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PMT15-02631 i I City of Menifee Permit No.: PMT16-02631 29714 HAUN RD. <A- MENIFEE, CA 92586 Type: Residential Re-Roof s xsm�r�P MENIFEE Date Issued: 0 812 712 01 5 8 PERMIT Site Address: 28262 LOS CIELOS DR, MENIFEE, CA Parcel Number: 336-212-021 92586 Construction Cost: $5,250.00 �! Existing Use: Proposed Use: Description of TEAR OFF EXISTING SHINGLES, INSTALL NEW CLASS A SHINGLE FLAT ROOF WILL RECEIVE Work: TORCH DOWN `INSPECTOR TO VERIFY R-38INSULATION' Owner Contractor JOHN GERSTNER BAKER ROOFING CORPORATION 28262 LOS CIELOS DRIVE 29515 DUNKIRK STREET MENIFEE, CA 92586 MENIFEE, CA 92586 Applicant Phone: 9512557237 LARRY BAKER License Number: 884731 BAKER ROOFING CORPORATION 29515 DUNKIRK STREET _ MENIFEE, CA 92586 Fee Description Q_tv Amount I$1 Inspections not specified 98 98.00 R $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 i 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.S License Clas License No. Code:The Contractor's License Law does not apply to an owner of a property G ,—, � � who builds or improves thereon, and who contracts for the projects with a Expires Signatu _ 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 ❑ 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 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:http://wm,leginfo.ca.gov/caiaw.html. . permit is issue/d..,Myy workers'co7ipensation insurance carrier and policy number are: Carrier \�"v��_ �U11A Property Owner or Authorized Agent Date Expires Policy#&3 9 Name of Agent Phone# [I By my Signature below, I certify to each of the following: I am the property owner of 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- I certify that in the performance of the work for which this permit is issued,I identified property for the Inspection purposes. - hall not emolov any persons in any manner so as to become subject to the workers'compensation laws of California,and agree that if should become `- {7- subject to the workers'compensation provisions of Section 3700 of the Labor Z� Code,I shall forthwith comply with those provisions. r44erty Owner or Authorized Agent p Date - � Date; ( `-l.`�� Applicant, �4 ' City Business License# P) 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 ''ENO 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 INTENDEDUSE OF THE BUILDING BY THE 3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE Lender's Name EYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION Lender's Address 7, FROM THE SOUTH COAST AIR QUALITY MANAGEMENT NO 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 EYES 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, NO 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 EYES 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 CZ NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY a civil penalty of not more than($500).) CODE;SECTION 25505, 25533,AND 25534 CONCERNING ❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL REPORTING. compensation, will do ( )all of or ( ) porting of the work, and the structure is PROPERTY OWNER AUTHORIZED AGENT not intended or offered for sale.(Section 7044, Business and Professions Code; The Contractor's State License Law does not apply to an owner of a-property X -0-- who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale.If,however, the building or improvement is sold within one year of completion, the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). & SAFETY PERMIT/PLAN CHECK APPLICATION �„ t'f Menifee DATE , , ( ' PERMIT/PLAN CHECK NUMBER Ptm,5 ' B TYPE: 0 COMMERCIAL 0 RESIDENTIAL 0 MULTI-FAMILY MOBILE HOME 0 POOL/SPA O SIGN SUBTYPE: 0 ADDITION 0 ALTERATION O DEMOLITION % ELECTRICAL 0 MECHANICAL 0 NEW O PLUMBING )QRE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK Vy G/ e SS y 5 � l ��a_/ Coo �fl ","Ct/e 4f-r� 540k-,,, PROJECTADDRESS 59 ASSESSOR'S PARCEL NUMBER ' �' pZ\a '�C'1� LOT TRAC� City AjnQ&Safety Dept. eni OWNER NAME ADDRESS PHONE -7 fp('3� /�EMpAIL Rece'Ve APPLICANT NAME LA--WV +nQ r d6- _R ri- ADDRESS `�- ��I 5- ic-b PHONE � () a� �-� �'.� EMAIL CONTRACTOR'S NAME C0.e,.��,f'2,�C`r el- Ice,-- OWNER BUILDER? OYES 9, iO BUSINESS NAME ADDRESS DMA �r°4 � PHONE r1S f) a;S�S�- -) 3\ / EMAIL CONTRACTOR'S STATE LIC NUMBER 7 �I *7 �? ( LICENSE CLASSIFICATION VALUATION$ SQ FT f L SO FT APPLI( DATE T CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION CITY OE MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNINGENGINEERING FIRE GREEN FI � SMIP INVOICE I AMOUNT 'au PAIDAMOUNT a1 n— VL CASH :%CHECK# C>CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT )CASH C.CHECK 9 C%CREDIT CARD VISA/Mc OWNER BUILDER VERIFIED "YESO NO DLNUMBER NOTARIZED LETTER YES ') NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 o ° :E . . . 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