PMT16-03670 City of Menifee Permit No. PMT1 6-03670
29714 HAUN RD. Type: Residential Addition
<A-CCIELX1' MENIFEE, CA 92586
MENIFEE Date Issued: 11/14/2016
P E R M I T
Site Address: 26336 ALEPPO PINE CIR, MENIFEE,CA Parcel Number: 360-671-014
92584 Construction Cost: $7,200.00
Existing Use: I &2 Family Residence Proposed Use:
Description of INSTALL 880 SO FT SOLID ALUMAWOOD PATIO COVER WELECTRICAL 4 LEDS
Work:
Omer Contractor
SAMMY NGUYEN GUTTERS N COVERS CONSTRUCTION INC
26336 ALEPPO PINE CIR 1622 ILLINOIS AVE SUITE 14
MENIFEE, CA 92584 PERRIS,CA 92571
Applicant Phone:95167280"
TIERRE AMANSEC License Number: 945962
GUTTERS N COVERS CONSTRUCTION INC
1622 ILLINOIS AVE SUITE 14
PERRIS, CA 92571
Fee Description Qty Amount
Receptacle,Switch,Outlet&Fixture 4 131.00
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 6.55
$306.20
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specrfications 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 othenvise 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�._l3ldg_PermiLTernplate.rpt Page I of I
City Of Menifee
LICENSED DECLARATION
I hereby affirm under penalty or perjury that I am licensed under provisions of 0 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 Code,�Fo my license is In full Me and effe Code:The Contractor's License Law does not apply to an owner of a propert:
License Clas� License No.. who builds or improves thereon, and who contracts for the projects with i
Expires-W Signature licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
0 1 am exempt from ficensure under the Contractors'State 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 it
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 pennit, I cannot legally sell a structure that I hav,
Policy# built as an owner-buildIng if it has not been constructed in Its entirety-by license,
contractors. I understand that a copy of the applicable law, Section 7044 of th.
0 1 have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application I
section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:httD7//www.le�info.cl,qQvjcalaw.html.
permit Is Issued.My workem'compensation Insyrance carrier and policy number are:
Carrier Property Owner orAuthorized Agent Date
-7
Expires— /�g Policy# :5wo-n I
El By my Signature below, I certify to each of the following: I am the propert
Name of Agent Phone# owner or authorized to act an the property owner's behalf. I have read IN
(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-(51 00)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
1 certify that In the performance of the work for which this permit Is issued,I identified rty for the inspection purposes.
shall not emolo any persons In any manner so as to become subject to the
workers'compensation laws of California, and agree that if I should become 7
subject to the workers'compensation provisions of Section 3700 of the Labor I at
Code,I shall forthwith comply with those provisions. Property O�vndr orAuthorized Agen
Date; Applicant; City Business 1-icense#
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 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 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 []YES 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, ---;RNO 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 EIYES INFORMATION 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 apiplQ,t to .-,QNO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE SECTION 25505 25533 AND 25534 CONCERNING
0 1. as owner of the property, or my employees With wages as their sole HAZANDOUS MATERIAL REPOktING.
compensation,will do( )all of or( )porting of the work. and the structure is PROPER7,OV/NER ORAUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply Acr 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).
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
W,W' Menlfee
DATE PERMIT/PLAN CHECK NUIMBER "(Co-- Q-Nol J5
TYPE: 0 COMMERCIAL "�RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA 0 SIGN
SUBTYPE: CADDITION OALTERATION 0DEMOUTION OELECTRICAL OMECHANICAL
XNEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES_
DESCRIPTION OF WORK
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER
LOT C TRACT
OWNER NAME '2-aro rvo N ci wi e-" c
ADDRESS F-v`I_0 ov o V�w c_y fv\-Q-V\,�Pp 64 Z564
PHONE 1.4 o 1Y,)_ EMAIL
APPLICANT NAME buAlc4s rQI C_QN,0_6
ADDRESS N�ZZ :*Ll JPCVY�S 0A C�7_��l
PHONE Cis) c/ 7 ce) cog EMAIL !�;,JVK (�Ujl UR-(G ol)
CONTRACTOR'S NAME — C� OWNERBUILDER, OYESXNO
BUSINESS NAME (�xk& vz� V\� rt,,
ADDRESS 1�zz_ 11:16k6lf-�1 Rryll's
PHONE q!51 C120-0096 - EMAIL
CONTRACTOR'S STATE LIC NUMBER CH5962- LICENSE CLASSIFICATION 2)-
VALUATION $ -�2oc) SO FT LSQ
APPLICANT'SSIGNATURE'--�,;,��/- ;�1 DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINE55 LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT W& I 1 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT I 1 0 CASH QCHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDERVERIFIED 0 YES 0 No DIL NUMBER NOTARIZED LETTER 0 YES 0 NO
C,�,, 92�;86-9,1 612-61,71
1�ji V-1
City of Manifee
Building & Safety Dept. i,
NOV 14 20o -EDGER UIRED
(,,-Tl(),N IRE-0.
Received
CITY OF MENIFEE
BUILDING AND SAFETY DEPARTMENT
PLAN APPROVAL
REVIEWED
DATE
(D QD(p-`ro8v4f��e�1p �s shail not be construed to be a permit for,or a
federal,state or city
approval of,any violati.on of any provisions of the
regulations and ordinances. This set of approved plans must be kept o the
jobsite until completion.
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