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PMT15-03917 City of Menifee Permit No.: PMT15-03917 _ 29714 HAUN RD. Type: Residential Addition 4!>CCELA > MENIFEE,CA 92586 MENIFEE Date Issued: 12/13/2015 PERMIT Site Address: 29241 GOOSENECK TR, MENIFEE, CA Parcel Number: 364-240-072 92584 Construction Cost: $6,047.00 Existing use: 1 &2 Family Residence Proposed use: Description of INSTALL 435 SO FT SOLID ALUMAWOOD PATIO COVER W/ELECTRICAL 5 POSTLIGHTS Work: Owner Contractor DEAN CARLSON GUTTERS N COVERS CONSTRUCTION INC 29241 GOOSENECK TR 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 QY Amount 151 Receptacle,Switch, Outlet&Fixture 5 136.00 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 $304.65 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_Templale.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 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 Clas Licen "I �-1 ; 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 entirety 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: htto:Nvnvw.leginfo.m.gov/calamhtmi. 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 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 thie 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 buildinc �,, ,, n constmclon. au l orize representatives of this city or county to enter the above. Carrie Cr,, UPIW� identified p y for the �i('�/s�pedi[y/nJ purposes. Policy#NM I Expires _710 L -/��Date Property er or Authorized Agent (This section need not be completed if the permit is for one-hundred dollars($100)or less) City Business License# J HAZARDOUS MATERIAL DECLARATION ❑ 1 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. �7 ( DYES y�NO Applicant, fie^,—� I ��7� Will the i Int`enHad 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 1(nes 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 PINO 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) hazardous materi I re orting. OWNER BUILDER DECLARATIONS DYES P A41 !� I hereby affirm under penalty of perjury that I am exempt from the Contractor's W J/ Date I I 1 111 License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OWNER OR AUTHORIZED AGENT next to the applicable item(s)(Section 7031.5. Business and Professions Code: EPA RENOVATION.REPAIR AND PAINTING fRRPI Any city or county that requires a permit to construct,alter, improve, demolish, 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 w'w'w.epa.gov/lead 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 Contractors Stale 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). ❑ 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 APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK `Menifee DATE I I�j ' PERMIT/PLAN CHECK NUMBER '! TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY C MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW IIOPLUMBIIN�1G O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK l,Ld <✓ LLI m VC IS �5 po,41 I ks PROJECTADDRESS O(�lol`1 5mecK -Trodin ni LI L I• ASSESSOR'S PARCEL NUMBER ,,/!QN' C TI r LOT K0 TRACT OWNER NAME aan .cur��/J(7{1 'n (� p� ADDRESS � C S n1 cI`- 1 I L ' 1 ( "1 2S Z>`'1� PHONE Q51_gN-,f�3(tf5• l EMAIL ,n APPLICANT NlA�-M�EQ� 1 S ADDRESS lqDo Va , L(Y-'GI n (!V yy 1 `1 1 V C SVS PHONE q 2)- EMAIL '� CONTRACTOR'S NAME \j .S ��pp/WVlrl OWNER BUILDER? O YES O NO BUSINESS NAME ADDRESS PHONE //�' EMAIL "I CONTRACTOR'S STATE LIC NUMBER Lj'13-4 ;)- LICENSE CLASSIFICATION VALUATION$ SQ FT `1 35 L SO FT APPLICANT'S SIGNATURE DATE "/J CITYSTAFFUSEONLY DEPARTMENT DISTRIBUTION FIRE CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN 1 SMIP INVOICE ,N` PAIDAMOUNT AMOUNT \ OCASH OCHECK# OCREDITCARD VISAIMC PLAN CHECK FEES PAIDAMOUNT OCASH OCHECKR OCREDITCARD VISA/MC OWNER BUILDER VERIFIED O 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 Jr r CP 3 City of Menifee W (� O (t i `� Building & Safety Dept. G y O CA s o c G: DEC 18 2015 CA Received s. j IN LEDGER & TRACK: INS 4 Cl Y OF MENIFEE B ILDING AND SAFETY DEPARTMENT PI AN APPROVAL I R 'VIEWED BY Ig I DA I Fp . chj not he construed to be a permit for,or an approval of,any violation of any provisions'afie federal,state or city I regulations and ordinances, This set of approved plans must be kept on the jobsite until completion. I i I � I