PMT15-03253 City of Menifee Permit No.: PMT15-03253
_ 29714 HAUN RD.
�hCCE! A!? MENIFEE,CA 92586 Type: Residential Addition
MENIFEE Date Issued:
10120/2015
PERMIT
Site Address: 29656 VIA NARAVILLA, MENIFEE, CA Parcel Number: 336-282-015
92586 Construction Cost: $2,656.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 14'X 23'SOLID ALUMAWOOD PATIO W11 LED LIGHT
Work:
Owner Contractor
RON MCCOMBER GUTTERS N COVERS CONSTRUCTION INC
29656 VIA NARAVILLA 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 ON Amount lSl
Receptacle, Switch, Outlet&Fixture 1 116.00
Building Permit Issuance 1 27.00
Deck/Patio, non-standard 1 133.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 1.00
General Plan Maintenance Fee-Building 1 6.65
$284.66
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 carded on thereunder when in violation of the Building Code or of any other
ordinance of City of Men'rfee.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 Bidg_Permt Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ 1 am exempt from Iicensure under the Contractors'State License Law forth
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
Professions Code an my license is in full force and eff ct. which I must have resided for at least one year prior to completion
License Cie' Licens Vo. improvements covered by this permit, I cannot legally sell a structure that I hat
Expires Signature built as an owner-building if it has not been constructed in Its entirety by license
contractors. I understand that a copy of the applicable law, Section 7044 of th
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application
submitted or at the following Web site:
❑ I hereby affirm under penalty of perjury one the fallowing declarations: http://www leoinfo.ra aov/celaw.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 proper
❑ 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 th
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 comp
permit is issued.My workers'compensation insyrance�arder and policy number are: with all applicable city and county ordinances and state laws relating to buildin
( construct] n.I authorize representatives of this city or county to enter the above
Carrier o 0-1-J identifi o erty far a insp ction purposes.
Policy#.]WCiIDD��ln Expires -23--I(O Data
hS
ProperlOwner or Authorized Agent
(This section need not be completed if the permit is for �3SS�City Business License#
one-hundred dollars($100)or less)
[If certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not enrol ov any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or:
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 f rthwith comply with those provisions..t DYES �NO
Applica� ^ I U, 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
WARNIN FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES NO
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the p osed building or modified facility be within 1000 feet of the oute
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES NNO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAQMD
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) hazardo s materat/reporting.
OWNER BUILDER DECLARATIONS DYES
`�.NO I A„� ,^
I hereby affirm under penalty of perjury that I am exempt from the Contractor's J�'/ VV
License Law for the reason(s)indicated below by the checkmadc(s)I have placed PROPERTY OWN R OR AUTHORIZED AGENT
next to the applicable hem(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 fRRP)
or repair any structure, prior to its issuance, also requires the applicant'for the
permit to fie 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-certthed firms and comply with
she is exempt from Iicensure 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 Firm Certification No.:
purpose of sale).
❑ 1, 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 Contractors 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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
,'`,1en1fee
DATE I Q- ZQ- 1 s PERMIT/PLAN CHECK NUMBER r Z S 3
TYPE: [-]COMMERCIAL []RESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN
SUBTYPE: []ADDITION []ALTERATION []DEMOLITION ❑ELECTRICAL []MECHANICAL
❑NEW ❑PLUMBING El RE-ROOF-NUMBER OF SQUARES r
DESCRIPTION OF WORK �l I LC D Ll 1A,
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L1 x 2 3
PROJECTADDRESS /Zq 5 Q, ( �LJ
ASSESSOR'S PARCEL NUMBER 33&- ZgZ, -01S LOT TRACT
PROPERTY OWNER'S NAME R Dn W L
ADDRESS 5 tp v(G I(lQ,r '� S ,n C 5 uildiing& Scity at N,afety ow
PHONE 451-o - lD 2SW - EMAIL T 2 0 2015
APPLICANT NAME JCK
ADDRESS 1c1Ulp L(n 0 ' 1 vd-11-1 10 f�(� ' Ca "/�
1
PHONE ��-��2/-f(pP�- EMAIL
CONTRACTOR'S NAME 'ILL) s OWNER BUILDER? ❑YES Z NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER qq"5CU0_ LICENSE CLASSIFICATION
VALUATION$ ZLQ6& SO FT L SO FT CC
APPLICANT'S SIGNATURE v nrhl r.i i 9.0/'1-- DATE ID' Zo
DEPARTMENT DISTRIBUTION ¢ I CITY OF MENIFEE BUSINESS LICENSE NUMBER
8 IN PLANNINGryry ENGINEERING FIRE GREEN (I SMIP D 3 SSs�t
AMOUNT Z 0 Ct 6 S PAID AMOUNT Z 5f I `S O CASH O CHECK# O CREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT OCASH 0 CHECK If OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building& Safety Department 29714 Haun Rd. Menifee, CA 92585 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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BUI1 DING AND SAFETY
PLAN APPROVAL
REVIEWED Bdjlk�
'App oval of these plans shall not be cc
appri val of,any violation of arty provfsf
regul itions and ordinances. This set of
jobsi a until completion.
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