PMT15-03800 City of Menifee Permit No.: PMT15-03800
29714 HAUN RD. Type: Residential Addition
<—ACCELA MENIFEE, CA 92586
W., MENIFEE Date Issued:
1211012015
PERMIT
Site Address: 28416 ELLER WAY, MENIFEE, CA 92585 Parcel Number: 329-070-045
Construction Cost: $1,650.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 150 SQ FT SOLID ALUMAWOOD PATIO W/ELECTRICAL 2 LIGHTS, SPA PLAN APPROVED
Work: FOR MH
Owner Contractor
REBECCA SALGADO GUTTERS N COVERS CONSTRUCTION INC
28416 ELLER WAY 19069 VAN BUERN BOULEVARD#114
MENIFEE, CA 92585 RIVERSIDE, CA 92508
Applicant Phone: 9516728022
MARCIA DAVIS License Number.945962
GUTTERS N COVERS CONSTRUCTION INC
19069 VAN BUERN BOULEVARD#114
RIVERSIDE, CA 92508
Fee Description Qtv Amount ISI
Receptacle, Switch, Outlet&Fixture 2 121.00
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
$289.65
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_Pernit_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ 1 am exempt from licensure under the Contractors'State License Law for the
I hereby affirm under penally 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 which I must have resided for at least one year prior to completion o
License Clas Licen "1 improvements covered by this permit, I cannot legally sell a structure that I have
Expires IP Signature 1 built as an owner-building if it has not been constructed in its entirety by licenser
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 penally of perjury one of the following declarations: http://www.leainfo.p.pov/calaw.html.
I 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 propedi
❑ 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 thh
section 3700 of the Labor Code, for the performance of the work for which this application and the information I have provided is corect. I agree to compll
permit is issued.My workers'compensation insurance carder and policy number are: with all applicable city and county ordinances and state laws relating to buildinc
,�,, ,, n constmdion.}aut prize representatives of this city or county to enter the above.
Carder 1 Ullf�1� identified kip y for the i specti purposes.
Policy# ( [C% Expires -7 Date
Property ner or Authorized Agent
(This section need not be completed if the permit is for City Business License#
one-hundred dollars($100)or less)
❑ 1 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. DYES y�NO
Applicant, 4e— q 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 forguid lines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND ❑YES 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 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 mated I re orting.
OWNER BUILDER DECLARATIONS DYES (0
I hereby affirm under penalty of perjury that I am exempt from the Contractor's A— Date -"III 11 I
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OWIlER OR AUTHORIZED AGENT
next to the applicable item(s)(Section 7031.5.Business and Professions Code: EPA RENOVATION.REPAIR AND PAINTING RRP
Any city or county that requires a permit to construct, alter, improve, demolish, ( 1
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 ern 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 ❑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 Finn 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 projects with a
.1
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
'Menifee
DATE a - PERMIT/PLAN CHECK NUMBER C5-0:/600
TYPE: O COMMERCIAL # RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK [ - h �I
Sci k4 .
nn
PROJECT ADDRESS �C I It'
ASSESSOR'S PARCEL NUMBER ;il��� 010 (JY7 LOT -� TRACT
OWNER NAME Q O nnt� pp
ADDRESS CII hI" 1'e 1 LId6O.
PHONE (-n i q) /pcol -7y' - y&q�_ EMAIL ��fn�
APPLICANT NAME �p V C 1 �Cn
ADDRESS l I1N\JA # I I q "AbUdgI ,
PHONE C� lD`Itrf`�(7�� EMAIL
CONTRACTOR'S NAME Q OWNER BUILDER? OYES ONO
BUSINESS NAME VS &n Q- -
ADDRESS1. -� Icy wn5l6e0%)dO8
PHONE a 6 1 n GG II(__0 EMAIL
CONTRACTOR'S STATE
ELLIIC�NUMBER R4 bq +7� LICENSE CLASSIFICATION
VALUATION$ ��n, )I.1 ,lJ� SQFT � ,7LJ LSQFT
APPLICANT'S SIGNATURE\� 'R. V A,r'� DATE 1 a - n
i
DEPARTMENT DISTRIBUTION ' O �� CITV OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE OG /� PAIDAMOUNT
AMOUNT o I V O CASH O CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER 0 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
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City of Menifee � ' (d
C 3udding & Safety Dept.
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BUILDING ANDS FETY DEPARTME s
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R.E\ri .'NED SY DATE
•ppnroval o`these plans shrill not be construed to be a permit for,or an
app,ovaI of,any violation of any provisions of the federal,state or city
ht of approved plans must be kept on the
reputations and ordinances. T is se
jobsite until completfon.
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