PMT15-02601 i
1
City of Menifee Permit No.: PMT15-02601
'''•�� 29714 HAUN RD.
CCIEL 'k: MENIFEE, CA 92586 Type: Residential Re-Roof
c°"` °`�$°k'.° MENIFEE Date Issued: 0812612015
i
PERMIT
Site Address: 28151 MURRIETA RD, MENIFEE, CA Parcel Number: 339-061-002
92586 Construction Cost: $8,400.00
Existing Use: Proposed Use:
Description of REMOVE EXISTING COMP ROOF, REROOF WITH NEW COOL ROOF COMP SHINGLES
Work:
Owner Contractor
DEAN BERRY WOOLBRIGHT'S ROOFING&CONSTRUCTION INC
28151 MURRIETA RD 20831 SILKTASSEL COURT
MENIFEE, CA 92586 WILDOMAR, CA 92595
Applicant Phone: 9516091818
JUSTIN WOOLBRIGHT License Number: 534158
WOOLBRIGHT'S ROOFING&CONSTRUCTION INC
20831 SILKTASSEL COURT
WILDOMAR, CA 92595
Fee Description Q_yt Amount is
I
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 Class G 3q U License No. 53 4 15 who builds or improves thereon, and who contracts for the projects with a
Expires(/�//6 Signature licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ lam exempt from licensors under the Contractors'State License Law for the
hav V hereby affirm under penalty of perjury one of the following declarations: following reason:
�j e 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#q0�` ��� 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
iY 1 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.IegInfo.ca.Qov1caIawhtmI.
permit is issued.My workers'compensation insurance carrier and policy number are:
Carfler7/Ate- Fil Property Owner or Authorized Agent Date
Expires 1�)/16 Policy#908Z31k
(�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 slate 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 purposes.
shall not employ any persons in any manner so as to become subject to the l
workers' compensation laws of California, and agree that if I should b m ecoe p 7&/13
subject to the workers'compensation provisions of Section 3700 of the Labor �gyperty Owner or Authorized Agent Date
Code,I shall forthwith comply with those provisions. 77 __ ^ 6G
City Business License# P /?7 7(047
Date;V-7-w- S Applicant;
WARNING: FAILURE O 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, DYES 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 AND 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 DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address PNO DISTRICT(SCAQMD) SEE PERMITTING CHECKLIST FOR
GUIDE LINES
OWNER BUILDER DECLARATIONS 9 � y—
I hereby affirm under penalty of perjury that I am exempt from the Contractor's PRINT NAME:Tl � AI&-n, h'lvrr
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
An city or coup that requires a permit to construct, alter, improve, demolish, NO
Y repair
county q P a 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 #ES 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 25505 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL IAEPORTING.
compensation, will do( )all of or( )porting of the work, and the structure is PROP TY OWNE AUTHORIZED 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).
d
PERMIT/PLANBUILDING & SAFETY APPLICATION
Menifee
DATE DATE Ztolig PERMIT/PLAN CHECK NUMBER M 15 T.W001
TYPE: O COMMERCIAL 'A RESIDENTIAL O MULTI-FAMILY O' MOBILE HOME 0 POOL/SPA 0 SIGN
SUBTYPE: C ADDITION 0 ALTERATION O DEMOLITION () ELECTRICAL 0 MECHANICAL
O NEW O PLUMBING 0 RE-ROOF-NUMBER OF SQUARES r'
DESCRIPTION OF WORK p,t n 0E OX I C'I Vv 9 r .w.oL In S a���^elan
O7' e.W o NjNT CANS fly, LeS
PROJECTADDRESS Q ( 7 ( tom! !L.
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME
ADDRESS '9i 'N'1 �- �ZS
PHONE(5 EMAIL
APPLICANT NAME �k
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME A 6n6lr. vnc. OWNER BUILDER? 0 YES ONO
BUSINESS NAME
ADDRESS vl - < 0� C Z5�1J'
PHONE6p')_ ) $�Q EMAIL Tri
CONTRACTOR'S STATE LIC NUMBER %;34 (.S t'j LICENSE CLASSIFICATION L3
VALUATION$ C SQ FT Z..SOa L SQ FT
APPLICANT'S SIGNATURE DATE '2G 17
CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION CITY OFOMEyIF�B1151SE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN h SMIP ,^5 /Y�/�Gl
INVOICE 1 00 PAIDAMOUNT 0 {)
AMOUNT jYJ O CASH CHECK# CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT C)CASH C)CHECK# C)CREDITCARD VISA/MC
OWNER BUILDER VERIFIED O YES 0 NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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