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PMT17-00290 City of Menifee Permit No.: PMT17-00290 29714 HAUN RD. <ACCEL/> MENIFEE,CA 92586 Type: Residential Addition MENIFEE Date Issued: 01131/2 01 7 PERMIT Site Address: 28239 SPRING CREEK WAY, MENIFEE, Parcel Number: 333-601-014 CA 92585 Construction Cost: $2,726.00 Existing Use: 1 &2 Family Residence Proposed Use: Description of INSTALL IV x 19 SOLID ALUMAWOOD PATIO COVER WITH 1 FAN Work: Owner Contractor DEWIGHT CROMIE GUTTERS N COVERS CONSTRUCTION INC 28239 SPRING CREEK WAY 1622 ILLINOIS AVE SUITE 14 MENIFEE,CA 92585 PERRIS,CA 92571 Applicant Phone:9516728022 TIERRE AMANSEC License Number.945962 GUTTERS N COVERS CONSTRUCTION INC 1622ILLINOIS AVE SUITE 14 PERRIS,CA 92571 Fee Description Otv Amount Receptacle, Switch, Outlet&Fixture 1 116.00 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 5.80 $290.45 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 licensr Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044,Business and Professioi Professions CodeA my Ilcense is in full a and effect Code:The Contractor's License Law does not apply to an owner of a proper License Close L License No ,J C�tDoq _ who builds or improves thereon, and who contracts for the projects with Expires .•r�t _ Signature licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATION DECLARATION ❑ I am exempt from licensure under the Contractors'State License Law for tl ❑ 1 hereby affirm under penalty of perjury one of the fallowing 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 1 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 em irely-by licens contractors. I understand that a copy of the applicable law, Section 7044 of t ❑ 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:htto://www.lealnfo.ca.gov/calaw.html. permit Is Issued.My workers'compensation Insurance carrier and policy number are: Carrier a- (i(.P1) l/(,l'Aabd) Property Owner or Authorized Agent Date r, 7 Expires O _ Policy# Name of Agent j i Phone# ❑ By my Signature below, I certify to each of the following: I am the prope owner or authorized to act on the property owner's behalf. I have read 0 (This section need Lr4S 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 build! construction.I authorize representatives of this city or county to enter the abo% ❑ I certify that In the performance of the work for which this permit is issued,I identified pro arty 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 1 should become _ subject to the workers'compensation provisions of Section 3700 of the Labor property Own ror Authorized Agent Dat Code,I shall forthwith comply with those provisions. Date; �` Applicant; .. __,. _, _ _ City Business License# WARNI G: FAILURE r, 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 / N0 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 ❑YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION Lender's Address N O FROM THE SOUTH COAST AIR QUALITY MANAGEMENT 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, '�0 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 I HAVE READ THE HAZARDOUS MATERIAL provisions of the Contractor's State License Law (Chapter 9 (commencing with 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 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 0 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 HAZAFf DOUS MATERIAL KEPOR1ING. compensation, will do( )all of or( )porting of the work, and the structure is PROPERyY OR AUTH ED AGENT not intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's State License Law does not apply 90 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). BUILDIN & SAFETY PERMIT/PLAN CHECK APPLICATION `Menifee DATE PERMIT/PLAN CHECK NUMBER n TYPE: O COMMERCIAL XRESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL NEW OPLUMBING ORE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK u E7 e( ix S' t1 PROJECTADDRESS ASSESSOR'S PARCE NUMBER 3 - Q y LOT TRACTUI City Of M t"y Dept. OWNER NAMEc..W� /" ii ADDRESS 2�Z �-J/- S j�J( Cpeek. PHONE �5l �� bod wl EMAIL Received APPLICANT NAME l i r✓t- ADDRESS PHONE EMAIL CONTRACTOR'S NAME r5lf {� y'S OWNER BUILDER? O YES BUSINESS NAME r L ,// ADDRESS 2 �1 / �f f-/ zS,7 PHONE EMAIL Corn CONTRACTOR'S STATE LIC NUMBER aj�ES�l 10� LICENSE CLASSIFICATION VALUATION $ 24—Z(I SO FT /47 8 L SQ FT APPLICANT'S SIGNATURE DATE CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS UCENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE •�� PAIDAMOUNT AMOUNT 6) � O CASH O CHECK# O CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO CiT%of Ivlenifee Rutldinq<'� Sufery rJ•e-;Ow'rmeni 29714 Ploun Ru, Menifee, CA 92586 9�1-672-677/ vmiay.cityofrnenifee.us Inspection Reque.sT Line 951-241T-62.13 Icy` I S' L LL I U s LL O a Bulld ng BfSafe y Dept. LEDGER & TRAGK iN'' EGTION REQUIRED AN 3 1 2017 RO'ceiV d -.;F 1' DwIFEE \ ' LDING AND SAFETY DEPARTMENT 01 APPROVAL FV1I:W, BY DATE pproval of these plans shall not be const ed to be a permit for,or an oroval of,any violation of any provisions f the federal,state or city / ;ulations and rdinances. This set of app oved plans must be kept on t jcosite until con ipletion. 1V\ �v Z'?,23g S �iyy�� mw( Pie. cr �725�5 �T . � >✓ :scan