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
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-Nw-AlOCyu/fi7enijee.u5 JIIe 95 1.-246-621 ': �of7
JUN J I
ReCe!V@d
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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