PMT15-01872 E
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City of Menifee Permit No.: PMT15-01872
29714 HAUN RD.
Type: Residential Re-Roof i
<ACCEL MENIFEE, CA 92586 ,
MENIFEE Date Issued: 07/06/2015
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PERMIT
Site Address: 26700 PAR DR, MENIFEE, CA 92586 Parcel Number: 337-363-012
Construction Cost: $7,000.00
Existing Use: Proposed Use:
Description of REMOVE EXISTING, RE-ROOF WITH COOL ROOF CERTAINTEED
Work:
Owner Contractor
STELLA ROSENTHAL HOUSETOP ROOFING
26700 PAR DR 31760 BRIGGS ROAD
MENIFEE, CA 92586 MENIFEE, CA 92584
Applicant Phone: 9516798369 -
RICH CARROLL License Number:371783
HOUSETOP ROOFING -
31760 BRIGGS ROAD
MENIFEE, CA 92584
Fee Description Qtv Amount isl
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 Cod�e—an2d Omyy license is in full force and effect. Code:The Contractor's License Law does not apply to an owner of a property
License Class License No. M7ag,3 who builds or improves thereon, and who contracts for the projects with a
Expires Llr Signature licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION CLARATION
❑ I am exempt from licensors under the Contractors'State License Law for the
❑ I 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, cannot legally sell a structure that 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:http://www.leginfo.ca.gov/calaw.html.
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier ��/` �(//t/fJ Property Owner or Authorized Agent Date
Expires / Z-/r Policy# -7//4 Z
y 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-
qVt
I certify that in the performance of the work for which this permit is issued,I identified property for the inspection purposes.
s all not amble v 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 forthwith comply with those provisions.
Date; (� l
Applicant; / - City Business License# 6)3 41
WARNING: FAILURE T 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 ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES �60 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
y,� FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address AO 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 ❑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, 'ENO 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 Stale 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 EYES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from Iicensure 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 to10 UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL IAEPORYING,
compensation, will do ( ) all of or( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZEDAGENT
not intended or offered for sale, (Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale. If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
PERMIT/PLANBUILDING & SAFETY APPLICATION
• �FMenifee
DATE 4 /c PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL O RESIDENTIAL 0 MULTI-FAMILY % MOBILE HOME POOL/SPA C>SIGN
SUBTYPE: 0 ADDITION C%ALTERATION :> DEMOLITION ELECTRICAL O MECHANICAL
"." NEW O PLUMBING VRE-ROOF-NUMBER OF SQUARES-egell —
DESCRIPTION OF WORK (��jlfQ// �,Ql,�ll.(/� ,��/,�- 7V
X 0&D1l4 Coo
PROJECT ADDRESS .ZovoO Py�. .0/-
ASSESSOR'S t 11
PARCEL NUMBER '�l'✓ .��p�j`�\� LOT _6491 TRACT O�
OWNER NAME S p 'ZO 56-y(/
ADDRESS 2 7600 /�A/L. al
PHONE _ I�7�!- �re•2�! EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILDER? 0 YES 'lt0
BUSINESS NAME
ADDRESS Q �L/G{if /CD• ,,//--
PHONE g0,,}'- l��� EMAIL / /1*7. A(V-15 G •CO
CONTRACTOR'S STATE LIC NUMBER 37 � LICENSE CLASSIFICATION (f
VALUATION$ 7 DD D SO FT
I 2,(a O D L SO FT
APPLICANT'S SIGNATURE C. DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION ITY OF MENIFEE BU E LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I SMIP
INVOICE (p PAID AMOUNT
AMOUNT CASH OCHECKM '.?CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT _ CASH "CHECKM ',�CREDITCARD VISA/MC
OWNER BUILDER VERIFIED (.:YES e' NO DL NUMBER NOTARIZED LETTER YES ) NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6771
www.cityofinenifee.us Inspection Request Line 951-246-6213
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