PMT16-03669 City of Menifee Permit No.: PMT16-03669
29714 HAUN RD. Type: Residential Addition
<A-CCFLA> MENIFEE, CA 92586
MENIFEE Date Issued 11114/2016
P E R M I T
Site Address: 26433 VELIA CT, MENIFEE, CA 92584 Parcel Number: 360-611-016
Construction Cost $7,640.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 720 SO FT SOLID ALUMAWOOD PATIO COVER WELECTRICAL 3 FANS,4 POSTLIGHTS,2
Work: SWITCHES,2 LED'S
Owner Contractor
LINDA KRUTHCAUP GUTTERS N COVERS CONSTRUCTION INC
26435 VELIA CT 1622 ILLINOIS AVE SUITE 14
MENIFEE, CA 92584 PERRIS, CA 92571
Applicant Phone: 9516728022
TIERRE AMANSEC License Number:945962
GUTTERS N COVERS CONSTRUCTION INC
1622 ILLINOIS AVE SUITE 14
PERRIS, CA 92571
Fee Description 9-ty. Amount 1$)
Receptacle, Switch, Outlet& Fixture 11 166.00
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 8.30
$342.95
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 Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION
I hereby affirm under penalty or perjury that I am licensed under provisions of 11 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 Professlor
Professions CodeE!�my license is In full foi;pe and effis�c Code:The Contractor's License Law does not apply to an owner of a proper
License Clas —�- ) License No.. who builds or improves thereon, and who contracts for the projects with
Expirer_��7 — Signature licensed contractor(s)pursuant to the Contractors State Llciense Law),
`7—
WORKERS'COMPENSATION DECLARATION
0 1 am exempt from ficensure under the Contractots'State License Law for fl*
El I 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
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
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 ha�
Policy# built as an owner�bullding If It has not been constructed in Its entirety-by licenst
contractors. I understand that a copy of the applicable law, Section 7044 of if
I have and will maintain workers' compensation Insurance, as required by Business and Professions Code,Is available upon request when this application
section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:htto:/AAwwleqinfo.ca,oQvicalawhtml.
permit Is Issued.My workers'compensation Insurance carrier and policy number are:
Carrier-a CUA dk-,� fia'470)6a—P Property Owner or Authorized Agent Date
Expires -3/ "
/* Policy# ,75WO-1) 1 tce. ).
0 By my Signature below, I certify to each of the following; I am the proper
Name of Agent Phone# owner or authorized to act on the property owner's behalf. I have read tl�
(This section need not be completed If the permit Is for application and the Information I have provided is correct. I agree to comp
one-hundred dollars($100)or less) with all applicable city and County ordinances and state laws relating to bulldh
constructor.)authorize representatives of this City or county to enter the abov
0 1 certify that In the performance of the work for which this permit Is Issued,I Identifieploperty for tl�ie inspection purposes.
shall not employ any persons In any manner so as to become subject to the h
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. PropertyOwn orAuthorized Agent
Date� Applicant: City Business License# 652i2q
WARNING: FAII_URE 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, C]YES OCCUPANT HANDLEA HAZARDOUS MATERIAL ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES I<N 0 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 DYES 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 DYES 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, __fiZ�o 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 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 OyES INFORMA71ON GUIDE AND THE SCAQMD 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($500).) CODE SECTION 25505 25533 AND 25634 CONCERNING
11 1, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL AEPOWYING.
compensation,Will do( )all of or( )porting of the work, and the structure is PROPER;PYQ%YNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Coft
The Contractor's State License Law does not apply io an owner of a property X � F
who, through employees' or personal effort, builds'ar improves the property,
provided that the Improvements are not intended or offered for sale,If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or Improved for the
purpose of sale).
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
D=ATEJ PERMIT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL *ESIDENTIAL OMULTI-FAMILY OMOBILEHOME 0 POOL/SPA 0 SIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRICAL OMECHANICAL
ANEW OPLUMBING 0 RE-ROOF-NUMBEROF SQUARES_
DESCRIPTION OF WORK
-1 - �j r) 0
-47C)
PROJECTADDRESS CA
ASSESSOR'S PARCELNUMBER II0 LOT TRACT
OWNERNAME -utv�d� kft��caw
ADDRESS /2�(-J�p ��U(4 (/',+ I-Vt4e-"e-t- �Z�
PHONE OK I f�-b �_5L/t EMAIL u
APPLICANT NAME L-o� � LN-4-4 - Tfeew-p, Ayno-r-�se�r-
ADDRESS -T Lu-,\�Ls Aykt Al Ll Puqy�s c 4 6 1 a;
PHONE sl C-/.7 ?) cog(i)) EMAIL
CONTRACTOR'S NAME (�t�L v OWNERRUILDER? OYESXNO
BUSINESS NAME (5)uja� yz; V,� Co�-f rt)
ADDRESS k2l --lt4vk6e-, Au -A ]Ll RqrY�5 C17-427)
PHONE 451 "720 OM EMAIL
CONTRACTOR'S STATE LIC NUMBER '9LA5962- Q LICENSE CLASSIFICATION
VALUATION$ SO FT SIZO LSQFT
APPLICANT'S SIGNATURE IDATE h0
CITYSTAFF USE ONLY
I DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING P L4NNING ENGINEERING FIRE GREEN SMIP
INVOICE I-!�> 1�� PAI D AMOU NT I
AMOUNT I OCASH OCHECK# 0 CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT C)CASH 0 CHECK# 0 CREDIT CARD VISAIMC
OWNER BUILDER VERIFIED OYES 0 No DILNUMBER NOTARIZEDLETTER 0 YES 0 NO
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LEDGER & TRACK
MPECTION REQUiRED
C* of�Menifee
Buildiqg & Saiety Dept.
201F
Cry OF Received
DEPARTMENT
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