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PMT16-01250 City of Menifee Permit No.: PMT16-01250 29714 HAUN RD. �f-�CCEL/> MENIFEE,CA 92586 Type: Residential Addition MENIFEE Date Issued: 04/21/2016 PERMIT Site Address: 26826 MOUNTAIN GLEN DR, MENIFEE, Parcel Number: 360-470-017 CA 92584 Construction Cost: $2,500.00 Existing use: 1 &2 Family Residence Proposed use: Description of INSTALL 10'x 31'SOLID ALUMAWOOD PATIO COVER WITH 2 FANS Work: Owner Contractor DERRECK RICKMAN GUTTERS N COVERS CONSTRUCTION INC 26826 MOUNTAIN GLEN DRIVE 19069 VAN BUERN BOULEVARD#114 MENIFEE, CA 92584 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 gty Amount t81 Receptacle, Switch,Outlet&Fixture 2 121.00 Building Permit Issuance 1 27.00 Deck/Patio, nonstandard 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 property who builds or improves thereon,and who contracts for the projects with a licensed contractors)pursuant to the Contractors State License Law). I hereby affirm under penalty of perjurythat I am under provisions of Chapter9(commencing with section 7000)of Division 3 of the Business and O I am exempt from licensure under the Contractor's State License Law for Professions Code and my license is in full force and effect. the following reason: License Class Xa License No.A C>N By my signature below I acknowledge that,except for my personal residence Expires 1-/ZAS Signature in which I must have resided for at least one year prior to completion of improvements covered by this permit.I cannot legally sell a structure that I WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in Its entirety by ❑I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section have and will maintain a certificate of consent of self-insure for worker's 7044 of the Business and Professions Cade,is available upon request when compensation,issued by the Director of Industrial Relations as provided for this application' submitted or at the following website: by Section 3700 of the Labor Code,forthe performance of work for which www.Ia2inf6.ca1ov/calaw.htmL this permit is issued. Policy# Date L/-ll -I Iv PROPE OR AUTHORIZED AGENT d I have and will maintain worker's compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which ❑By my signature below I certify to each of the fol lowing:I am the property this permit is issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this number are: application and the information 1 have provided is correct.I agree to comply with all applicable city and county ordinances and state laws relating to Carrier lee,, 1�t building contra ion.lauthorize representatives of this city or county to Policy# •o !O`i'/pc'(, Expires 49 _' -ZS -f- enter theabovelidendfied property for inspection purposes. ilm (This section need not to be completed Is the permit is for one-hundred ! Date 4-Z1 —I(D dollars($100)or less PROP RTY OWNER OR AUTHORIZED AGENT ❑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 CITY BUSINESS LICENSE# worker's compensation laws of California,and agree that if I should become 14AZARDOUS MATERIAL DECLARATION subject to the workers co tp sation provisions of Section 3700 of the Labor Code,I shall forthvfr pty 'h those provisions. �i Will the applicant or future building occupant handle hazardous material or a Date y-Z1 'I/o mixture containing a hazardous material equal to or greater that the Applicant amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 Dyes �00 UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building AND CIVIL FINES UPTO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines CONSTRUCTION LENDING AGENCY ❑Yes %No I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the lending agency for the performance of the work which this permit is issued outer boundary of a school? (Section 3097 Civil Code) ❑Yes "WNo OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of California Health&Safety Code,Section 25505 and 25534 concerning Contractors License Law for the reason(s)indicated below by the hazardous material re o i . checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Aes ❑No Business and Professions Code).Any city or county that requires a permit to Date L/-y1-f(p construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED AGENT issuance,also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRP) License Law(Chapter 9(commencing with Section 7009)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors Business and Professions Code)or that he or she is exempt from licensure receiving compensation for most work that disturbs paint in a pre-1978 and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property than($500). managers who do the paint-disturbing work themselves or through their ❑1,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit: compensation,will do( )all of or( )portion of the work,and the structure is www.epa.eov/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-800.424-LEAD(5323). Code;The Contactors State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible for this project property who,through employees'or personal effort,builds or improves the property provided that the improvements are not intended or offered for Certified Firm Name: sale.If,however,the building or improvement is sold within one year of Firm Certification No.: completion,the Owner-Builder will have the burden of proving that it was not built or Improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because: ❑1,as owner of the property am exclusively contracting with licensed contactors to construct the project(Section 7044,Business and Professions Code:The Contactors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP Acknowledgement. 7�- BUILDING • SAFETY PERMIT/PLAN • • • - APPLICATION 0 .... :. "tof ` Men DATE 04/2112 0 1 6 PERMIT/PLAN CHECK NUMBER TYPE: []COMMERCIAL ❑✓ RESIDENTIAL []MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA []SIGN SUBTYPE: []ADDITION ❑ALTERATION []DEMOLITION []ELECTRICAL ❑MECHANICAFityofMenif e [Z]NEW []PLUMBING ❑RE-ROOF-NUMBER OF SQUARES Building & Safety Dept. DESCRIPTION OF WORK ALUMINUM PATIO COVER,310 SQ.FT.W/2 FANS APR 2 1 2 16 PROJECTADDRESS 26826 MOUNTAIN GLEN DR. � FJ� ASSESSOR'S PARCEL NUMBER ';�U 0 -LA-in-01-1 LOT 1-1 TRACT a PROPERTY OWNER'S NAME DERRECK&KERI RICKMAN ADDRESS 26826 MOUNTAIN GLEN DR.MENIFEE,CA 92584 PHONE (626)533-7910 EMAIL APPLICANT NAME REBECCA HALL ADDRESS 19069 VAN BUREN BLVD.#114-247,RIVERSIDE,CA 92508 PHONE (951)672-8022 EMAIL CONTRACTOR'S NAME SEANDARE OWNER BUILDER? ❑YESQNO BUSINESS NAME GUTTERS N COVERS CONSTRUCTION INC. ADDRESS 19069 VAN BUREN BLVD#114-247,RIVERSIDE,CA 92508 PHONE (951)672-8022 EMAIL CONTRACTOR'SSTATE LIC NUMBER 945962 LICENSE CLASSIFICATION B VALUATION$ $2,500.00 SQ FT L SQ FT � t APPLICANT'S SIGNATURE DATE LI`ZI - I Va eE�' DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS UCENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE PAID AMOUNT AMOUNT , �• =' CASH CCHECK# OCREDITCARD VISA/MC PLAN CHECK FEES PAID AMOUNT CASH O CHECK# O CREDITCARD VISA/MC OWNER BUILDER VERIFIED C YES C NO DL NUMBER NOTARIZED LETTER C' YES O NO City of Menifee Building&Safety Department 29714 Noun Rd. Menifee, CA 92586 951-672-6777 wv)w.cityofinenifee.us Inspection Request Line 951 246-6213 _ LEDGER &REQU RED CK INSPECTION 15` 0 a� W U. LL Buildi g&f Safety DeMenifee O 'PR 2 12016 CITY OF MENIFEE BUILDING AND SAFETY DEPARTMENT C PLAN APPROVAL . C REVIEWED BY VAT /.� *Approval of these plans shall not be construed to be a permit for,or an approval of,any violation of any previsions of the federal,state or city regulations and ordinances. This set of approved plans must be kept on t e tobsite unin completion. 1�crZCk+ kex' (ZkkMcw) Cgvev �b8ab V�Ac� � n ihCsler�r. 5z1 C1 310S� b+. C VA a, z.SO4 2 F-h'NS �iSl Ll�t 3�3y AA \\ Vck-v e • �29 I� 0-T 10 S CP L E