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PMT18-03610 City of Menifee Permit No.: PMT18-03610 29714 HAUN RD.11 1 MENIFEE, CA 92586 Type: Residential Addition MENIFEE MENIFEE Date Issued: 07/20/2018 PERMIT Site Address: 26761 WORTHY DR, MENIFEE,CA Parcel Number: 331-442-001 92585 Construction Cost: $6,396.00 Existing Use: 1 &2 Family Residence Proposed Use: Description of INSTALL 482 SF SOLID ALUMAWOOD PATIO COVER WITH 2 FANS, 5 LED LIGHTS, 1 GFI OUTLET Work: Owner Contractor DAVID DICKERSON GUTTERS N COVERS CONSTRUCTION INC 26761 WORTHY DRIVE 1622 ILLINOIS AVE SUITE 14 MENIFEE, CA 92585 PERRIS, CA 92571 Applicant phone: 9519280098 AMBER COLLINS License Number.945962 GUTTERS N COVERS CONSTRUCTION INC 1622ILLINOIS AVE SUITE 14 PERRIS, CA 92571 Fee Description gtv Amount IS) Receptacle,Switch,Outlet&Fixture 9 156.00 Building Permit Issuance 1 27.00 DecklPatio,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 7.80 $332.45 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 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_Pennit_Template.rpt Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractors)pursuant to the Contractors Slate License Law). Chapter9(commencing with section 70oo)of Division 3 of the Business and u I am exempt from licensure under the Contractor's State License Law for Professions Code an my license is In full force and effect. /,, the following reason: License Clla�ss r License No.`� �oZ By my signature below I acknowledge that,except formy personal residence Expires `7�Signature in which l must have resided for at least one year priorto completion of WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legallysell a structure that 1 have built as an owner-builder if it has not been constructed in its entirety by o I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section have and will maintain a certificate of Consent of self-insure forworker's 7044 of the Business and Professions Code,is available upon request when compensation,issued by the Director of Industrial Relations as provided for this application is submitted or at the following website: by Section 3700 of the Labor Code,for the performance of work for which this permit is svvxi.leeinfo.ca.eov/calasv.html. is PoricyR ��1 sssued.h1nS/2Z_—,V_123 Date f�l lave and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT section 3700 of the Labor Code,for the performance of the work for which o By my signature below l certify to each of the following:I am the property this permit is issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this number are: r application and the information I have provided is correct.I agree to comply Carrier Mf §12671 l/C(ih/��G //rLi with all applicable city and county ordinances and stale laws relating to p a� building construction.I authorize representatives of this city or county to Policy If V/ Z✓Y'3 Expires 12,0p enter the above identified property for inspection purposes. (This section need not to be completed is the permit is for one-hundred dollars($300)or less Date PROPERTY OWNER OR AUTHORIZED AGENT O I certify that in the performance of the work for which this permit is issued, J-_ �� I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE if �2 51Pj5 worker's compensation laws of California,and agree that If I should became HAZARDOUS MATERIAL DECLARATION subject to the worker's compensation provisions of Section 370D of the Labor Code,[shall forthwith cxmpiy/Kh those provisions. Will she applicant or future building occupant handle hazardous material or Applicant _14/r2bo/_ mixture containing a hazardous material equal to or greater that the amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes AAo UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modiRation from South ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast At Quality Management District(SCAQM D)?See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines CONSTRUCTION LENDING AGENCY oYes "kilo I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 10DO feet of the lending agencyfor the performance of the work which this permit is issued outer boundary of a school? (Section 3097 Civil Code) o Yes p-Nio OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD permitting checklist.I understand my requirements under the State of I Contraherebyctor's or'ss Li under penaltyfor the perjury that I am exempt from the California Health&Safety Code,Section 255D5 and 25534 concerning Contractor's License Law fanext to the reason(s)applicable below by the hazardous material reporting. theckmark(s)1 have placed next to the applicable item(s)(Section 7031.5 p11fRs o Business and Professions Code).Any city or county thatrequires a permit to pate construct,alter,Improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED AGENT 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 EPA RENOVATION,REPAIR AND PAINTING(RRPI License Law(Chapter9(Commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRPI Rule requires contractors Business and Professions Code)or that he or she is exempt from licensure receiving compensation for most work that disturbs paint in a pre-1978 and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property than($500). managers who do the paint-disturbing work themselves or through their o1,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit: compensation,will do( I all of or( )portion of the work,and the structure is wswv.eoa.eov/lead or Contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-800.424-LEAD(5323). Code;The Contractor's State License Law does not apply to an owner of a o An EPA Lead-Safe Certified Renovator Will be responsible for this project property who,through employees'or personal effort,builds or Improves the property provided that the improvements are not intended or offered for Certified Firm Name: sale.If,however,the building or improvement Is sold within one year of Firm Certification No: completion,the Owner-Builder will have the burden of proving that it was not built or improved for the purpose of sale. O No EPA Lead-Safe Certified Firm is required for this project because: o I,as owner of the property am exclusively contracting with licensed contractors to construct the project(Section 7D44,Business and Professions Code:The Contractor's State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP hAber aufac �_ ►/_ �V Acknowledgement. BUILDING & SAFETY PERIAIT/PL Ai\ CHECK APPLICATION! MENIFEE � DATE: //1 01 PERMIT/PLAN CHECK NUMBER W1v1 , 1 D:il!/ PLANNING CASE NUMBER City of Menifee y' � uI Ing ep . TYPE: O COMMERCIAL / JJIESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHA O NEW O PLUMBINNGG, O RE-ROOF NUMBER OF SQUARES DESCRIPTION OF WORK OS O e% PROJECT ADDRESS , lo7Ca I dt��r�rni 'Or ZIP C1J� ASSESSOR'S PARCEL NUMBE'R/ �/331- a -G� /-�LOT TRACT OWNER NAME // __ y jd �/�i� /r (� ADDRESS 6;7 TD D�1i / / /�JC/ ` Zf5y_,5 PHONE 626 _ 6(P - �j3�Y5 EMAIL APPLICANT NAME �he'f Q V�//��,/�\ S /,� �j ADDRESS L (� �� ( �7CIl S / I e-02-S '?26 / PHONE EMAIL CONTRACTOR'S NAME CC rC� OWNER BUILDER? O YES ONO BUSINESS NAME b1''^^ P ,� / ADDRESS ��. Z 7_ /��I��I{{ln 6 S (f /!/ Z5 l PHONE EMAIL / CONTRACTOR'S STATE'LIC NUMBER " tA576/v LICENSE CLASSIFICATION VALUATION$ SO FT uk2� L SQ FT APPLICANT'S SIGNATURE DATE DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE 042 INVOICE TOTAL GREEN 1 _ SMIP OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777 www.cityofmenifee.us AFAANA pjlNIF City of Menlfee LEDGER & TRACK Building Crept, OSHA APPROVED IUSPECTION REQUIRED JUL 19 2018 LADDER REQUIRED AT Received FINAL INSPECTION v tb l o � o C�j ? ---------------- CITY OF MENIFEE G AND SAFEjo NT PLAN A PROVALa REV1E' _ 1� E'Approval of t ese plans shall not ba p it for,or anapproval of.a y violation of any prral,state or cityegulations a ordinances. This ss m st be Nept on the jobsite until ompletion. LA = e1 JaQ V' cd p ck eb n Z�,�I �o�c• 0•t N� �I�,21�sDu.a ��ch�Q R)k,y\- fee- CV, 21 avib U t,u-DS I ou- QQ k