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PMT17-00292 City of Menifee Permit No.: PMT17-00292 _ 29714 HAUN RD. 4 p; AA7. MENIFEE,CA 9258E Type: Residential Addition MENIFEE Date Issued: 01131/2017 PERMIT Site Address: 28600 LANTERN PARK LN, MENIFEE, CA Parcel Number: 372-270-019 92W Construction Cost: $5,936.00 Existing Use: 1 &2 Family Residence Proposed Use: Description of INSTALL 492 SF SOLID AND LATTICE ALUMAWOOD PATIO COVER WITH 1 FAN,2 OUTLETS Work: Owner Contractor MARK BALADY GUTTERS N COVERS CONSTRUCTION INC 28600 LANTERN PARK LANE 1622ILLINOIS AVE SUITE 14 MENIFEE, CA 92584 PERRIS, CA 92571 Applicant Phone:9516728022 TIERRE AMANSEC License Number.945962 GUTTERS N COVERS CONSTRUCTION INC 1622ILLINOIS AVE SUITE 14 PERRIS,CA 92571 Fee Description O_yt Amount($ 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 $300.95 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_Permil_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 ❑ 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 Professiol Professions CodeRa,P my license is in full a and ffec Code:The Contractor's License Law does not apply to an owner of a proper License Clas License No. �/ rpp( who builds or improves thereon, and who contracts for the projects with Expires _ Signature f licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATIO DECLARATION ❑ I am exempt from Iicensure under the Contractors'Stale License Law for 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-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 Code, for the performance of the work for which this submitted or at the following Web site:htto•llwvnv Ieoinfo.ca.00vlcalawhtml. permit is Issued.My workers'compensation insurance carrier and policy number are: Cih?iZ G �n. �.'„ n Property caner orAuthonzed gent Date Carrier , twr ExpiresT Policy# SWC J J . Name of Agent Phone# [I 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 njo 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 abot ❑ I certify that in the performance of the work for which this permit Is issued,I identified pro rt for the inspection purposes. shall not emolov any persons In any manner so as to become subject to the workers'compensation laws of California, and agree that If I should become _ _ l subject to the workers'compensation provisions of Section 3700 of the Labor Property Own r orAuthorized Agent Date Code,I shall fo ith comply with those prov ssliloons. Q Date;_ _ Appllcant; ,7 - City Business License# �� S J 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, 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 /;81NO 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 Lender's Address NO FROM THE SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMO)SEE PERMITTING CHECKLIST FOR GUIDE LINES OWNER BUILDER DECLARATIONS 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, "ENO 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 OYES 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 0 UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY a civil penalty of not more than(5500).) CODE SECTION 25506 25533 AND 25534 CONCERNING ❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL ffEPORI ING. compensation,will do( ) all of or( )porting of the work, and the structure is PROPERy O R OR AUTHORIZED AGENT not intended or offered for sale.(Section 7044,Business and Professions Cade; The Contractor's State License Law does not apply io 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 nurnnsc of mlcl BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION Menifee DATE PERMIT/PLAN CHECK NUMBER a, OL TYPE: O COMMERCIAL RESIDENTIAL 0 MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION 0 ALTERATION O DEMOLITION O ELECTRICAL 0 1GG jtCHOIIN"ifee % NEW 0 PLUMBING 0 RE-ROOF-NUMBER OF SQUARES In�g & Safety Dept. DESCRIPTION OF WORK 4, J,-t_Y qZ 1 F-8 ,Z Q-uF(e-F,) PROJECTADDRESS (�! Kt? z celve ASSESSOR'S PARCEL NUMBER a l e�-Q,Q- 01a LOT TRACT OWNER NAME fty - n ADDRESS Z Gj pprh rtL vi <c q/ PHONE �� Srj 3�'/E!� EMAIL �-r APPLICANT NAME e e ADDRESS PHONE EMAIL CONTRACTOR'S NAME {�,j / OWNER BUILDER? O YES O NO BUSINESS NAME ADDRESS /� ' Z5--I- PHONE q's I Ub 00273 EMAIL CONTRACTOR'S STAT//E��LIC NUMBER . ��{s�/�� LICENSE CLASSIFICATION VALUATION$ SOFT LSQFT 2 APPLICANT'S SIGNATURE DATE I 3� CITYSTAFF USE ONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE / /� PAIDAMOUNT AMOUNT OW• -1� C151OCASH OCHECK# 0CREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT I 1 0CASH 0CHECK# 0 CREDIT CARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES 0 NO City of Mer,ifee Suiittinq& safety C%eparrment 29.114 Noun RD. PAzni/ee, CA 92586 951-612-6771 :xvnv.cisyofineu'fee.us Inspectl0n Request Line 9.51 24G62.13 CEDGER &- 'INSPECTION REQUIRED O U W �1at U U- i City omenitee wilding q Satety Dept. V JAN 31 2017 ¢. Re e°tved CITY OF MENIFEE BUILDING AND SAFETY DEPARTMENT' PLAN APPROVAL REVIEWFE) BY ATf 'Approval of these plans shal!not be construed to be a permit for,or an txJ aoproval of,any violation of any provisions of the federal,state or city regulations and ordinances. This set of approved 31ans must be kept on the jcbsite until completion. id 140 s+ 4N= Fa,, k. 3e.la�y l4laay�nivtu.w� (��i�Covi� � l`(OT Tc75cY�'t.� p � 5�! 35Ffa J&W-e�k sGZb