PMT15-03748 City of Menifee Permit No.: PMT15-03748
29714 HAUN RD.
�A_CCELA? MENIFEE,CA 92586 Type: Residential Addition
MENIFEE Date Issued: 12/03/2015
PERMIT
Site Address: 27928 LEMONWOOD DR, MENIFEE,CA Parcel Number: 340-064-021
92584 Construction Cost: $3,304.00
Existing Use: 1 &2 Family Residence Proposed use:
Description of INSTALL 2-SOLID ALUMAWOOD PATIO COVERS 1-266 SQ FT,2-140 SQ FT W/NO ELECTRICAL
Work:
Owner Contractor
CARMEN LANDELIUS GUTTERS N COVERS CONSTRUCTION INC
2792B LEMONWOOD DR 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 Oft Amount fbl
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
$168.66
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_Pendt Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ Iam exempt from licensum under the Contractors'State License Law forth(
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 effef which I must have resided for at least one year prior to completion--o
License Cias Licen "1 �1 2- 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 entirely by license[
contractors. I understand that a copy of the applicable law,Section 7044 of the
WORKERS'COMPENSATION DECLA TION Business and Professions Code,is available upon request when this application ie
submitted or at the following Web site:
❑ 1 hereby affirm under penalty of perjury one of the following declarations: http:/Aw .leginfo.m.gov/calaw.himi.
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 following: I am the propertl
❑ 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 We
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 compy
permit Is issued.My workers'compensation insurance carder and policy number are: with all applicable city and county ordinances and slate laws relating to building
<S�� , ,�, ,, n construction.Rautprize representatives of this city or county to enter the above.
Carrier CYL,�t'.f UYIf� identified orrttlhee�i'p/slpecc�ticin purposes.
Policy# O-P-1 ExpiresTl�le �_6 rl /�Date
Property ner crAuthorized Agent
(This section need not be completed if the permit is for City Business License#
one-hundred dollars($100)or less)
HAZARDOUS MATERIAL DECLARATION
❑ I 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 amounts specified on the Hazardous Materials Information Guide?
Code,I shall forthwith comply with those provisions.
)( ❑YES f�NO
Applicant, �e `'I /7� WIII the in1t`ended 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 guid VIineSUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND ❑YESO
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Wi11thesed 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 SCAOMD
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 mated ZdAir,&A—
g.
OWNER BUILDER DECLARATIONS DYES 0
I hereby affirm under penally of perjury that 1 am exempt from the Contractor'sDate -1 I I 111
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OWI 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 IRRPI
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 era to employees with wages as their sole www.epa.govAead 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 O 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 orolects with a
SAFETY . • APPLICATION
"I' Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME C POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBIING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK - (,1,H QQum . oF- o S C
PROJECTADDRESS �� ,ripumn( ',� p(A ., (p
ASSESSOR'S PARCEL NUMBER ✓"['[) �'�D�"�� LOT O`'"l TRACT
OWNER NAME nn eA cj
ADDRESS vl w " 'saw
PHONE 5 In - '�,�(p� EMAIL
APPLICANT NAME Ky IS ((L �n]nnC
ADDRESS tF n p e III 01 "Io�J
PHONE g51'(PI�• nt ')a- EMAIL
CONTRACTOR'S NAME OWNER BUILDER? O YESV NO
BUSINESS NAME !�I
ADDRESS
PHONE /7'�� EMAIL
CONTRACTOR'S STATE LIC NUMBER �uCjvlto LICENSE CLASSIFICATION
VALUATION$ 30 ' SO FT rJ L SQ FT
APPLICANT'S SIGNATURE DATE Ia'
r
DEPARTMENT DISTRIBUTION v I00 CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT O
AMOUNT 0CASH CHECK# 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES :' NO DL NUMBER NOTARIZED LETTER 0 YES O NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us inspection Request line 951-246-6213
$' LEDGER & TRACK m
q v+vf 'P,? PcCTION REQUIRED n
� E
� OR.1�'tnl1A� • � � �
City of Menifee L
Building & Safety Pt• V'
DEC 0 3 2015
�,4.� �I�rO
CITY OF MENIFEE
BUILDING AND SAFETY DEPARTMENT
PLAN APPROVAL
REVIEWED B DATE
— t be a permit for,or an
approval of these plans shall ���//11 4
approval of,any violation of any proVi�oli o • e federal,state or city
N regulations and ordinances. This set of approved plans must be kept on the v
jobsite until completion. C
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