PMT16-03607 City of Menifee Permit No.: PMT16-03607
29714 HAUN RD.
<A-CCEL�� MENIFEE,CA 92586 Type: Residential Addition
MENIFEE Date Issued: 11/0312016
P E R M I T
Site Address: 32745 LANITARRA LOOP, MENIFEE, CA Parcel Number: 372-340-002
92584 Construction Cost; $5,900.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL-SOLID PATIO COVER 717 SOFT-2 FANS&2 OUTLETS
Work:
Owner Contractor
SCOTTJENSEN GUTTERS N COVERS CONSTRUCTION INC
32745 LAMTARRA LOOP 1622 ILLINOIS AVE SUITE 14
MENIFEE,CA 92584 PERRIS, CA 92571
Applicant Phone: 9516728022
CLYDE DARE License Number:945962
GUTTERS N COVERS CONSTRUCTION INC
1622 ILLINOIS AVE SUITE 14
PERRIS,CA 92571
Fee Description QtV Amount($
Receptacle, Switch, Outlet&Fixture 4 131.00
Building Permit Issuance 1 27.00
DecWPatio, 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 6.55
$306.20
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications or from preventing builiding operations being camed on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise stated,a pe"It for construction under which no work is commenced within six
months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA Bldg_Permit Templatesipt Page 1 of I
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Menifee
DATE PERMIT/PLAN CHECK NUMBER "-�rvyl Ili b-S(oul-
TYPE; C-'COMMERCIAL \��RESIDENTIAL 0 MULTI-F MILY C. MOBILE HOME C) POOL/SPA OSIGN
SUBTYPE: 0 ADDITION 0 ALTERATION 0 DEMOLITION 0 ELECTRICAL ` MECHANICAL
PLUMBING RE-:RiO:OF-NUMBER OF SQUARES
DESCRIPTION OF WORK
'41
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER 377*1 -
OWNER NAME 3,J 0 OU;k_ LOT TRACT 2.lyq
ADDRESS
PHONE t5iL
6C7 1 -7t)
EMAIL
APPLICANT NAME
ADDRESS
PHONE
EMAIL
CONTRAcrOR'S NAME OWNERBUILDER? OYE
BUSINESS NAME
ADDRESS
PHONE c� 7S-,q I
EMAIL
CONTRACTOR'S STATE LiC NUMBER C�L�4S C
7( -2
VALUATION$ 'o — LICENSE CLASSIFICATION ? . Cle
. 5� SQ FT
APPLICANT'S SIGNAT LSQFT
URE
#I DATE
DEPARTMENT DISTRIBUTION
BUILDING PLANNING FIRE JEEN LITY OF MtNIFEE BUSINESS LICENSE NUMBER
INVOICE SMIP
AMOU14T . 2-0 PAID AMOUNT O'CASH 0CHECK#
PLAN CHECK FEES PAIDAMOUNT ICREDITCARD VISA/MC
OWNER 3UiLDER VERIFIED 0YES 0 NO DL NUMBER 0 CASH CHECK# OCREDITCARD VISA/MC
b
9,3
City Of Menifee
LICENSED DECLARATION
I hereby affirm under penalty or perjury that I am licensed under provisions of El 1, as owner of the property an exclusively contracting with license(
Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044,Business and Profession:
Professions Gode,Rpd my license is In full a and effec Code:The Contractor's License Law does not apply to an owner of a propert:
License Cl J--) License No
who builds or improves thereon, and who contracts for the projects with
Expires-�Rl — Signature licensed contractor(s)pursuant to the Contractors State License Law),
WORKERS'COMPENSATION DECLARATION
[I I am exempt from ficensure under the Contractors'Skate License Law for th.
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 li
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 c
Section 3700.of the Labor Code. for the performance of work for which this
permit Is issued, improvements covered by this permit, I cannot legally sell a structure that I hay.
Policy# built as an owner-building If It has not been constructed I n its entiretyby license
contractors. I understand that a copy of the applicable law, Section 7044 of th�
11 1 have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application 1
section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:http,//www.leginfo.ca,goy/ealawhtml.
permit is Issued.My workers'compensation Insurance carder and policy number are:
Carrier Se /1)t— . 6�UU0 Property Owner or Authorized Agent Date
Expires -7 Policy# 3wo-0
'A3'//-1-
Name of Agent Phone 9 0 By my Signature below, I certify to each of the following: I am the propert
owner or authorized to act on the property owner's behalf, I have read thl
(This section need not be completed if the permit is for application and the Information I have provided is correct. I agree to compi
one-hundred dollars($100)or less) with all applicable city and county ordinances and state laws relating to buildin
construction.I authorize representatives of this city or county to enter the above
D I certify that In the performance of the work for which this permit is issued,I identified property for Ilia inspection purposes.
shall not employ 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 Section 3700 of the Labor
Code,I shall forthwith comply With those provisions. Property O�nllr orAuthorized Agent Date,
Date; Applicant; City Business License#
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, []YES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST, AND ATTORNEYS FEES KNO EQUAL 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
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address 4NO 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, —�9-NO SCHOOL?
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 Contractors 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 CIYES INFORMATION GUIDE AND THE SCAOMD PERMITTING
she is exempt from licensure 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 UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY�
a civil penalty of not more than($500).) CODE SECTION 25505 25533,AND 26534 CONCERNING
0 1, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL iAEPOR1 ING.
compensation, will do ( )all of or( )porting of the work, and the structure is PROPER/TYP�YNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply Ao an owner of a property X
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).
city Of menitec
Building & Safety DePt,
NOV b 3 201b
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CITY OF MENIFEE
BUILDING AND SAFETY DEPARTMENT
PLAN PPROVAL
IQIEWED BY kV—
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*Approval of these plans shall not be construed to be a penwit for, an
approval of,any violation of any provisions of the W",sm or
regulation'!and ordinances. is set o approve p ans muisTbe p on the
jobsite Unt I completion.
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