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PMT15-02907 City of Menifee Permit No.: PMT16-02907 29714 HAUN RD. Type: Residential Addition '74C ILA-? MENIFEE, CA 92586 o'"""''"A$At , MENIFEE Date Issued: 0 911 812 01 6 PERMIT Site Address: 28046 WINDSOR DR, MENIFEE, CA Parcel Number: 337-164-001 92586 Construction Cost: $1,770.00 Existing Use: 1 &2 Family Residence Proposed Use: Description of INSTALL 190 SO FT SOLID ALUMAWOOD PATIO COVER WITH 1 FAN Work: Owner Contractor GARY EVANS GUTTERS N COVERS CONSTRUCTION INC 28046 WINDSOR DRIVE 19069 VAN BUERN BOULEVARD#114 MENIFEE, CA 92586 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 Ry Amount f$1 Ree'p ss. 3w.:ns' 'y r -s e— s�';rn, s1 ' f .':s;:sxT4,�r§^Mi�'m 16QbB Building Permit Issuance 1 27.00 YLldc fc%P.., loa � ', : � GREEN FEE 1 1.00 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 I City Of Menifee { LICENSED DECLARATION ❑ 1 am exempt from licensure under the Contractors'Slate License Law for thf following reason: 1 hereby affirm under penalty or perjury that I am licensed under provisions of 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 Ali Professions Code andphy license is in full force and effe I �t which I must have resided for at least one year prior to completion a License Clas Llcens, t� improvements covered by this permit, I cannot legally sell a structure that I havr Expires Signature ( ° built as an owner-building If It has not been constructed In Its entirety by Ilceri 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: ❑ 1 hereby affirm under penalty of perjury one of the following declarations: htto://www.leoinfo ca govlcalaw 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 Dale 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 propertt ❑ 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 lhi: 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 slate laws relating to buildiri '. C construction. aul prize representatives of this city or county to enter the above Carrier a.l� t Q�Q�] ®�{�O identified pe yfor the! specti purposes. r^ IC Date r?lrs Policy#e�L 't l Expires�Z I�� Property Ckvner or Authorized Agent (This section need not be completed if the permit is for y Cit Business License one-hundred dollars($100)or less) ❑ 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. ) ❑YES yk NO Applicant, �^e,—' I�� /T 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 guld SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND ❑YESO CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the�fines "ad 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 DYES kNO 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 motion I re orting.fg ��/y��-- OWNER BUILDER DECLARATIONS DYES 10 Date� I I ll1 I hereby affirm Linder penalty of perjury that I am exempt from the Contractor's y-�--r,-y— 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 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 Stale 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.(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 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 Acknowlednement : APPLICATION ��w . Menifee DATE PERMIT/PLAN CHECK NUMBER S — TYPE: C, COMMERCIAL RESIDENTIAL '> MULTI-FAMILY 19 MOBILE HOME 0 POOL/SPA O SIGN SUBTYPE: C:ADDITION C ALTERATION DEMOLITION 0 ELECTRICAL 0 MECHANICAL O NEW O PLUMBING b RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK �jjrj1U f ffih Dco vtrqav� PROJECT ADDRESS d y� Wind Sp r Sun CLfLA q 25&o . ASSESSOR'S PARCEL NUMBER 5?jI - `LpN- 00\ LOT TRACT OWNER NAME �j --\ v ADDRESS Zg f,>C a Z PHONE ��j-f nYiU-(�� EMAIL APPLICANT NAME '� r ADDRESS JQ- &q UQn U - Gq v PHONE v'Jj-Ip"12-RNZ' EMAIL CONTRACTOR'S NAME Lj 4krs tj c ,c-S OWNER BUILDER? t:; YES NO BUSINESS NAME ADDRESS PHONE EMAIL CONTRACTOR'S STATE LIC NUMBER 04F)gr I LICENSE CLASSIFICATION VALUATION $ SO FT 1 6Q) L SO FT APPLICANT'S SIGNATURE DATE DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICEpetA PAID AMOUNT AMOUNT . CI CASH 0CHECK# OCREDITCARD VISA/MC PLAN CHECK FEES PAID AMOUNT CCASH C%CHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED -'YES 0 NO DL NUMBER NOTARIZED LETTER C' YES C; NO City of Menifee Building&Safety Department 29714 HDun Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 0 L D rn - m « r � ro PPY G � lec-�� 1 Qo rro � Q n x ?:� m P�'t'CtS-QA(P ��Y