PMT16-03688 City of Menifee Permit No.: PMT16-03688
29714 HAUN RD. Type: Residential Addition
<'-%C�- L:A-> MENIFEE,CA 92586
MENIFEE Date Issued 11115/2016
P E R M I T
Site Address: 30817 OAK KNOLL DR,MENIFEE, CA Parcel Number: 364-340-012
92584 Construction Cost: $4,123.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL SOLID ALUMAWOOD PATIO COVER WITH 2 FANS, 1 OUTLET
Work:
Owner Contractor
PETER LARSEN GUTTERS IN COVERS CONSTRUCTION INC
30817 OAK KNOLL DRIVE 1622 ILLINOIS AVE SUITE 14
MENIFEE, CA 92584 PERRIS, CA 92571
Applicant Phone:9516728022
GUTTERS N COVERS CONSTRUCTION INC License Number; 945962
1622 ILLINOIS AVE SUITE 14
PERRIS,CA 92571
Fee Description Qtv Amount(S)
Receptacle, Switch, Outlet&Fixture 3 126.00
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 6.30
$300.96
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 an 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.rpt Page 1 of 1
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 Professior
Professions Coda,!�fi my license Is in full a and effec Code:The Contractor's License Low does not apply to an owner of a propen
License Clas§ License No.
who builds or improves thereon, and who contracts for the projects with
Expires_!Vj� Signature licensed contractor(s)pursuant to the Contractors State LIcimse Law),
WORKER&COMPENSATION DECLARATION
Q I am exempt from licensure under the Contractors'State License Law for tt
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
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 he%
Policy# built as an owner-bulding If it has not been constructed in Its antbety-by licenst
contractors. I understand that a copy of the applicable law, Section 7044 of 0
13 1 have and will maintain workers' compensation Insurance, as required by Business and Professions Code,is avallable-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:httplllwww.feolnfo.ca,goy/calawhtmi.
permit is Issued.My workers'compensation Insurance carrier and policy number are:
C 19 Property Owner orAuthodzed Agent Date
arrier , finAO)L42,-P
Expires 7 3 Pollcy#,5wo-/) I
0 By my Signature below, I certify to each of the following: I am the proper
Name of Agent Phone# owner or authodzed to act on the property owner's behalf, I have read fl-
(This section need D-01 be completed if the permit Is for application and the Information I have provided Is correct. I agree to comF
one-hundred dollars($100)or less) with all applicable city and county ordinances and state laws relating to bulldh
construction.I 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 identified property for t4e 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 prolslons. Property 0�vnllr orAuthorized Agent Datj
Date; Applicant; City Business License
WARNING: FAILURE TO SECURE WORKERS' HAZARDOUS MATERIAL D�CLARATION
COMPENSATION COVERAGE 18 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 HANDLEA HAZARDOUS MATERIAL ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES <- 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(SCAOMD) 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, impmve, demolish, ---,aNO 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 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 applQnt to 0 UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE SECTION 25505 25633 AND 25534 CONCERNING
C3 1, as owner of the property, or my employees with wages as their sole ROADOUS MATERIAL ftEPOWING.
compensation,will do( )all of or( )porting of the work, and the stiticture is PROPER;PYPV/NER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractors State License Law does not apply 4o an owner of a property X 1 1-0
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
ournoqA nf..I.)
Is all I I NJ I 102601-1112 a wm 9 IN kvilk1gumn
Menifee
DATE it if5l it PERMIT/PLAN CHECK NUMBER ams - noal 5ffi
TYPE: OCOMMERCIAL "�RESIDENTIAL OMULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION CALTERATION ODEMOLITION CELECTRICAL OMECHANICAL
ANEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES_ (I
DESCRIPTION OF WORK 0\k-VVN '-DhAl n �I�A cr ElulldA T=yccl opt.
145 6 g So�-Z Cl ?, Ff6q\� ou--Kc� NOV 15 2011�
ECTADDRESS ZtSl-1 Crik Kvioll OQ59-LA ;�ocoiveqfl
ASSESSOR'S PARCEL NUMBER $04�l3k4n-nlo;;L LOT TRACT
OWNERNAME 4j0P)P/J;j/Z
kj
ADDRESS VIV-4,6
PHONE %(4-51�-5L/ IWIs EMAIL
APPLICANT NAME
ADDRESS h�zz wvNAvskam-lLl Pwk*'s (K q zz;4-I
PHONE Cis) ca '6 cocy EMAIL K N'( V
0
CONTRACTOFVS NAME v OWNERBUILDER? OYES��NO
BUSINESS NAME rt,
ADDRESS 1�2Z -lWVk6e--.' Au -3� N R"ry'�<> clzt;'4)
PHONE 45) (220 0026 EMAIL C W �"(okv!&Ocm4look-(OVA
CONTRACTOR'S STATE LIC NUMBER9q59k2- LICENSE CLASSIFICATION
VALUATION$ q I -n SO FT LSQFT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION USINE55 LICEME NUMULIA
SUADING iLANNING ENGINEERING FmE I GREEN SMIP 777
INVOICE PAIDAMOUNT
AMOUNT 1,2 OCASH OCHECK# 0 CREDIT CARD VISAIMC
.S P
PLAN CHECK FEES PAIDAMOUNT 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DL NUMBER NOTARIZED LETTER 0 YES () NO
Cicy Of Iviellife"? fjujidinq _vI 14 1 foull 3a. CA 92,;86-9�1 61�-6/171
Off-'-W!?;freP.W; �10 P; R-"'ves f;ifie 951 246-62.1.3
2�\
0
ILL
C-)
C" of MenitGE
a Alldingy& Safety E opt,
NOVI 15 2011
R(@C' elvel
LEDGER, & TRACK
MPECTION REQUIRF
CITY OF MENIFEE
BUILDING AND SAFE��ARTME� T
PLAN APPROVAL
if . I
REVIEWEE) i k,/S8l!9= I VE-
'Approval of these plans shall not be construed to be a permit for,or an
approval of,any violation of any provisions of the federal,state or city
regulations and ordinances. This set of approved plans must be kept on the
jobsite until completion.
jq
t--156 9
e-- C)q- q ZS�5q 'Z �FM t�
ICNIS 1\�D T T6 S(P LC