PMT15-01229 i
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City of Menifee Permit No.: PMT16-01229
29714 HAUN RD. Type: Residential Re-Roof
MENIFEE, CA 92586
MENIFEE Date Issued: 06/11/2015
PERMIT
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Site Address: 27197 HOWARD ST, MENIFEE, CA 92586 Parcel Number: 335-313-005
Construction Cost: $7,675.00 �I
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Existing Use: Proposed Use:
Description of TEAR OFF OLD SHINGLES, INSULATE ATTIC TO R-38 INSULATION, INSTALL NEW COMP
Work: SHINGLES OWENS CORNING 30 YR
Owner Contractor
LINDA AMBAT BAKER ROOFING CORPORATION
27197 HOWARD ST 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 Oty Amount
u =.e su rm
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
specifications or from preventing building 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 force and effect. Code:The Contractor's License Law does not apply to an owner of a property
License,pCllass�.L�S License No. `� L r who builds or improves thereon, and who contracts for the projects with a
Expires,'? Signature G— 'z----/- 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. built as an owner-building if it has not been constructed in its entirety by licensed
Policy# contractors. I understand that a copy of the applicable law, Section 7044 of the
have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is
�ection 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:htto'iiwww.leciinfo,ca.gov/calaw.htrTil.
permit is issued.//M��y workers'compensation insurance carrier and policy number are:
Carrier <1-' C-f FE L m A ropeNy Owner or Authorized Agent Date
Expiresf Policy#R ,)Ct'. o�?
❑ By my Signature below, I certify to each of the following: I am the property
Name of Agent Phone# owner 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 state 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 propgrty for the inspection purposes.
shall not emolov any persons in any manner so as to become subject to the ✓i/
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 A ent Date
Code, I shall forthwith comply with those provisions. - t�7
112 City Business License#
Date; Applicant; /` -----
rc
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 OR A
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE ��i``` MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES ,�"0 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 ❑YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address 0 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 reasons)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, °J-!TNO 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($500).) CODE SEC MATERIAL 25505
550 25533'WG D 25534 CONCERNING
El 1, as owner of the property, or my employees with wages as their sole HAZARDOUS
compensation, will do ( )all of or( ) porting of the work, and the structure is PROPERTY OWNER ORAUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X �
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
&- wenifee
DATE ��S� PERMIT/PLAN CHECK NUMBER o as
TYPE: ❑COMMERCIAL �RESIDENTIAL MULTI-FAMILY ❑MOBILEHOME POOL/SPA ❑SIGN
SUBTYPE: []ADDITION [-]ALTERATION []DEMOLITION []ELECTRICAL ❑MECHANICAL
[]NEW []PLUMBING RE-ROOF-NUMBER OF SQUARES 90. -Z
DESCRIPTION OF WORK r (�j-{--l"' b _j L f �S It v\S U'l ol�'e--cA++ C
PROJECTADDRESS T7 440 kra
ASSESSOR'S PARCEL
NUMBER �Jj7j 7���� LOT 0 TRACT �Q
OWNER NAME pP
ADDRESSS-t-
PHONE EMAIL
APPLICANT NAME L. [< f v N e�
ADDRESS a. -r/_6
PHONE r (� �� a�9'-7a37 EMAIL
CONTRACTOR'S NAME C' I,— OWNER BUILDER? ❑YES O
BUSINESS NAME cz -Q v— �� J
ADDRESS 52
PHONE �q'�7 ) Y ?37 EMAIL
CONTRACTOR'S STATE
LIC NUMBER Egy 7 � r LICENSE CLASSIFICATION
7
VALUATION$ ( p 7 SO FT 2 L SO FT
.. n
APPLICANT'S SIGNATURE /--52 DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN l SMIP
INVOICE dp PAID AMOUNT
AMOUNT -;`CASH -CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0 CASH %'CHECK# CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER :0 YES O NO
City of Menifee Building&Safety Department 29714 Haun Rd. P4enifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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