PMT16-01109 City of Menifee Permit No.: PMT16-01109
29714 HAUN RD.
'ACCELA? MENIFEE,CA 92586 Type: Residential Addition
MENIFEE Date Issued:
04/12/2016
PERMIT
Site Address: 23919 CONEJO DR, MENIFEE,CA 92587 Parcel Number: 351-074-009
Construction Cost: $3,700.00
Existing Use: 1 &2 Family Residence Proposed use:
Description of INSTALL 420 SQ FT SOLID ALUMAWOOD PATIO COVER ON MH,W/ELECTRICAL 2 FANS
Work:
Owner Contractor
MICHELLE UPCHURCH GUTTERS N COVERS CONSTRUCTION INC
23919 CONEJO DR 19069 VAN BUERN BOULEVARD#114
MENIFEE, CA 92587 RIVERSIDE,CA 92508
Applicant Phone:9516728022
REBECCA HALL License Number: 945962
GUTTERS N COVERS CONSTRUCTION INC
19069 VAN BUERN BOULEVARD#114
RIVERSIDE,CA 92508
Fee Description ON Amount f$1
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
General Plan Maintenance Fee-Electrical 1 6.05
$295.70
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
City Of Menifee
LICENSED DECLARATION ❑ lam exempt from licensure under the Contractors'Slate License Law for it
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
Professions Code an y license is in full force and effect. which I must have resided for at least one year prior to completion
License Class W Lice s o. �1N , Z improvements covered by this permit. I cannot legally sell a structure that I hai
Expires ` lzo 1(o 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 If
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application
submitted or at the following Web site:
❑ 1 hereby affirm under penalty of perjury one of the following declarations: htt g/ r.le i fo. ov/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 `Z-Z;—r(o
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
P�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 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 insurance carder and policy number are: with all applicable city and county ordinances and state laws relating to buiidir
constmctiikooiiin.I aulh rize representatives of this city or county to enter the above
So.Carder P ✓Ia 4nn ident beaaspection purposes.
Policy# 5Lvr_ IC&Iotp(o Expires -7!�3IIb Date Z— ZS-1b
Properly ro erAuthorizedAgent G
(This section need not be completed if the permit is for
one-hundred dollars($100)or less) City Business License# j)�5 5�`j,� ■
❑ 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 e
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 pec111 don the Hazardous Materials Information Guide?
Code,I shall f h ith omply with those provisions. ❑YES:rpe
Applicant; � Date; Z�' U, 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 guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND ❑YESrjANO
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed 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 ❑YESNO
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 material reporting.
OWNER BUILER DECLARATIONS 1rES ❑NO
D
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date 2—2g—I&
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY NER 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 rile 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:
❑ roe www.epa.govAead or contact the National Lead Information Center at
I, as owner of the p p rty, 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 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
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
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
s
eni[eCi
DATE 04/11/2016 PERMIT/PLAN CHECK NUMBER
TYPE: []COMMERCIAL QRESIDENTIAL []MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION [—]ALTERATION [:]DEMOLITION [—]ELECTRICAL []MECHANICAL
❑✓ NEW []PLUMBING [IRE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK ALUMINUM PATIO COVER,SOLID,ATTACHED, 420 SQ.FT.W/2 CEILING FANS
PROJECTADDRESS 23919 CONEJO DR.MENIFEE,CA 92587
ASSESSOR'S PARCEL NUMBER =fjj �MN r()0 LOT 5-7 TRACT
PROPERTY OWNER'S NAME MICHELLE UPCHURCH
ADDRESS 23919 CONEJO DR.MENIFEE,CA 92587
PHONE (951)816-7542 EMAIL
APPLICANT NAME REBECCA HALL
ADDRESS 19069 VAN BUREN BLVD#114-247, RIVERSIDE,CA 92508
PHONE (951)672-8022 EMAIL
CONTRACTOR'S NAME GUTTERS N COVERS OWNER BUILDER? [:JYES❑NO
BUSINESS NAME
ADDRESS 19069 VAN BUREN BLVD.#114-247,RIVERSIDE,CA 92508
PHONE (951)672-8022 EMAIL
CONTRACTOR'S STATE LIC NUMBER 945962 LICENSE CLASSIFICATION B
VALUATION$ $3,700.00 q FT 420 L SQ FT
APPLICANT'S SIGNATURE DATE
I
DEPARTMENT DISTRIBUTION 1.PI CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN WW SMIP
INVOICE e7® PAIDAMOUNT
AMOUNT CCASH =CHECK# ''-'CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT p CASH O CHECK# O CREDITCARD VISA/MC
OWNER BUILDER VERIFIED C YES NO OIL NUMBER NOTARIZED LETTER 0 YES 10 NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92585 951-672-6777
www.cityofinenifee.us Inspection Request line 951-246-6223
City of Menifee
„a
nep
ApR 12 2016
Received
I Z'
1�IIr - -
�IWEDGER & TRACK
I PECTION REQUIRED
0
"f 0 MENIFEE
ILD1 j AND SAFETY DEPARTMENT
LAN A' 'ROVAL
`/l:'UJF B<� 41►al1 '
DATE
of these pl s shall not be construed to be a permit for,or an c ,
of,any viola n of any provisions of the federal,state or city v
!ons and ordinan s. This set of approved plans must be kept on the
until completion. v
. O
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