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PMT15-02643 City of Menifee Permit No.: PMT16-02643 29714 HAUN RD.MENIFEE, CA 92586 Type: Residential Addition MENIFEE Date Issued: 0 812 7/2 01 5 PERMIT Site Address: 29641 CAMINO CRISTAL, MENIFEE, CA Parcel Number: 340-403-028 92584 Construction Cost: $3,150.00 Existing Use: 1 &2 Family Residence Proposed Use: Description of INSTALL 307 SQ FT SOLID ALUMAWOOD PATIO COVER WITH 1 FAN Work: Owner Contractor JAN HERMANNS WEST COAST SIDING&TRIM 29641 CAMINO CRISTAL 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 CRY Amount 1$1 Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 ..F; $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 Co arcl my license is in fu11f rcq e 11deffect. Code:The Contractor's License Law does not apply to an owner of a property License Cl ss J Liceryse who builds or improves thereon, and who contracts for the projects with a Expires ) Signature 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 ❑ 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. built as an owner-building if it has not been constructed in its entirety by licensed Policy# contractors. I understand that a copy of the applicable law, Section 7044 of the N I have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is �e Zion 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:htto//www leoinfo(: `alaw.html. permit is issued,ffMy worker compensation Insurance carrier and policy number are: Carrier ,/OJ 11� //,l Property Owner or Authorized Agenf Date Expires /r /6 Policy# V('f WC JJJZ�� [?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 onr hundred dollars($100)or less) with al�applicabla ity and county ordinances and state laws relating to building [[g� constfuctio�n. autF{ nze representatives of this city or county to enter the above- q/ll certify that in the performance of the work for which this permit is issued, I identified property or the inspection purposes. s{hh�all not emnlov any persons in any manner so as to become subject to the / workers' compensation laws of California, and gree tha if I should become X L 7 5 subject to the workers'compensation provigio a of Secti in 3700 of the Labor Pr p�y Owner or Authorized Agent Date Code, I sh II fort. ith comply with those prpvis 6 s. j lh�\ City Business License# Date; �—� �6 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, []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 �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 []YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION \❑N FROM THE SOUTH COAST AIR QUALITY MANAGEMENT Lender's Address �O DISTRICT(SCAQMD) SEE PERMITTING CHECKLIST FOR GUIDE LINES OWNER BUILDER DECLARATIONS 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 []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, E�OO 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 ❑YES INFORMATION GUIDE AND THE SCAQMD PERMITTING she Is exempt from licensure and the basis for the alleged exemption. Any CHECKLIST. I UNDE STAND MY REQUIREMENTS violation of Section 7031.5 by any Applicant for a permit subjects the applicant to &NO UNDTH STATE OF ALIFORNIA HEALTH AND SAFETY a civil penalty of not more than ($500).) CODE, 5S5C ION %505 5533 AND 25534 CONCERNING ❑ 1, as owner of the property, or my employees with wages as their sole HAZARDOU ATERIAL f �POR'�ING. compensation, will do ( )all of or ( ) porting of the work, and the structure is PROPEFYTY NER OR� THORIZED AGENT not intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's State License Law does not apply to an owner of a property X who, through employees' or personal effort, builds or improves the property, ° provided that the improvements are not intended or offered for sale. If,however, the building or improvement is sold within one year of completion, the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). 0$ 1 �2 � BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION I I Menifee DATE l Z PERMIT/PLAN CHECK NUMBER g- G� TYPE: CC COMMERCIAL 4 RESIDENTIAL MULTI-FAMILY Ci MOBILE HOME t_; POOL/SPA C% SIGN SUBTYPE: C% ADDITION Q ALTERATION C: DEMOLITION 0 ELECTRICAL 0 MECHANICAL - I NEW C? PLU`M11BING O) RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK 7110 I i C ov f PROJECTADDRESS �� (yL 1 11 (; I Q ASSESSOR'S PARCEL NUMBER- Lk05 - Cam$ LOT TRACT OWNER NAME - -jA '(( N S ADDRESS 6l rjyvy jArj ji51, City of enl PHONE �5I -1 - 1°'i 4? EMAIL iiding &Safety Dept. APPLICANT NAME !C j NIG 2 7 - 015 ADDRESS le"I . PHONE Cf7 t- ��.S��l�l EMAIL e�elve CONTRACTOR'S NAME itn (ily. OWNERBUILDER? ?YESANO BUSINESS NAME I yJj 661v1 ADDRESS �77 l�'tCI(/ G dr . PHONE -l�,l (T.�},- r011>) EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION$ SO FT L SO FT APPLICANT'S SIGNATURE / DATE 17IIS CITYSTAFF USE ONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE ^Q PAID AMOUNT AMOUNT I V �� C= CASH C>CHECK# "CREDITCARD VISA/MC PLAN CHECK FEES PAID AMOUNT CASH C'CHECK 0,CREDIT CARD VISA/MC OWNER BUILDER VERIFIED 0 YES I% NO DL NUMBER NOTARIZED LETTER C, YES NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 -� �'��'�� u<^'Y� Grryk� \ Wt2w�� L �1LS�M 'Se�vt �tf✓+na� 5 BSI l�1 1�'IY3 LEDGER & TRACK INSPECTION REQUIRED a, O oity of Menifee W 6u'dtftng & Safety Q® e-. U AOG 21 2015 U. CITY OF MENIFEE LLI BUILDING AND SAFETY DEPART PLAN APPROVAL n� REVIEWED BY 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. I