PMT15-01284 i
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City of Menifee Permit No.: PMT15-01284
29714 HAUN RD. !
' CaCI MENIFEE, CA 92586
Type: Residential Re-Roof
MENIFEE Date Issued: 06/15/2015
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PERMIT
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Site Address: 26161 FOUNTAIN BLEU DR, MENIFEE, Parcel Number: 337-103-007
CA 92586 Construction Cost: $9,427.00
Existing Use: Proposed Use:
Description of TEAR OFF 2 LAYERS COMP INSTALL 30#FELT NEW COMP SHINGLES
Work:
Owner Contractor
JERRY SWIFT DAN'S ROOFING INC
26161 FOUNTAIN BLEU DR 19011 MERMACKAVENUE
MENIFEE, CA 92586 LAKE ELSINORE, CA 92532
Applicant Phone: 9514710008
DAVE DOUGLAS License Number: 491438
DAN'S ROOFING INC
19011 MERMACKAVENUE
LAKE ELSINORE, CA 92532
Fee Description Qtv Amount l$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
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_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 forc��3. Code:The Contractor's License Law does not apply to an owner of a property
License Class C-3S License o. who builds or improves thereon, and who contracts for the projects with a
Expires 11,3 0,)(,Signature c j� licensed contractor(s)pursuant to the Contractors State License Law).
WORK ERS'COMPENSATION DECLARATION a
❑ 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, 1 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
aI have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is
ction 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:hfti),//www.leainfo.ca.ciov/calaw.himl.
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier Ile-5 5 (-"s• cc . Property Owner or Authorized Agent Date
Expires af,L/- / (e Policy# 33 co0 SG 7s•I-/1//
❑ By my Signature below, I certify to each of the following: I am the property
Name of Agent � , k/ Phone# � owner or authorized to act on the property owner's behalf. I have read this
(This section need not be complete tf the permit is for Y f/005 application and the information I have provided is correct. I agree to comply
one-hundred dollars t be c 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-
0 1 certify that in the performance of the work for which this permit is issued, I identified property for the inspection purpose .
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 Pmpe wner or Authorized Agent Date
Code,I shall forthwith comply with those provisions.
5 yS- / DApplicant; City Business License#
Date;
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 Q 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?
u. agency for the performance of the work which this permit is issued (Section WILL THE INTENDED USE OF THE BUILDING BY THE
p 3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE
Lender's Name AYES FROM THE CONSTRUCTIONT FOR THE HE SOUTH COAST AIR MANAGEMENT
Lender's Address 13NO 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, [aN0 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 DYES 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 C?VO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE
SECDOILS SECTION
25505RIAL f�f POR�WGD 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole
compensation,will do ( )all of or( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZE ENT
not intended or offered for sale.(Section 7044,Business and Professions Code; ./� 7, •1
The Contractor's State License Law does not apply to an owner of a property X 1/°'' 7�
who, through employees' or personal effort, builds or improves the property,
Provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
BUILDING & SAFETY • APPLICATION
Menifee NW- 7
DATE o1
PERMIT/PLAN CHECK NUMBER 1 a 8
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY :) MOBILE HOME 0 POOL/SPA C)SIGN
SUBTYPE: 0 ADDITION 0 ALTERATION O DEMOLITION 0 ELECTRICAL C) MECHANICAL
O NEW O PLUMBING RE-ROOF-NUMBER OF SQUARES oZ
DESCRIPTION OF WORK ,, r F
4 6 t-// a *` A /f ,,, 5 4,
PROJECT ADDRESS 2,G /(o / FO cJ /-C.-/
ASSESSOR'S PARCEL NUMBER 3t) 7 - 103-t)n LOT Lo J TRACT "[-\
OWNER NAME e-or r ,
ADDRESS
PHONE �.L/y.. �j !'j 7 L EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILDER? ON YES C NO
BUSINESS NAME G�
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER V9/ 9113 9, LICENSE CLASSIFICATION C-d
VALUATION$ rj L/Z SO FT 2-Za a L SO FT
APPLICANT'S SIGNATURE ! DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN too SMIP S
INVOICE PAID AMOUNT
AMOUNT 1� 0 CASH OCHECK# O.CREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT C)CASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED O YES C) NO DL NUMBER NOTARIZED LETTER J YES O NO
City of Menifee Building& Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-5213
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New Title 24 APPROVED colors/ Compton Plant Service
Area
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Antique Silver(Oak, Dur TruD) CRRC ID 0890-0011 Amber(Oak, •Dur TruD)
CRRC ID 0890-0009
�,ac, -fir-- rr�- ,• -..s--- ------------^------
Sierra Gray* (Oak, Dur TruD) CRRC ID 0890-0013 Oyster Shell (Oak, Dur TruD) CRRC ID 0890-0012
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• � f ��� - a r � fr �
,- + menifee
,a c: Safety Dept.
AY 15 2015
receive
Shasta White(Oak, Dur TruD) CRRC ID 0890-0002
Supreme 25 yr 3 tab
Shasta White CRRC ID 0890-0001
Aspen Gray CRRC ID 0890-0010
Amber CRRC ID 0890-0014
'SIERRA GRAY RE-FORMULATION AVAILIABLE IN COMPTON PLANT ONLY 3/16/2015