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PMT15-02905 I City of Menifee Permit No.: PMT15-02905 29714 HAUN RD. Type: Residential Addition '9i 6 A—> MENIFEE, CA 92586 MENIFEE Date Issued: 09/18/2015 PERMIT Site Address: 28864 BROOKHILL CT, MENIFEE, CA Parcel Number: 333-680-017 92584 Construction Cost: $5,075.00 Existing use: 1 &2 Family Residence Proposed use: Description of INSTALL 470 SO FT SOLID ALUMAWOOD PATIO COVER WITH 2 FAN, 1 SWITCH Work: Owner Contractor TOM GHANNY GUTTERS N COVERS CONSTRUCTION INC 28864 BROOKHILL COURT 19069 VAN BUERN BOULEVARD#114 MENIFEE, CA 92584 RIVERSIDE, CA 92508 Applicant Phone: 9516728022 KRISTY HENDRICKSON License Number: 945962 GUTTERS N COVERS CONSTRUCTION INC 19069 VAN BUERN BOULEVARD#114 - RIVERSIDE, CA 92508 Fee Description QtY Amount l$) Building Permit Issuance 1 27.00 dLLY3x=..,sd,�rfi..siF 6+W.aiv 1:.hS{4 m.A...s..t.u"Z..o-. {�}Lwi3i:s xxaS"c'F Jv3u k. � YSdM1-�ra�a'n GREEN FEE 1 1.00 �MIR�RE9D�NTiAL� r`'�"� ��,tnss •a �y�°�Ye�h�i Yr 17"""€7"'�" �r"a a �+T'ym General Plan Maintenance Fee .Building 1 6.65 $294.65 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 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 0 1 am exempt from icensure under the Contractors'State License Law for th( 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 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 N l Improvements covered by this permit, I cannot legally sell a structure that I havt " Signature if it has not been constructed in its entirety by license( Expires 1 built as an owner-building contractors. I understand that a copy of the applicable law, Section 7044 of the WORKERS'COMPENSATION DECLAR TIC N Business and Professions Code,is available upon request when this application i; submitted or at the following Web site: ❑ 1 hereby affirm under penalty perjury one the following declarations: http�//www leainfo ca aov/calaw html. I have and will maintain a certificate of consentt 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 compl) 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.k out orize representatives of this city or county to enter the above Carriers�luAJI 61uii9 identified pe yfor the specticin purposes. /) Policy#S "U. I 1 Expires rII Z3 J/W Date Property 04Nner or Authorized Agent (This section need not be completed if the permit is for one-hundred dollars($100)or less) City Business License#_ lJ JJ ❑ I certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION 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 amounts specified on the Hazardous Materials Information Guide? Code, I shall forthwith comply with those provisions. f 1 ( DYES �NO Applicant, �'e�-- I i I�7 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 guideilines SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND ❑YES V NO CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the pr osed 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 VNO 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 I reporting. OWNER BUILDER DECLARATIONS ❑YES fA(0 /� �, "IST I hereby affirm under penalty of perjury that I am exempt from the Contractor's 11�� Date License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OW ER OR AUTHORIZED AGENT 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: ❑ I, as owner of the property, or my employees with wages as their sole www,epa.gov/lead or contact the National Lead Information Center at 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, the building or improvement is sold within one year of completion, the Owner- Certified Firm Name: Builder will have the burden of proving that it was not built or improved for the purpose of sale). Firm Certification No.: ❑ 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 o i...,.,,a..a...,.,.,..., BUILDING & SAFETY PERMIT/PLAN CHECK A• • • f Menifee DATE -1 1-7 J PERMIT/PLAN CHECK NUMBER TYPE: Q COMMERCIAL O RESIDENTIAL ((% MULTI-FAMILY ". MOBILE HOME C) POOL/SPA % SIGN SUBTYPE: 0 ADDITION 0 ALTERATION CD DEMOLITION 0 ELECTRICAL 0 MECHANICAL O N/EIW " PL,UU/MBING�r1G RE-ROOT --N�UMBEEAR,OF SQUARES /`,�, n DESCRIPTION OF WORK "I�0 J i IS�.�.l U.kId Ol cnt 9 Eaj)S 18wlAh '/ p I PROJECT ADDRESS 2 8e Q Kh I I I CT n CIZS `Y ASSESSOR'S PARCEL NUMBER 5SS• („ 50• Q%'1 LOT TRACT I OWNER NAME p�y) a nn ADDRESS IS46UHt(( 11 .ems q 2 PHONE - Z19(a EMAIL APPLICANT NAME I'CS+L� pbaLld(so}) ADDRESS HoW vw i3u-Y 1vd -41(L- /�Zr \U CA `- PHONE aSH010-802-2- EMAIL CONTRACTOR'S NAME (j Coi aS OWNER BUILDER? O YES/5-NO BUSINESS NAME ADDRESS PHONE Cam; EMAIL CONTRACTOR'S STATE LIC NUMBER gc4s llpZ LICENSE CLASSIFICATION VALUATION$ 5D-15 SQFT 4-70 LSQFT APPLICANT'S SIGNATURE DATE I DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE Q PAID AMOUNT 1 w ry AMOUNT -\ • � •LOS CASH C%CHECK# OCREDITCARD VISA/MC PLAN CHECK FEES PAID AMOUNT 0CASH 0 CHECK# CCREDITCARD VISA/MC OWNER BUILDERVERIFIED "YES O NO DL NUMBER NOTARIZED LETTER O YES O 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 ;Z Q \ / � 7 �.� \ � 2 : / ƒ q \ / K_ 2 � � � � rn C) :10 . m � � m |� Os"V010� | . .