PMT16-02689 City of Menifee Permit No.: PMT16-02689
29714 HAUN RD. Type: Residential Addition
<ACCEl_R-? MENIFEE, CA 92586
MENIFEE Date Issued: 0811712016
P E R M I T
SiteAddress: 29616 ROCK CANYON RD, MENIFEE, CA Parcel Number: 340-461-009
92584 Construction Cost: $2,480.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of PERMIT AS BUILT ALUMAWOOD PATIO COVERS 12'X20'SOLID&TX 10' LATTICE
Work:
Owner Contractor
JOE TAYLOR GUTTERS N COVERS CONSTRUCTION INC
29616 ROCK CANYON RD 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 Qtv Amount
Building Permit Issuance 1 2TOO
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
$168.65
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 Ternplate.ript Page 1 of 1
City Of Menifee
LICENSED DECLARATION El I am exempt from licensure under the Contractors'State License Law forth(
I hereby affirm under penalty or perjury that I am licensed under provisions of following reason:
Chapter 9(commending with section 7000)of Division 3 of the Business and By my signature below I acknowledge that,except for my personal residence ir
Professions Code argy license i.a in full force and effe which I must have resided for at least one year prior to completlon-,o
License Clasq UCE �.9C;6)(P Z improvements covered by this permit, I cannot legally sell a structure that I hav(
�Signature_ built as an owner-building if it has not been constructed in its entirety by ficensec
contractors. I understand that a copy of the applicable law, Section 7044 of thE
WORKERS'COMPENSI ION DECILAP�TION Business and Professions Code,is available upon request when this application i�
0 1 hereby affirm under penalty of perjury one of the following declarations, submitted or at the following Web site:
I have and will maintain a certificate of consent of self-insure for workers; hffp.,//www.leginfo.m.govimlaw.htmi.
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# 0 By my Signature below, I certify to each of the follovifing: I am the propedI,
0 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 thi.,
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 compl)
permit is issued.My workers'compensation insurance carder and policy number are: with all applicable city and county ordinances and state laws relating to buildirLc
construction. aut a representatives of this city or county to enter the above
Carrie ub6 identified pRy or the i pecticin purposes.
Policy Le _Expires 7 260,2�� Date
Property OWner or Authorized Agent
(This section need not be completed if the permit is for
one-hundred dollaris(1100)or less) City Business License#
0 1 certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not enrol 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 �NO
Applicant, Will the intended use of the building by the applicant or future building
occupant require a permit for the construction or modification from South
4G: FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See penmitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guld klines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES NO
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the pr "ad 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 0
CONSTRUCTION LENDING AGENCY
I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirin 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 materill re orfing.
OWNER BUILDER DECLARATIONS 0 YES
I hereby affirm under penalty of perjury that I am exempt from the Contractor's — Endarlaot, Date
License Law for the reason(s)indicated below by the chackmark(s)I have placed PROPERTY OWIIIER 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 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 distuts paint In a pre-1 978
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 ficensure 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:
www.epa.gov/lead or contact the National Lead Information Center at
1. as owner of the property, 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 State License Law does not apply to an owner of a property 0 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).
0 1, as owner of the property an exclusively contracting with licensed 0 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
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
"Menif
Iee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL ORESIDENTIAL 0MULTI-FAMILY 0MOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION CALTERATiON ODEMOLITION OELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES—
DESCRIPTION OF WORK -Ars bu &� co�yrs
/2K;20 soL4d , -7x / o Lal-hc-&
PROJECTADDRESS 301101(p �oCr- ( CA (I(�T)JL) ous-9Y
ASSESSOR'S PARCEL NUMBER ')LOT TRACT 157
OWNER NAME joe, -Fa(,4 I cr
ADDRESS AC)I0110 k9()C��- 0 () n
PHONE ��(O - q IS- 319 5 YMAIL
APPLICANT NAME 4<r- iS:ho
ADDRESS VCAd ekt Y-�?4 A 61 VC1 -h� 1 ((4 EV CC4 92,9)K
PHONE 6)!�-j g-02 q EMAIL
CONTRACTOR'S NAME aDjjf '-5
OWNERBUILDER? OYES,<NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER C) 01 1-)— LICENSE CLASSIFICATION
VALUATION$ 1�ql3p - SO FT (D LSQFT
APPLICANT'S SIGNATURE DATE L-2h�2
CITY STAFF USE ONLY
DEPARTMENT DI-STKIBUTIUN 01 CITY OF MENIFEE BUSINESS LICENSE NUMBE
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP I I I
INVOICE w� PAIDAMOUNT OCASH OCHECK# 0 CREDIT CARD VISAINIC
AMOUNT toC I I
PLAN CHECK FEES PAIDAMOUNT I 1 0 CASH 0 CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
01
02
C,
al LEDGER & TRACK
MSPECTION REQUIRE(I
City ot Menifee
Building & Safety DE Pt.
AUG 17 2016 6,
rj�y OF PIENIFEE -d�r(!) ROCeiVOCI
BUILDIN(i AND SAFETY DEPARTMENT C—
PLAN APPROVAL
R EVI EWE D BY"-��--SJMN�
DATE
*Approva I of th la is bil.31i ;�;*�3,t onsmied to�je a permit for,or an
app-oval of,anyjiol�altion of ar v of zhe federal,state or city
regulations and rdinances, ":il's t dp;�ro�,-j ans must be kept on the
jobsite until completion.
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