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PMT15-02611 i City of Menifee Permit No.: PMT15-02611 29714 HAUN RD. Type: Residential Re-Roof CCEL-%' MENIFEE, CA 92586 MENIFEE Date Issued: 08126/2016 j d PERMIT Site Address: 26612 JAELENE ST, MENIFEE, CA 92586 Parcel Number: 335-282-017 Construction Cost: $9,000.00 Existing Use: Proposed Use: Description of TEAR OFF EXISTING LAYERS, REROOF W/30#FELT, 30 YR COOL ROOF SHINGLES Work: Owner Contractor GARY FARRELL DONNOR ENTERPRISES INC 26612 JAELENE ST 20221 PEAR CIRCLE MENIFEE, CA 92586 PERRIS, CA 92570 Applicant Phone: 9519433344 RON HEARTZ License Number: 800984 DONNOR ENTERPRISES INC 20221 PEAR CIRCLE PERRIS, CA 92570 Fee Description 41 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. A,_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 C 5 License No. .9OO who builds or improves thereon, and who contracts for the projects with a Expires_I-I_(r- Signature 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. 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 ❑ 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: ..��J Carrier_/�M—Y�.-..- Property Owner or Authorized Agent Date Ca.c.�v� Expires Policy#mow 9r__� " r✓�yCfO ❑ 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 author 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 ape[y the i _._�rnn�es. shall not emclov 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. O City Business License# 7,15611119 Date; Applicant; WARNIN : FAILURE ECURE WORKERS' HAZARDOUS MATERIAL DECLARATION COMPENSATION COVERAGE IS NLAWFUL, 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 UPANT 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 ONO EQUAL TO OR GREATER THAN THE AMOUNTS CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS I hereby affirm that under the penally 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 ROM FOR THE CONSTRUCTION OR MODIFICATION RAOM THE SOUTH COAST AIR QUALITY MANAGEMENT Lender's Address CC33�NN00 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 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, O 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 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 UNDERS MY REQUIREMENTS violation of Section 7031.5 by any Applicant for a permit subjects the applicant to ❑NO UNDER THE STATE OF LIFORNIA HEALTH AND SAFETY a civil penalty of not more than($500).) CODE, BE ION 2 25533 AND 25534 CONCERNING ❑ 1, as owner of the property, or my employees with wages as their sole HAZARD. M IAL f}EPORffING. compensation, will do ( )all of or( )porting of the work, and the structure is PROP NER OR AUTHORIZEDAGENT not intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's State License Law does not apply to an owner of a property X _ -who, through employees'or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale.If,however, the building or improvement is sold within one year of completion, the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK Amenifee DATE PERMIT/PLAN CHECK NUMBER TYPE: O COMMERCIAL '`RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: C ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PLUMBING 46 RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK d 3 © 7w r''crtT f 3.CD Ye , 1S.�L PROJECTADDRESS G'O� I �L,ctl^ --LC--)J r_ �L ASSESSOR'S PARCEL NUMBER ��jvt;00177 LOT � TRACT ((J��� OWNER NAME '4 YL -P'tA 2 ADDRESS 2 CQ PHONE `?(C�'— ��X— a 3 9 (��_ EMAIL APPLICANT NAME 14(Q. 0 IG.6 d-t'- ) ADDRESS p C lk PHONE EMAIL CONTRACTOR'S NAME ,)XJ OWNER BUILDER? 0 YES NO BUSINESS NAME lA _0 ADDRESS PHONE oIG`� � "'7 7 �I-� c'EMAIL p CONTRACTOR'S STATE LIC NUMBER �dC �w/ LICENSE CLASSIFICATION <�L" 7 VALUATION$ Q® O SQ FT 3,3 L SQ FT APPLICANT'S SIGNATURE DATE CITY STAFF USE ONLY KDEPARTMENT DISTRIBUTION CITY OF paEpyFET JgS�.LICENSE NUMBER ANNING ENGINEERING FIRE GREEN � SMIP UU_%%/4GJ�.'` �oOV/00 PAIDAMOUNT `� CASH �%CHECKK CCREDIT CARD VISA/MCCHECK FEES PAID AMOUNT0CASH CCHECK# OCREDITCARD VISA/MCOLDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER O YES 0 NO City of Menifee Building&Safety Department 29714 Houn Rd. 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