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PMT17-01753 City of Menifee Permit No.: PMT17-01753 29714 HAUN RD. �l-ICCELA> MENIFEE, CA 92586 Type: Residential Addition MENIFEE Date Issued: 0 610 512 01 7 PERMIT Site Address: 26139 MCLAUGHLIN RD, MENIFEE, CA Parcel Number: 331-040-057 92585 Construction Cost: $4,390.00 Existing Use: 1 &2 Family Residence Proposed Use: Description of INSTALL ALUMAWOOD PATIO COVER,480 SO FT-WITH ELECTRICAL-2 FANS.ATTACHED TO Work: MH, HCD APPROVED Owner Contractor KELLEY PEBLEY GUTTERS N COVERS CONSTRUCTION INC 26139 MCLAUGHLIN RD 1622ILLINOIS AVE SUITE 14 MENIFEE, CA 92585 PERRIS, CA 92571 Applicant Phone: 9516728022 GUTTERS N COVERS CONSTRUCTION INC License Number:945962 1622 ILLINOIS AVE SUITE 14 PERRIS,CA 92571 Phone: 9516728022 Fee Description OQtt Amount kS) Receptacle, Switch, Outlet&Fixture 2 121.00 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 6.05 $295.70 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_Pennil_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 licens Chapter 9 (commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044,Business and Professic Professions Codeja my license is in full a and effe��J" Code:The Contractor's License Law does not apply to an owner of a prope License Clas _ License No. ,J �OO`•, who builds or Improves thereon, and who contracts for the projects wilt Expires _ 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 ❑ 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 1 h: Policy# built as an owner-building if It has not been constructed in Its entirety-by licen: contractors. I understand that a copy of the applicable law,Section 7044 of ❑ 1 have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this applicaliot section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:htto://w .looinfo.ca,goy/calaw.html. permit Is Issued,My workers'compensation Insurance carrier and policy number are: Carrier ..JY. �(1,PiZ fL �Q' 'jQJjSC,(� Property Owner or Authorized gent Date Expires -7/� �! Policy Name of Agent Phone# ❑ By my Signature below, I certify to each of the following: I am the propr owner or authorized to act on the property owner's behalf. I have read I (This section need 04S be completed if the permit Is for application and the Information I have provided Is correct. I agree to com 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 prope 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 Authorized Agent v D�.. Code,I shall fo ith comply with those provisions. p - r City Business License# Date; Applicant; .� 7,� r WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL HAZARDOUS MATERIAL DECLARATION 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 HANDLEA HAZARDOUS MATERIAL ORA DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE � � MIXTURE CONTAINING A HAZARDOUS MATERIAL LABOR CODE, INTEREST,AND ATTORNEYS FEES Gff1N0 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 DYES 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 MATERIAI Section 7000)of Division 3 of the Business and Professions Code)or that he or DYES INFORMATION GUIDE AND THE SCAQMD PERMITTIN( she is exempt from licensure and the basis for the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREMENT: violation of Section 7031.5 by any Applicant for a permit subjects the applicant to NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFET' a civil penalty of not more than ($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNIN( ❑ 1, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL DEPORTING. compensation,will do( )all of or( )porting of the work, and the structure is PROPER Y O A} R AUTHORIZED AGENT not Intended or offered for sale.(Section 7044,Business and Professions Code, The Contractor's Stale License Law does not apply 90 an owner of a property X who, through employees' or personal effort, builds or improves the property, provided that the Improvements are not intended or offered for sale.If,however, the building or Improvement is sold within one year of completion, the Owner- Builder will have the burden of proving that it was not built or improved for the Purpose of sale). 02.4110-11 am rfil. a N M 11 . W-11 101111111 so 1941 � . . `Menifee DATE PERMIT/PLAN CHECK NUMBER _1_0I'W 3 TYPE: 0 COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK SO S Zinn Aoached +a ► k" ) NC4> PROJECTADDRESS �12585 ASSESSOR'S PARCEL NUMBER 3'JI ' O4 -OrYlLOT 3 TRACT O OWNER NAME GGl ADDRESS 2ij I p. M PL f- / Z PHONE q5 ' 3j �j�09� EMAIL APPLICANT NAME QV✓� fl-Irma Vl Sec- ADDRESS �+ cQ PHONE ' C'JliU �� 1 V EMAIL CONTRACTOR'S NAME OWNER BUILDER? O YES � NO BUSINESS NAME n ADDRESS PHONE EMAIL -FOB Li CONTRACTOR'S STATE� LIC NUMBER "/�'��j C/(�_Z_ LICENSE CLASSIFICATION B VALUATION$ .50//b SO FT / L SQ FT APPLICANT'S SIGNATURE CITYSTAFF USE ONLY DEPARTMENT DISTRIBUTION I CITY OF MENIFEE BUSINESS UCEME NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN I' SMIP . �� INVOICE 2R T PAID AMOUNT AMOUNT — `�. 0CASH O CHECK# OCREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT 0CASH 0 CHECK# 0 CREDIT CARD VISA/MC OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO city o "iry of lvIerijee Oullc6ug& 5oje;y Jepclr lvlen _t 971:F lloon Hu. Nf=nlfee, eAauttdkn)9,a s7j tP4 qpt. -Nw-AlOCyu/fi7enijee.u5 JIIe 95 1.-246-621 ': �of7 JUN J I ReCe!V@d O U Y O CITY OF MENIFEE BUILDING AND SAFE DEPARTMENT PLAN APPROVAL 1��PL REVIEWED B -o •'� . ( � DATE _ *Approval of these plans shali not be construed to be a permit for,or an aaproval of,any violation of any provisions of the federal,state or city regulations and ordinances. This set of approved plans must be kept on the jobsite until completion. ke;k. PSI �E �2� 1�ltiLW�iV�utMQc �LcnJPX 2.039 80 Sol..t.cl Ztavi5 IMet� e-C1, 425�S City of Menifee Yvnn IIO�T To S(OL,6-:7 Building & Safety Dept. JUN 0 5 2017