PMT15-01755 City of Menifee Permit No.: PMT15-01755
29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Re-Roof
MENIFEE Date Issued: 0 6124/2 01 5
PERMIT
Site Address: 25801 SUN CITY BLVD, MENIFEE, CA Parcel Number: 339-122-010
92586 Construction Cost: $5,000.00
Existing Use: Proposed Use:
Description of REMOVE EXISTING COMP ROOF, REROOF W/COMP OWENS CORNING SHASTA WHITE COOL
Work: ROOF
Owner Contractor
SHIRLEY MCCREA FREDERICK RICHARDSON CONSTRUCTION
25801 SUN CITY BLVD P 0 BOX 6083
MENIFEE, CA 92586 MORENO VALLEY, CA 92554
Applicant Phone: 9516536132
JOHN RICHARDSON License Number: 643209
FREDERICK RICHARDSON CONSTRUCTION
P O BOX 6083
MORENO VALLEY, CA 92554
Fee Description Qtv Amount($)
l i ace Z:.
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 1 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 C nd license' in full [fp�:t. Code:The Contractor's License Law does not apply to an owner of a property
License CI cense N 7 who builds or improves thereon, and who contracts for the projects with a
Expire / Si n lure
licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATI N DECLARATION
❑ 1 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
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:htto'//www leginfo ce aov/calaw html.
permit is issued.My war ers'compensation insurance carrier and policy number are:
'am— I Property Owner or Authorized Agent Date
Carrier
Expires
Z/By my Signature beiuw, i certify the followi, _ N uperty
Name of Agent Phone# rowner or authorized to act on the property owner a uc"_" 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. epresentatives 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 identifie property for the i spection purposes.
shall not employ any persons in any manner so as to become subject to the
workers' compensation laws of California, and agree if I should become
tio Section
subject to the workers'compensa vlslo 700 of the Labor property Owner or Authorized Agerft Date
Code,I sh I fort with comply fiTthose prov' i A ��
/ 4 - � City Business License# U
Date;" `✓ plicant; �t�
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, AYES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE / MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES pyNO EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY r_ 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 �JD10 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 OYES 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, 16NO 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 -�9ES 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($500).) CODE, SECTIO 05, 25533,AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole US ERI EPORTING.
compensation,will do ( )all of or( )porting of the work, and the structure is PROPE WNER O NTHORI D AGFjNT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X r
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
CUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE PERMIT/PLAN CHECK NUMBER FM ` « QI,15S
TYPE: 0,COMMERCIAL 7GESIDENTIAL :) MULTI-FAMILY O MOBILE HOME 0 POOL/SPA - SIGN
SUBTYPE: C ADDITION <: ALTERATION 0 DEMOLITION 0 ELECTRICAL 0 MECHANICAL
O NEW `) PLUMBING AE-ROOF
APPLICATION NAME ,
DESCRIPTION OF WORK `��HCYC
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER 3�- � LOT _h TRACT a5✓
OWNER NAME
ADDRESS
PHONE qt9 -Co7.2, 067W EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME CST OWNER BUILDER? c%YES ' 0
BUSINESS NAME 1J 72 e44A2�
ADDRESS r//97 77,Jl 4t7N1 I ;AIJCHO (:!—(Vl O
PHON '_,�6 Z12' g�i�i EMAIL �+
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ OG� GIFT L SQ FT
APPLICANT'S SIGNA URE (f2 t� DATE d'7
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION �w, CITY OF MEN WSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE SMIP I- GREEN 3
INVOICE W PAIDAMOUNT
AMOUNT L%CASH %CHECK# ?-%CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT CASH %CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED �01 YES C NO LICENSE NUMBER NOTARIZED LETTER - YES 0 NO
City of Menifee Building& Safety Department 29714 HDun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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