PMT17-00291 City of Menifee Permit No.: PMT17-00291
29714 HAUN RD.
<A_CCEL.A? MENIFEE, CA 92586 Type: Residential Addition
MENIFEE Date Issued:
01/31/2017
PERMIT
Site Address: 31183 HANOVER LN, MENIFEE,CA Parcel Number: 372-023-017
92584 Construction Cost: $6,150.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 543 SF SOLID ALUMAWOOD PATIO COVER,2 FANS,6 POST LIGHTS, 3 OUTLETS, 1
Work: SWITCH
Owner Contractor
DEBBIE RODRIGUEZ GUTTERS N COVERS CONSTRUCTION INC
31183 HANOVER LANE 1622 ILLINOIS AVE SUITE 14
MENIFEE, CA 92584 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 ,City Amount tbl
Receptacle, Switch, Outlet&Fixture 12 171.00
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 8.55
$$348.20
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 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_Pennit_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 CodeV my license is in full forpa and ffecc Code:The Contractor's License Law does not apply to an owner of a proper
License CI - License No. "V/ �paC _ 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
❑ 1 am exempt from Iicensure under the Contractors'State License Law for ll
❑ 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-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
❑ 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 Cade, for the performance of the work for which this submitted or at the following Web site:htto://www.leginfo.m.gov/calaw html.
permit Is issued.My worke(rs_compensatioon Insurance carrier and policy number are:
Carrier .Y:(i(,Pi/[;/Y,h /(JJ Property Owner or Authorized gent Date
Expires 7 -3 Policy#_Swc1) i-
Name of Agent Phone# El 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 It
(This section need p_o_t be completed if the permit is for application and the Information I have provided is correct. I agree to comi
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%
❑ 1 certify that In the performance of the work for which this permit Is issued,I identified pro 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 rty Own r or Authorized Agent Dat
Code,I shall fo ith comply with those provisions. prope
Date;_ _ Applicant; City Business License
WARNING: 0 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 AHAZARDOUS 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 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, O 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 (Chapter9 (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 Iicensure 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 O UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE SECTION 25505, 25533 AND 25534 CONCERNING
CI 1, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL REPORTING.
compensation,will do( )all of or( )porting of the work, and the structure is FIR PER O R OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code; ��
The Contractor's State License Law does not apply 4o an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the Improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or Improved for the
Purpose of sale).
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
`.`Menifee
e
DATE — PERMIT/PLAN CHECK NUMBER -
TYPE: O COMMERCIAL kRESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
NEW OPLUMBING ORE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK % (Vj Q,( a-hb VCtV
5q3 m 2fa 5 (a k; 36ufi d lsw�fc
PROJECTADDRESS3111- 3 an000e{- qa�zW Building & Safety Dept.
ASSESSOR'S PARCEL NUMBER LOT TRACE
OWNERNAME 'D- Z
ADDRESS 3 ' 73 Zn i e,, 9Z5 eceive
PHONE 95/ 2 952q EMAIL
APPLICANT NAME
'ef S r-) - --T-erve . F'P G
ADDRESS
PHONE 95) 9Z8 cogtgj EMAIL
CONTRACTOR'S NAME OWNER BUILDER? OYES O NO
BUSINESS NAME 1
ADDRESS /, C� `�
PHONE 95 19Z 8 nogR EMAIL co
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ 60/5c) SO FT 3 L SQ FT
APPLICANT'S SIGNATURE DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN I- SMIP 1
INVOICE13qS .al PAID AMOUNTII
AMOUNT O CASH O CHECK k O CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK ll O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
uty of IVlenifee Buildieg&Safety Depni tmeot 29114 HDun Na. Menifee, CA 92586 931-612-6171
www.cityofinenifee.us Inspec-ion Request Line 951-246-62.13
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pa ' zs OUJI
LEDGER & TRACK °ng of Safety eUu
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INSPECTION REQUIRED, JAN 31 20 7
Received
ago
CITY OF AENIFEE
BUI!UNG AND SAFETY DEI AR MENT
PLAN A PROVAL
iEW D BY ` DATE
r
approval of I hese plans shall not be construed to be a per it for,o
pproval of,a y violation of any provisions of the federal, to or city V
::gulations a d ordinances. This set of approved plans mu t be kept on the
jobsite untiQomp a ion.
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