PMT15-02903 City of Menifee Permit No.: PMT16-02903
29714 HAUN RD. Type: Residential Addition
'9-VCCtEE MENIFEE, CA 92586
MENIFEE Date Issued: 0911812015
i
i
PERMIT
Site Address: 30169 CALLE POMPEII, MENIFEE, CA Parcel Number: 364-113-004
92584 Construction Cost: $2,738.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 286 SO FT SOLID ALUMAWOOD PATIO COVER WITH 2 FANS, 3 POST LIGHTS
Work:
Owner Contractor 's
CINDY FOYSYTH GUTTERS N COVERS CONSTRUCTION INC
30169 CALLE POMPEII 19059 VAN BUERN BOULEVARD#114 ''..
MENIFEE, CA 92584 RIVERSIDE, CA 92508
Applicant Phone: 9516728022
KRISTY HENDRICKSON License Number: 945962
GUTTERS N COVERS CONSTRUCTION INC
19069 VAN BUERN BOULEVARD#114
RIVERSIDE, CA 92508
Fee Description Qtv Amount 1$)
Building Permit Issuance 1 27.00
� 00.
GREEN FEE ,1 1.00
rNMIT2RES......T�JAVe � L',v� -u. .3...a..z .. '.,a*. e ro-03P+'?>� 2 r? n'
General Plan Maintenance Fee-Building 1 6.65
$304.66
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
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City Of Menifee
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LICENSED DECLARATION ❑ I am exempt from licensure under the Contractors'State License Law for IN
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 it '.
Professions Code an y license is in full force and effe J which I must have resided for at least one year prior to completion o
License Clas Licens Z improvements covered by this permit, I cannot legally sell a structure that I havf
built as an owner-building if it has not been constructed in its entirety b licenser Expires (�Signature 1 9 y Y ' I
contractors. I understand that a copy of the applicable law, Section 7044 of the
WORKERS'COMPENSATION DECLAR TION Business and Professions Code,is available upon request when this application k !,
submitted or at the following Web site:
❑ I hereby affirm under penalty of perjury one of the following declarations: httoa/www.leginfo ca gov/calaw html.
1 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 fallowing: I am the property {,
❑ I have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read thie
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 carrier and policy number are: with all applicable city and county ordinances and stale laws relating to buildinc
/� construction. aul prize representatives of this city or county to enter the above
Carrier' 'j m (��G(-(/ identified p y for the i spectic n purposes.
Policy# 'Lici Expires 1[Z3 I/�7 Date
I— Property Owner or Authorized Agent
(This section need not be completed if the permit is for
one-hundred dollars($100)or less) City Business License
❑ I certify that in the performance of the work for which this permit is issued,1 HAZARDOUS MATERIAL DECLARATION
shall not ample 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 amounts specified on the Hazardous Materials Information Guide?
Code,I shall forthwith comply with those provisions. DYES �NO
Applicant I i 1 I/�� Will the intended use of the building by the applicant or future building
occupant require a permit for the construction or modification from South
WARNING: FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for gold lines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND El YES NO
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($1 00,000), IN ADDITION TO THE COST OF COMPENSATION, Will the pr used building or modifed 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 EYES UINO
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 materi ll re orting.
OWNER BUILDER DECLARATIONS El YES 0
I hereby affirm under penalty of perjury that I am exempt from the Contractor's -uvrh &l Date `
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OWNER OR AUTHORIZED AGENT
IS—
next to the applicable Items) (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:
www.epa.gov/lead or contact the National Lead Information Center at
❑ I, as owner of the property, or my employees with wages as their sole 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.(Sectlon 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 El 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
1 � . . •
®' Menifee
DATE PERMIT/PLAN CHECK NUMBER 3
TYPE: 0 COMMERCIAL 0 RESIDENTIAL 0 MULTI-FAMILY MOBILE HOME POOL/SPA O SIGN
SUBTYPE: C ADDITION 0 ALTERATION 0 DEMOLITION 0 ELECTRICAL 0 MECHANICAL
O NEW O PLUMBING 0 alum
OF SQUARES
DESCRIPTION OF WORK 26(,V Sa1LGi lil,lU {^(1 P aFaos
cg"f L ' _ nn
PROJECT ADDRESS �I� CCLLLQ_ PDwPf,, iVI�
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAMES Cm -FD
ADDRESS 3n ((Oci LLI, i tt ZS
PHONE ,rj���— y-IO3 EMAIL
APPLICANT NAME A endv V11 //''��
ADDRESS //]]1C) togCc h'7 uX VCR # 1�y EV "I
PHONE v1 J j—bj2—A()Z_.7.I�'�,,I EMAIL
CONTRACTOR'S NAME I,(.-kffS OWNER BUILDER? OYES VNO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LICC NUMBER 9(4 r5gt LICENSE CLASSIFICATION
VALUATION $ 2-730 SO.FT 7 „ LSQFT
4 � 7�}. —7 /
APPLICANT'S SIGNATURE TE —4 / /J
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT S ls ,'CASH OCHECK# CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT <; CASH ''CHECK# "CREDITCARD VISA/MC
OWNER BUILDER VERIFIED Ci YES i.i NO DL NUMBER NOTARIZED LETTER YES 0 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
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