PMT16-04036 City of Menifee Permit No. PMT16-04036
29714 HAUN RD. Type: Residential Addition
<ACCELA—> MENIFEE,CA 92586
MENIFEE Date Issued: 12/1212016
PERMIT
Site Address: 26792 LAZY CREEK RD, MENIFEE,CA Parcel Number: 338-330-002
92586 Construction Cost: $7,957.00
Existing Use: I &2 Family Residence Proposed Use:
Description of INSTALL 798 SO FT SOLID ALUMAWOOD PATIO COVER WELECTRICAL 2 FANS, 3 POST LIGHTS,
Work: 2 OUTLETS, 1 SVATCH
Owner Contractor
HERMAN HERNANDEZ GUTTERS N COVERS CONSTRUCTION INC
26792 LAZY CREEK RD 1622 ILLINOIS AVE SUITE 14
MENIFEE, CA 92586 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 Oty Amount($1
Receptacle,Switch, Outlet&Fixture 8 151�00
Building Permit Issuance 1 27.00
Deck/Patio, non-standard 1 133.00
GREENFEE 1 1.00
SMIP RESIDENTIAL 1 2.00
General Plan Maintenance Fee-Building 1 6.65
General Plan Maintenance Fee-Electrical 1 7.55
$328.20
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 buillding operations being carded 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 B1dg__Permft—TempIate.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 licensf
Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044,Business and Professioi
Professions Code,!sif my license is in full a and effec Code:The Contractor's License Law does not apply to an owner of a proper
License Clapq �-J License No.- who builds or improves thereon, and who contracts for the Projects with
Expires—q-6R — Signature licensed contractor(s)pursuant to the Contractors State Lic�nse Law).
WORKERS'COMPENSATION DECLARATION o I am exempt from licensure under the Contraclors'State License Law for 0
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 Relaltions as provided for by which I must have resided for at least one year prior to ampletion
Section 3700,of the Labor Code, for the performance of work for which this improvements covered by this permit,I cannot legally sell a structure that I he
permit is issued.
Policy# built as an owner-building if it has not been constructed in Its entirety-by licens
contractors. I understand that a copy of the applicable law,Section 7044 of I
0 1 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:http,/Awmleqinfo.m.goy/Calaw.html.
permit is issued.My workers'compensation Insyrance carder and policy number are:
Carrleraa'LPMAI� A40)6-LP Property Owner orAuthorized Agent Date
Expires Policy# 14CA. ).
0 By my Signature below, I certify to each of the following: I am the prope
Name of Agent Phone# owner or authorized to act on the property owners behalf. I have read it
(This section need ao_t be completed if the permit is for application and the Information I have provided Is correct I agree to coml
one-hundred dollars($100)or less) with all applicable city and county ordinances and state laws relating to buildi
construction.I authorize representatives of this city or county to enter the abo%
0 1 certify that In the performance ci the work for which this permit is issued,I identified p operty for tilis inspection oses.
shall not employ any persons In any manner so as to become subject to the 7
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, party 0�n r or Authorized Agent Datd
. / I City Business License
Date;___/� Applicant;, 7
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 kUNDRED THOUSAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDING
($100,000), IN ADDITION TO THE COST OF COMPENSATION, OYES OCCUPANT HANDLE A 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 E]YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address 4NO DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR
" GUIDE LINES
OWNER BUILDER DECLARATIONS
I hereby affirm under penalty of perjury that I am exempt from the Contractors PRINT NAME:
License Law for the reason(s)Indicated below by the checkmark(s)I have placed DYES WI LL 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. -;�iZNO 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 []yES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she Is exempt from Ecensure 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 applf�lnt to li�A 0 LINDER THE STATE OF CALIFORNIA H EALTH AN D 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 HAZARDOUS MATERIAL AEPOW�ING.
compensation,will do I )all of or( )porting of the work, and the structure is PROPER2XX 0 AUTHOR ED 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 am not intended or offered for sale.If,however,
the building or improvement Is sold within one year of compleflon, the Owner-
Builder will have the burden of proving that it was not built or improved for the
Purpose Of salel.
SAFETY PERMIT/PLAN CHECK APPLICATION
M e n i f e e
DATE PERMIT/PLAN CHECK NUMBER 40—()go
TYPE: 0 COMMERCIAL ")(RESIDENTIAL OMULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRICAL OMECHANICAL
)(NEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES—
DESCRIPTION OF WORK (�qq-y- �q Pu� snua
ZT7an po C Z CUIjk
4 k�i s I S Lx�,I�ic
PROJEcTADDRESS 2-6-1-9 z Q@-2�Ck-te- NIP vxj4 e-e z sa,
e�U
ASSESSOR'S PARCEL NUMBER 5�31?�11350- b* LOT TRACT ;�OD tO-
OWNER NAME 0(-yrvlL::�vl �A-ev-y-)Dndrz-
ADDRESS
PHONE 01S) G14S(�SS�) EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME (-Y7�k-�-&S P� CO\le*� OWNER BUILDER? 0 YES No
BUSINESS NAME
ADDRESS jb27, Tj(�VIC�S
PHONE 067 cqzs co�18 EMAIL L47W-VS N(nvev3o o(k+)1)6k.(Op7,
CONTRACTOR'S STATE LIC NUMBER olq,5 LICENSE CLASSIFICATION 13
VALUATION $ -go/5,* SO,FT L SO,FT
APPLICANT'S SIGNATURE "'TE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION MT77rffS=bINE55 ULLN5E NUMBER
BUILDING PiANNING ENGiNEERiNG FiRE I GREEN SMIP
INVOICE ;5gg.4
AMOUNT _!� PAID AMOUNT OCASH OCHECK# 0 CREDIT CARD VISA/MC
PLAN CHECK FEES I PAID AMOUNT 0 CASH 0 CHECK If 0 CREDIT CARD VISA/MC
OWNER BUILDERVERIFIED 0 YES 0 NO DLNUMBER NOTARIZED LE17ER 0 YES 0 NO
City oj Menifee 8 udding & 5afetv 1�epui rroeril i'-91'14 Houn Ra. Menilee, CA 92536 9 31-6 12-611
..vww.rityofi,nen,,fee.us inspection f?FquesC Line 951-246-6213
City of Menifee
Building & Safety Dept. LEDGER & IRACK
DEC 12 201b NSPECTION REOUIREU
Rece';
'I '10F MENIFEE
'!!-DING AND SAFETY DEPARTMENT
NAPPROVAL
DATE
strued to be a permit or,or an
I or'
ml ot,any vlolo.%f,ot.�,K'" 1� �11)nj Of the federal,state or city
and ordironces. Thm ska )i ar.proved plans must b keptonthe
�ndl .ornpletion. too*
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