PMT15-02723 1
City of Menifee Permit No.: PMT15-02723
29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Addition
MENIFEE Date Issued: 09/02/2015
PERMIT
Site Address: 29107 WILLOWS LANDING DR, Parcel Number: 333-330-051
MENIFEE, CA 92585 Construction Cost: $2,270.00
Existing use: 1 &2 Family Residence Proposed use: j
Description of INSTALL 12'x 21' SOLID ALUMAWOOD PATIO COVER WITH 1 FAN 1,
Work: i
Owner Contractor
MARK NEUMANN GUTTERS N COVERS CONSTRUCTION INC '
29107 WILLOWS LANDING DRIVE 19069 VAN BUERN BOULEVARD#114
MENIFEE, CA 92585 RIVERSIDE, CA 92508
Applicant Phone: 9516728022
KRISTY HENDRICKSON License Number: 945962
GUTTERS N COVERS CONSTRUCTION INC
19069 VAN BUERN BOULEVARD#114
RIVERSIDE, CA 92508
Fee Description G1yt Amount l$)
ee,t Ic e
Building Permit Issuance 1 27.00
D b.
GREEN FEE 1 1.00
E A_
General Plan Maintenance Fee-Building 1 6.65
$284.65
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 am exempt from licensure under the Contractors'State License Law for the
I hereby affirm under penalty or perjury that I am licensed under provisions of following reason:
Chapter 9(commencing with section 7000)of Division 3 of the Business and By my signature below I acknowledge that, except for my personal residence in
Professions Code and y license is in full force and effec) n which I must have resided for at least one year prior to completion of
License Class �Licens Uo O— improvements covered by this permit, I cannot legally sell a structure that I have
Expires ' Signature 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
WORKERS'COMPENSATION DECLARA ION Business and Professions Code,is available upon request when this application is
submitted or at the following Web site:
❑ 1 hereby affirm under penalty of perjury one of the following declarations: http://www.leginfo.ca.aov/calaw.html.
I have and will maintain a certificate of consent of self-insure for workers'
compensation, issued by the Director of Industrial Relations as provided for by Date
Section 3700 of the Labor Code, for the performance of work for which this
permit is issued. Property Owner or Authorized Agent
Policy# ❑ By my Signature below, I certify to each of the following: I am the property
❑ 1 have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read this
section 3700 of the Labor Code, for the performance of the work for which this application and the information I have provided is correct. I agree to comply
permit is issued.My workers'compensation insurance arrier and policy number are: with all applicable city and county ordinances and state laws relating to building
constructs n.III authorize representatives of this city or county to enter the above-
Carrier ide fie pr pe y for/th-a inspec ion pur oses. _
Policy# xOc I Expires S Q_GI(e - Date
Prope Owner or Authorized Ag((e��nt��r
(This section need not be completed if the permit is for City Business License# w?_
one-hundred dollars($100)or less)
HAZARDOUS MATERIAL DECLARATION
❑ 1 certify that in the performance of the work for which this permit is issued,I
shall not employ any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or a
workers' compensation laws of California, and agree that if I should become mixture containing a hazardous material equal to or greater that the
subject to the workers'compensation provisions of Section 3700 of the Labor amount�s/pacified on the Hazardous Materials Information Guide?
Code,I shall forthwith comply with
wwiit"thh those provisions. ❑YES C)f�l NO
Appli �(r/ S�aCe� 1 Will the Vinteennded use of the building by the applicant or future building
occupant require a permit for the construction or modification from South
WARNI FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelin s
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND ❑YES NO
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the prop sad building or modified facility be within 1000 feet of the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES ❑YES `IO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist.I understand my requirements under the State of
agency for the performance of the work which this permit is issued (Section California Health&Safety Code,Section 25505 and 25534 concerning
3097 Civil Code) hazardous atone repo in .OWNER BUILDER DECLARATIONS DYES ---- L /
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OWNER O AUTHORIZED AGENT
next to the applicable item(s) (Section 7031.5. Business and Professions Code:
Any city or county that requires a permit to construct, alter, improve, demolish, EPA RENOVATION,REPAIR AND PAINTING(RRP)
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 The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
provisions of the Contractor's State License Law(Chapter 9 (commencing with receiving compensation for most work that disturbs paint in a pre-1978
Section 7000)of Division 3 of the Business and Professions Code)or that he or residence or childcare facility to be RRP-certified firms and comply with
she is exempt from licensure and the basis for the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than($500).) employees.For more information about EPA's Renovation Program visit:
❑ I, as owner of theproperty, or m em to employees with wages as their sole www.epa.gov/lead or contact the National Lead Information Center at
y P Y 9 1-800-424-LEAD(5323).
compensation,will do( )all of or( ) porting of the work, and the structure is
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 ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however, Certified Firm Name:
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 Firm Certification No.:
purpose of sale).
❑ I, as owner of the property an exclusively contracting with licensed No EPA Lead-Safe Certified Firm is required for this project because:
contractors to construct the project(Section 7044, Business and Professions
Code:The Contractor's License Law does not apply to an owner of a property
who builds or improves thereon, and who contracts for the projects with a
licensed contractor(s)pursuant to the Contractors State License Law). If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
'I
BUILDING & SAFETY • APPLICATION
Amenifee
DATE PERMIT/PLAN CHECK NUMBER
I y Lot me ifee
TYPE: O COMMERCIAL () RESIDENTIAL C) MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPABU"r(5V& Safe y Dept.
SUBTYPE: O ADDITION 0 ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL SEP O 2 2015
O NEWW l�O PLUMBING 0RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK 5o d L,I0n Palo covc C41 ' ed
PROJECTADDRESS C7( 1 V 1, ( andwq [)(^ • n 4e"I Z 8s
ASSESSOR'S PARCEL NUMBER ..3? ' 34!?n-oal LOT TRACT
OWNER NAME rK n-2urfunn - ,,
ADDRESS �� jI a J R p(� '1y Un.
PHONEl)d�r�d-�`aSBO EMAIL
APPLICANT NAME C n
ADDRESS Q ir-
p r"7 �-
PHONE "rJ�`�D�r�-/�O�J-� EMAIL
CONTRACTOR'S NAME cowK OWNER BUILDER? C)YES Q
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LI7C NUMBER �C�S�ILo� LICENSE CLASSIFICATION
VALUATION$ LI/ O OFT 9- L SO FT
APPLICANT'S SIGNATURE .�6
MIA
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT
MOUT OCASH OCHECK It GCREDITCARD VISA/MC
EAN
CHECK FEES PAID AMOUNT 0 CASH O CHECK It ()CREDIT CARD VISA/MC
ILDER VERI FI ED O YES O NO DL NUMBER NOTARIZED LETTER 0 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
- N � 9,
m v p
3
a� Z -n m v cl
v
Zd
N
a r D m
m
o c
o �
N � v
s a
� o a
i
A m �
a m
M
m
C) x
� 120
5 I m ZG/ C n
CD n
I _ 21 0 -R7o � n �l7Te
— — ��
CD o w o CD
�C
O /n z J
po-Nq O `<-.:
OFFICE CO