LOT TRACT
OWNER NAME/ Inv),( ymn
ADDRESS Z-p3 l w5
PHONE 0)51' EMAIL
APPLICANT NAME 1 �h
ADDRESS
PHONE 01(� , �,� — I 1 EMAIL
CONTRACTOR'S NAME (vj OWNER BUILDER? %YES'"NO
BUSINESf I lSA^
NAME/
ADDRESS V 1 j
PHONE 01,) 5e 1!!j EMAIL ^�
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION V
VALUATION$ �0 Q FT 17 1 5 P L SO FT
APPLICANT'S SIGNATURE DATE (tl It
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION I � SMIP CITY OF MENI2FEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN
INVOICE PAID AMOUNT
AMOUNT %CASH %CHECK# CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT :'CASH CHECK It :%CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED '.:YES 0 NO DLNUMBER NOTARIZED LETTER ') YES NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.citycfinenifee.us Inspection Request Line 951-245-5213
gtJ ,D (W<(
city of Menifee
Building & Safety Dept,
UG 10 2015
ece�ved
LEDGER & TRACK
INSPECTION REQUIRED
I
r'l OF MENIFEE
1LDING AND SAF ARTMEN
..AN APPROVAL M
REVIEWED By A DATE 0
"Approval of these plans shall not be constr ed to be a permit Ir,or an .1
approval of,any violation of any prov'sions o the federal,state r city _
regulations and ordinances. This set of appro ed plans must b kept on the
jobsite until completion.
y
l'd 0£40-969-696 6ulplsiseaoIsom eb9ol9L06Env
° Carl Putnam P.E.
3441 Ivylink Place .,
Lynchburg,VA 24503 '
ark utna , a
June 4, 2015 Citg safety Dept.
MenitGO
Building
Heath Morgan AUG i Q 2D15
Amedmax Exterior Home Products
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
carloutnamna comcast.net.
Sincerely,
Carl Putnam, P.E.
ENCjN�
?LITNq� F
gg139
13012017 .*
CIVt
�OF CP�10
UN �� 2Q15
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