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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