PMT17-00521 City of Menifee Permit No.: PMT17-00521
29714 HAUN RD.
�A_CCEL/? MENIFEE,CA 92586 Type: Residential Addition
MENIFEE Date Issued:
0212312017
PERMIT
Site Address: 27455 MORTENSEN CT, MENIFEE, CA Parcel Number: 360-660-023
92584 Construction Cost: $3,055.00
Existing use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 350 SO FT SOLID ALUMAWOOD PATIO COVER,W/ELECTRICAL 1 FAN
Work:
Owner Contractor
DANIELLA RAMIREZ GUTTERS N COVERS CONSTRUCTION INC
27455 MORTENSEN CT 1622ILLINOIS AVE SUITE 14
MENIFEE, CA 92584 PERRIS, CA 92571
Applicant Phone:9516728022
TIERRA AMANSEC License Number:945962
GUTTERS N COVERS CONSTRUCTION INC
1622ILLINOIS AVE SUITE 14
PERRIS, CA 92571
Fee Description Piz Amount 151
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 staled,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_61dg_Penit 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 licenst
Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044,Business and Professioi
Professions Coded my license is in in full
Code:The Contractor's License Law does not apply to an owner of a proper
License Clas License No. r who builds or improves thereon, and who contracts for the projects with
Expires _ Signatures_ licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ I am exempt from licensure under the Contractors'Stale License Law for d
❑ 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 entirely,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 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:htto://www.leginfo.ca.gov/calaw.html.
permit is issued.My workers'compensation Insurance carrier and policy number are:
Carrier Property weer or Authonzed Agent Date
, A rs-c.1' `
Expires 7/acA Policy# 5lNC 11 i_ I_
Name of Agent Phone# ❑ By my Signature below, 1 certify to each of the following: I am the props
owner or authorized to act on the property owner's behalf. I have read 11
(This section need be completed if the permit Is for application and the Information I have provided is correct. I agree to coral
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 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 I should become _
subject to the workers'compensation provisions of Section 3700 of the Labor property Own r or Aulhodzed Agent Dat
Code,I shall forthwith comply with those provisions.
dl
Date;_ / _ Applicant; . ._ City Business License
WARNIN 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 ORA
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 ❑YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
Lender's Address NO 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, ---ANO 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 licensure and the basis for the alleged exemption. Any CHECKLIST. 1 UNDERSTAND MY REQUIREMENTS
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to ,—,P(NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE, SECTION 25505, 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL REPORTING.
compensation,will do( ) all of or( )porting of the work, and the structure is PROPERE ER On
R AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;The Contractor's State License Law does not apply to an owner of a property
who, through employees' or personal effort, builds or improves the property.
Provided that the Improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or Improved for the
Purpose of sale).
BUILDIN & SAFETY PERMIT/PLAN CHECK APPLICATION
Al o Menifee
DATE PERMIT/PLAN CHECK NUMBER f m (1— 00 ✓d4
TYPE: O COMMER IAL VRESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK AumEo u mPa o (Jar, 3so
) Fah
PROJECTADDRESS 22 5s
ASSESSOR'S PARCEL NUMBER %0 - A00 40 5 LOT ol I TRACT ✓1�y a-✓
OWNER NAME j2Z
ADDRESS 2-iq oson Mendcc 02 2S
PHONE Wq �0 -402L' EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME �,1 OWNER BUILDER? O YES ONO
IrJ I V BUSINESS NAME I' � T(1 ers
I �ADDRESS 2- note *1(-/ en( s 2 :T/
PHONE 9s i 9zg 0028 / EMAIL
CONTRACTOR'S STATE LIC NUMBER g��5 9�r� LICENSE CLASSIFICATION 1-3
VALUATION$ SOFT Q L SQ FT i
/
APPLICANT'S SIGNATURE DATE I 'T
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BWLOING PLANNING ENGitimlaa FIRE GREEN I,n SMIP '
oo
INVOICE G PAID AMOUNT
AMOUNT 1 D O CASH O CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Piieeifee�uilciing ( Sujety ucpnrtment 2971 11Dun Rd. rldeni/ee, CA 92536 951-6!2-6771
a vw,1v.cityalmem,jee.us Inspection Requesc Linz 951-246-6213
,City of enifee
6ui ding & efety Dept.
FEB 3 2017
CITY OFMENIFEE �:> Received
BUILDING AND 5 FETY DEPARTMENT �\
["LAN APPROVAL
REVIEWED BY 24I •
DAT2
v
*Approval of these plans shalt not he con>trued to he a hermit for,or an
approval of,any violation of arty provisions of the federal,star or city V
regulations and ordinances. This set of approved plans must b kept on the
3�pbsite until completion. IN r i j I
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