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PMT16-03552 City of Menifee Permit No-: PMT16-03552 29714 HAUN RD. Type: Residential Addition <A_CCEU� MENIFEE,CA 92586 MENIFEE Date Issued: 1110212016 P E R M I T Site Address: 29156 SHIPWRIGHT DR, MENIFEE, CA Parcel Number: 333-431-008 92585 Construction Cost: $4,500.00 Existing Use: 1 &2 Family Residence Proposed Use: Description of INSTALL SOLID ALUMAWOOD PATIO COVER. 15X36 2 FANS&3 LIGHTS Work: Owner Contractor JOHN DOERR PATIO GUY ALUMAWOOD CONTRACTOR 29156 SHIPWRIGHT 41197 GOLDEN GATE CIR STE 108 MENIFEE,CA 92585 MURRIETA, CA 92562 Applicant Phone: 9513330056 LOIS MONTINI Lirense Number:872839 PATIO GUY ALUMAWOOD CONTRACTOR 41197 GOLDEN GATE CIR STE 108 MURRIETA,CA 92562 Fee Description Qy Amount 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 General Plan Maintenance Fee-Electrical 1 6.80 $311AS The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and specifications orfrom preventing builiding operations being carried on thereunderwhen 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 B[dg_Perm1LTemplate.rpt Page I of 1 DATE 11 42 PERMIT/PLAN CHECK NUMBER �o - TYPE: 0- COMMERCIAL V- RESIDEN91AL QMULTI-FAMILY 9MOBILEHOME PO SPA, -519 OLI N SUIblYPL: (-)AL)L)IIIUN ()ALTERA-HUN uutmuLiTiON L) ELECiRiCAL C, MECHANICAL "EW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK -1E,�( :;L , 047-77) 0,I)VLE-S . �� L/ q /47-S� PROJECTADDRESS AL? /�542 f3 14 I)L)LC A�IqAl-l—- D/'� - ASSESSOR'S PARCEL NUMBER -�5D 006 LOT TRACT -7- OWNER NAME �- D*1\1 q ADDRESS ,19 Af42 S; 4) )/�j qg7- 'nt� . PHONE 714- 7A/-1 L-11 42 EMAIL APPLICANTINAME M,!n)A27--r A.,' ADDRESS PHONE 7 EMAIL CONTRACTOR'S NAME QOWNER BUILDER? 0 YES VWd' BUSINESS NAME T7 1) V ADDRESS L111 q 9 jA PHONE M A I L�cwm M ci� *ad 7AR -ASSIFICATION CONTRACTOR'$$TATE LICNLIM.BER dQ LICENSE CL VALUATION$ )-Z), SQ FT TL-IZ) L SO FT :5:�f - PPLICAfWS SIGNATURE 2 J DATE E.;9-7 DEPAKTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE I GJEN SMIP INVOICE AMOUNT PAID AMOUNT 0 CASH 0 CHECK# OCREDITCARD VISA/MC PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK 9 0CREDIT.CA-RO V9WIAC OWNER BUILDER VERIFIED 0YESC) NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO City Of Menifee LICENSED DECLARATION I hereby affirm under penalty or perjury that I am licensed under provisions of 13 1, as owner of the property an exclusively contracting with licensed Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044,Business and Professions Professions Code a my license is in hill"foga License Class License No. t �d ffpt� Code:The Contractor's License Law does not apply to an owner of a property Expires who builds or improves thereon, and who contracts for the projects with a _te licensed mntractor(s)pursuant to the Contractors State License Law). J(bignature_(�;)��� WORKERS'COMPENSATION DECLARATION 0 1 am exempt from ficensure under the Contractors'State License Law for the 0 1 hereby affirm under penalty of perjury one of the following declarations: following reason: I have and will maintain a certificate of consent of self-insure for workers' By my signature below I acknowledge that,except for my personal residence in compensation,issued by the Director of Industrial Relations as provided for by which I must have resided for at least one year prior to completion of Section 3700 of the Labor Code, for the performance of work for which this improvements covered by this permit. I cannot legally sell a structure that I have permit is issued. Policy# built as an owner-building if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the 0 1 have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:http�l/www.IeQinfo.m.gov/mlaw.html permit is issued.My workers'compensation insurance carder and policy number are: Carrier Property Owner or Authorized Agent Date ExipireLm Policy# Name of Agent Phone [I By my Signature below, I certify to each of the following: I am the property owner or authorized to act on the property owners behalf. I have read this (This dection need not be completed if the permit is for application and the information I have provided is correct. I agree to comply one-hundred dollars($100)or less) with all applicable city and county ordinances and state laws relating to building construction.Athorize representatives of this city or county to enter the above- 0 1 certify that in the performance of the work for which this permit is issued,I identifi y I shall not emplo any persons in any manner so as to become subject to the workers'compensation laws of California, and agree that If I should become subject to the workers'compensation provisions of tion 3700 of the Labor Property Ow4er"GrAuthorized Agent U Date Code,I she[)forthwith comply with those proi islons. Date; Applicant; _1/City Business License# 4q WARNING: FAILURE TO SECURE WORKERS' HAZARDOUS MATERIAL DECLARATION COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDING ($100,000), IN ADDITION TO THE COST OF COMPENSATION, OYES OCCUPANT 14ANDLEA HAZARDOUS MATERIAL ORA DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL LABOR CODE, INTEREST,AND ATTORNEYS FEES 8AIe--rQ­UAL TO OR GREATER THAN THE AMOUNTS CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS I hereby affirm that under the penalty of perjury there is a construction lending INFORMATION GUIDE? agency for the performance of the work which this permit is issued(Section WILL THE INTENDED USE OF THE BUILDING BY THE 3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE Lender's Name OYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION. —ER9M-THE SOUTH COAST AIR QUALITY MANAGEMENT Lender's Address Llwu- DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR OWNER BUILDER DECLARATIONS GUIDE LINES I hereby affirm under penalty of perjury that I am exempt from the Contractor's PRINT NAME: License Law for the reason(s)indicated below by the checkmark(s)I have placed OYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY next to the applicable item(s)(Section 7031.5. Business and Professions Code: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A Any city or county that requires a permit to construct, alter, improve, demolish, Q��bo 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 provisions of the Contractor's State License Law(Chapter 9(commencing with I HAVE READ THE HAZARDOUS MATERIAL Section 7000)of Division 3 of the Business and Professions Code)or that he or r-iYES INFORMATION GUIDE AND THE SCAQMD PERMITTING she is exempt from ficensure and the basis for the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREMENTS violation of Section 7031.5 by any Applicant for a permit subjects the applicant to 0 E__UNDFR-THE STATE OF CALIFORNIA HEALTH AND SAFETY a civil penalty of not more than(S500).) CODE, SECTIO 25505. 25533 AND 25534 CONCERNING 0 1. as owner of the propeft or my employees with wages as their sole RDOUS M RIAL REPOW6NG. compensation,will do( )all of or( )porting of the work, and the structure is i R RA GE 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 P7 who, through employees'or personal effort, builds or improves the property, provided that the Improvements are not intended or offered for sale.If,however. 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 purpose of sale). 4w )e V Y� V� LEDG E H "i BAG SnLib QUI M MPECTION REQ City of Menifee ept. LATI-S Building & Sa�e'y 2 20% Fia! r- IT- C-0 KS ra L Received 61 Lw "714 6 LID C5 b ' eLECrAQ le,;' ar-thr4s- 3LI q 977-IS C1 B tILDING AN.D6 . VTYgETj P ME REVIEW D BY DATE *Approval of th AAha:l not be construed to be a Permit for,or an S3 approvaiof,an violation of anv provisjons of the federal,state or city 1USU1dUU Irldinances. This set of approved plans must be kept on th jobsiteuntilco pletion, e 4)4)LA &,7. J� ! 71q- W4MC�.D e--TA r-b IUC7=?J,aa�v MTOD Soy AUMWOMD CCft6qz:hw 14 �S to )47_ r4W%-r- �i oten j� L)rejej 4 in 13-1 IS U Wark