PMT17-01927 City of Menifee Permit No.: PMT17-01927
29714 HAUN RD. T Residential Addition
�AE:CCLA— MENIFEE,CA 92586 yam'
MENIFEE Date Issued: 0611612017
PERMIT
Site Address: 31099 DOMINIC CIR, MENIFEE, CA Parcel Number: 360-551-002
92584 Construction Cost: $5,230.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of INSTALL 460SFT ALUMINUM PATIO COVER SOLID+ LATTICE PATIO TOTAL 460 SQFT SOLID
Work: 240SOFT LATTICE 220SQFT 1 FAN 1 OUTLET
Owner Contractor
JENNIFER&JEFF WHITE GUTTERS N COVERS CONSTRUCTION INC
31099 DOMINIC CIR 1622 ILLINOIS AVE SUITE 14
MENIFEE, CA 92584 PERRIS, CA 92571
Applicant Phone:9516728022
TIERRRA AMANSEC License Number: 945962
GUTTERS N COVERS CONSTRUCTION INC
1622 ILLINOIS AVE SUITE 14
PERRIS, CA 92571
Fee Description Qtv Amount ISI
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 carded 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_Permit_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 Cocl"5 my license is in full We
e anC ifec Code:The Contractor's License Law does not apply to an owner of a prope
License Clas �(�License No. J` r who builds or improves thereon, and who contracts for the projects witt
Expires _ Signature —�� 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
❑ 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 consWcted in Its entirety-by licem
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 applicatioi
section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:htto,/L- v.laainfo.ca.aovlcolawhtml.
permit is Issued.Myworkerrs'comp/e�nsatio/1n Insurance carrier and policy number are:
Carrier . �P/�L/Y.i //(,l7QJ'(5�.� Property caner or Authorized gent Date
Expires 7/ 3/ Policy#
Name of Agent Phone# ❑ 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 I
(This section need rf_ot 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 dly or county to enter the abo
❑ 1 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 Fr or Authorized Agent Do.o
Code,I shall fo with comply with those provisions.
-
r City Business License#
Date;_ _ _ Applicant; _
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, OYES OCCUPANT HANDLE HAZARDOUS MATERIAL ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE ' � MIXTURE CONTAINING A HAZARDOUS MATERIAL
�� ��
LABOR CODE, INTEREST,AND ATTORNEYS FEES y;®N0 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(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 DYES 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, _.�:KNO 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 MATERIAI
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 []YES INFORMATION GUIDE AND THE SCAQMD PERMITTIN(
she is exempt from licensure and the basis for the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREMENTI
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to 0 UNDER THE STATE OF CALIFORNIA HEALTH AND SAFET
a civil penalty of not more than($500).) CODE SECTION 25505 25533 AND 25534 CONCERNINC
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL REPORTING.
compensation,will do( )all of or( )porting of the work, and the structure Is FIR PERyY r DR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's Slate License Law does not apply 4o an owner of a property X r - ---• -• •-�- -
who, through employees' or personal effort, builds or improves the property
Provided that the Improvements are not intended or offered for sale.If,however,
the building or Improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
®'"Menifee
RpLkiived
DATE PERMIT/PLAN CHECK NUMBER - Dill a
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME 0 POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK R 2vA\4?-v"
t
2 0 -Solo c = to z ekn
PROJECTADDRESS �.J1) 612
ASSESSOR'S PARCEL NUMBER LOT 101 TRACT
OWNER NAMES
ADDRESS 3\u9cl Vl V/
PHONE �as j {�-{Cjt�. EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME � Q, OWNER BUILDER? O YE 0
BUSINESS NAME ' r
ADDRESS 11 .�� V��\Q)pB\
PHONE QS l qZf� OCY38 EMAIL a'1e(Sr1(n7 f15 0 .Ckd bvI k
CONTRACTOR'S STATE LIC NUMBER ")CJS9& - LICENSE CLASSIFICATION
VALUATION$ `SQ FT !Ljo L SQ FT
APPLICANT'S SIGNATURE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION y- N CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN R SMIP �
INVOICE �' PAIDAMOUNT
AMOUNT ,�� 0 CASH O CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0 CHECK# CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES 0 NO DL NUMBER NOTARIZED LETTER 0 YES O NO
by of Ivlerrifee Buiidinq & Srjfary Jr:uur tin =.;In un No. IVlengee. CA 13r'586 951-612-o 7/
citycfr„critic<z.us!nspe:;runRequel,rI-trip9512<i,-621
city Of
Bull Uin9& S enifec
S.
p"
JUN 15 2013
eiVLzd �-
f" ..
W
0
L%
U .
Ipi lid. 82 � illy
Zo 2u
I o' Z'V 10'
CITY OF MENIFEE t
BUILDING AND.SAF DEPART MENT
PLAN APPROVAL
REVIEWED BY. DATE
'Approval of these plans shall not be construed to be a permit*Oran f
approval of,any violation of any provisions of the federal,state or dty �= Fa
regulations and ordinances• This set of approved plant must he kept on the
jobsite until completion. : EDGER & TRACK
(INSPECTION REQUIRED
A um,j -LvX'VdAa Co A f
`Meu�.t Q ee CW�i Zs�'-i zuo_�sD��d z�I�
P q51 3 `6�I�i�t N C)-( TOSS n1 IVaL"a 3�