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
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` 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
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INSPECTION
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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.
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