PMT15-00873 1
City of Menifee Permit No.: PMT15-00873
_ 29714 HAUN RD. Type: Residential Re-Roof
'W61UEL�4' MENIFEE, CA 92586
MENIFEE Date Issued: 04/08/2016
PERMIT
Site Address: 26431 HARRISBURG DR, MENIFEE, CA Parcel Number: 335-243-009
92586 Construction Cost: $7,345.00
Existing Use: Proposed Use:
Description of TEAR OFF OLD SHINGLES, INSTALL NEW SHINGLES 30 YR LIFETIME OWENS CORNING—R-38
Work: INSULATION TO BE VERIFIED AT INSPECTION"
Owner Contractor
ELEANOR SORENSON BAKER ROOFING CORPORATION
26431 HARRISBURG DR 29515 DUNKIRK STREET
MENIFEE, CA 92586 MENIFEE, CA 92586
Applicant Phone: 9512557237
LAWRENCE BAKER License Number: 884731
BAKER ROOFING CORPORATION
29515 DUNKIRK STREET
MENIFEE, CA 92586
Fee Description (( yt Amount 1$1
Inspections not specified _ _ _98 98.00
$126.00
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifcations 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 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 licensed
Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professions
Professions Code and my license is in full f rce and effect. Code:The Contractor's License Law does not apply to an owner of a property
License Class _�_License N 8�f r who builds or improves thereon, and who contracts for the projects with a
Expires Signatures 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 the
❑ 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 in
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 of
Section 3700 of the Labor Code, for the performance of work for which this improvements covered by this permit, I cannot legally sell a structure that I have
permit is issued.
Policy# built as an owner-building if it has not been constructed in its entirety by licensed
contractors. I understand that a copy of the applicable law, Section 7044 of the
" I have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is
!section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:http'liwm.leginfo.ca.aov/calaw.html.
'permit is issued.My workers'compensation insurance carrier and policy number are:
(r /t k Property caner or Aut prized Agent Date
Carrier`�'t`�"� °� k
Expires� Policy# t73�'�7 U` •l UX
By my Signature below, I certify to each of the following: I am the property
Name of Agent Phone# wner or authorized to act on the property owner's behalf. I have read this
(This section need not be completed if the permit is for application and the information I have provided is correct. I agree to comply
one-hundred dollars($100)or less) with all applicable city and county ordinances and slate laws relating to building
construction. I authorize representatives of this city or county to enter the above-
. ❑ I certify that in the performance of the work for which this permit is issued,I identified property 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 Owner or Authorized Agent Date
Code, I shall forthwitp-oomply with those provisions.
�7 /°---� City Business License
Date; Applicant; r- 0
WARNING: 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 i 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
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address NO
DISTRICT(SCAQMD) SEE PERMITTING CHECKLIST FOR
GUIDE LINES
OWNER BUILDER DECLARATIONS
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, NO 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, I UNDERSTAND MY REQUIREMENTS
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE,
SECTION
HAZARDOUS 2 MATERIAL 25533 AND 25534 CONCERNING
El 1, as owner of the property, or my employees with wages as their sole
compensation,will do ( )all of or( ) porting of the work, and the structure is PROPERTY OWNER OR A THORIZED A ENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X /\
who, through employees' or personal effort, builds or improves the property, ,—
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee `A
DATE 1O ��� PERMIT/PLAN CHECK NUMBER O-[6-OCIZ I3
TYPE: ❑COMMERCIAL ESIDENTIAL MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA SIGN
SUBTYPE: []ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL MECHANICAL
[_]NEW [-]PLUMBING ❑RE-ROOF-NUMBER OF SQUARES oZ
DESCRIPTION OF WORK
S� ..�
IA
PROJECTADDRESS D G 3C ( Ctdb-r Pj Q f r,
ASSESSOR'S PARCEL NUMBER 3--55-a43-009 LOT II-M TRACT fjejq- j
OWNER NAME f aP\C Aa� r-e A :Sus",
ADDRESS G ��f I a or tr1 Y Q e �tn
PHONE _ t Ot � 12�- EMAIL
APPLICANT NAME G. - Cke f
ADDRESS og 5/ 5 Cp /' f<. , P%A
PHONE(Q$/` 3 5/- a37 EMAIL
CONTRACTOR'S NAME L...CR +� . q_ OWNER BUILDER? ❑YES P
NO
BUSINESS NAME p� F,./n� -.. 1,
ADDRESS C S •.�1 cJ I,. F -. S"F. ! 1 -�`P C
PHONE ��S- r�S`S a EMAIL ^ s�
CONTRACTOR'S ST TE LIC NUMBER (� ( 3 LICENSE CLASSIFICATION ` J'
VALUATION$ 7 3 L_� S7 $Q FT 0-1 L SQ FT
APPLICANT'S SIGNATURE sL.+ DATE / s-
CITYSTAFF USEONLY
DEPARTMENT DISTRIBUTION I CITY OF MENIF E BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN 1 $MIP O�
INVOICE r>J,,GO PAID AMOUNT
AMOUNT /'� CCASH 0CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES NO DL NUMBER NOTARIZED LETTER t% YES =) NO
City of Menifee Building&Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofineni/ee.us Inspection Request Line 951-246-6213
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