PMT17-00090 City of Menifee Permit No.: PMT17-00090
29714 HAUN RD. Type: Residential Addition
<ACCELA? MENIFEE, CA 92586
rv,.,..,sbMxo-..• MENIFEE Date Issued: 01/1 71201 7
PERMIT
Site Address: 26457 ADELINA DR, MENIFEE,CA 92584 Parcel Number: 360-612-007
Construction Cost: $2,725.00
Existing use: 1 &2 Family Residence Proposed use:
Description of INSTALL 15'x 15'SOLID ALUMAWOOD PATIO COVER WITH 1 FAN, 1 SWITCH
Work:
Owner Contractor
ORIN&PATRICIA KNOWLTON GUTTERS N COVERS CONSTRUCTION INC
26457 ADELINA DRIVE 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 Ply. Amount(SI
Receptacle, Switch, Outlet&Fixture 2 121.00
Building Permit Issuance 1 27.00
DecWPatio,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 6.05
$296.70
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 ❑ I, 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 Professioi
Professions Cocle.!5li my license Is in full(oSpe G�ffe� — Code:The Contractor's License Law does not apply to an owner of a proper
License Clas License No. �/ Y�pC r who builds or improves thereon, and who contracts for the projects with
Expires- _ Signature licensed contractor(s)pursuant to the Contractors State License Law).
—�_
WORKERS'COMPENSATION DECLARATION
❑ lam exempt from licensure under the Contractors'State License Law for It
❑ 1 hereby affirm under penalty of perjury one of the following declarations: fallowing 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 Cade, 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-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 t
❑ I have and will maintain workers' compensation insurance, as required by Business and Professions Cade,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:hfti)*,//www.leginfo.ca.cloy/calaw.htmI.
permit Is issued.My workers'compensation Insurance carder and policy number are:
Carrier (i(,Pi�L l l a ACf'� roperty caner orAut ooze Agent Date
Expires 7 / Policy#
Name of Agent Phone# ❑ By my Signature below, I certify to each of the fallowing: I am the prope
owner or authorized to act on the property owner's behalf. I have read it
(This section need not 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%
❑ 1 certify that In the performance of the work for which this permit is issued,I identified property for the 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 property Own r orAuthorized Agent Da
Code,I shall forthwith comply with those provisions.r City Business License# 6,35_!�S /
p
Date; _ Applicant;
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 HANDLE A HAZARDOUS MATERIAL OR
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES /<NO 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 NO DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR
OWNER BUILDER DECLARATIONS
GUIDE LINES
I hereby affirm under penally 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 OYES 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 OYES 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 applicant to NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE SECTION 25505 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL I EPORIING.
compensation, will do( )all of or( )porting of the work, and the structure is PROPERT-YrOV/NER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code; /
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property, �—
provided that the Improvements are not intended of offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the '
purpose of sale). '
BUILDING & SAFETY PERMIT/PLAN CH ECK Ar . •
F Menifee
DATE 1 PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL YRESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDIT ON O ALTERATION O DEMOLITION C ELECTRICAL O MECHANICAL
O NEW O PLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Z
Lo i i^ l a- Building & Safety Dep .
PROJECTADDRESS �� Y ' u JAN 17. 2017
ASSESSOR'S PARCEL NUMBER 2&0-L0%Q- LOT TRACT
Received-
OWNERNAME / V)
- 6 ADDRESS S4 <Yla y�,C 2C ZS
PHONE 6 I 1Y5 &SSZ EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME 1.12 OWNER BUILDER? 0 YES 0 NO
BUSINESS NAME 7 1 ,
ADDRESS 16j LZ 1 \tL Y`C(� 4ry�) (]—( 2S
PHONE C 1S ) 9Z'P) I)09LO) EMAIL 3 gty,5 • C6
CONTRACTOR'S STATE LIC NUMBER %y4,'6 Z LICENSE CLASSIFICATION
VALUATION$ Z72-5 SO FT zz_5 L SQ FT
APPLICANT'S SIGNATURE DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN 1 i SMIP
INVOICE pglD AMOUNT
AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES C NO DL NUMBER NOTARIZED LETTER O YES C NO
City of Ivlenifee building& Safety Deportment_97?<1 HDun rid. IVlnnifee, Cif 92586 93l 612-6/11
;vw,jv.rityafrrlen'eeAI5IRSpeCtljn Request Line 951-246-6213
LEDGER & TRACK
INSPECTION REQUIRED �.
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City of Menifee
Building & Safety D pt.
JAN 17 2017
Receive
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CITY OF MENIFEE
BUILDING AND SAFE DEPP RTMENT
PLAN APPROVAL
REVIEWED 13y -A11 1
DATE
`Approval of these plans shall not be construed to b a permit for,or an
vvv approval of,any violation of any provisions of the fe lefal,state or city
regulations and ordinances. This set of approved pl ns must be kept on the
jobsite until completion.
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