PMT15-02781 City of Menifee Permit No.: PMT15-02781 4
29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Re-Roof
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MENIFEE Date Issued: 09/09I2015
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1
PERMIT
1
Site Address: 27660 MEDFORD WAY, MENIFEE, CA Parcel Number: 335-256-005
92586 Construction Cost: $12,592.00a
Existing Use: Proposed Use:
Description of TEAR OFF EXISTING ROOF, REROOF W/COOL ROOF COMP SHINGLES
Work:
Owner Contractor
BARBARA ENGLISH ARCADE CURVES ROOFING
27660 MEDFORD WAY P 0 BOX 9442
MENIFEE, CA 92586 ALTA LOMA, CA 91701
Applicant Phone: 9493382869
DOMINIC VASQUEZ License Number: 797664
ARCADE CURVES ROOFING
P 0 BOX 9442
ALTA LOMA, CA 91701
Fee Description gyt Amount I$1
e I oe 0,
Inspections not specified 98 98.00
General Plan Maintenance Fee-Building 1 4.90
$130.90
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 staled,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 am exempt from licensors under the Contractors'State License Law for the
following reason:
I hereby affirm under penalty or perjury that I am licensed under provisions of
Chapter 9(commencing with section 7000)of Division 3 of the Business and By my signature below I acknowledge that, except for my personal residence in
Professions Codg a�rd ense is in full force=efft - which I must have resided for at least one year prior to completion of
License Class C� ''// Licen improvements covered by this permit, I cannot legallysell a structure that I have
Expires �:3 �� Signature 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
WORKERS'COMPENSATION DECLA Business and Professions Code,is available upon request when this application is
submitted or at the following Web site:
❑ 1 hereby affirm under penalty of perjury one of the following declarations: htto'I/www leoinfo ca gov/calaw html.
I have and will maintain a certificate of consent of self-insure for workers'
compensation,issued by the Director of Industrial Relations as provided for by Date
Section 3700 of the Labor Code, for the performance of work for which this
permit is issued. Property Owner or Authorized Agent
Policy# ❑ By my Signature below, I certify to each of the following: I am the property
� I have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read this
--,tion 3700 of the Labor Code, for the performance of the work for which this application and the information I have provided is correct. I agree to comply
permit is issued.My workers'compensation insurance carrier and policy number are: with all apg�cah y..aryd county ordinances and state laws relating to building
�/ cons v cti authorize repTggsenlatives of this city or county to enter the above-
Carrier '� / l - �-- ide tified property for the' 6pbction purposes.
.e„Jt - e7�/"a - — Date
Policy# Expires
Prop rty Ow er or Ed A e t
(This section need not be completed if the permit is for City Business License#
one-hundred dollars($100)or less)
HAZARDOUS MATERIAL DECLARATION
❑ I certify that in the performance of the work for which this permit is issued,I
shall not emolov any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or a
workers' compensation laws of California, and agree that if I should become mixture containing a hazardous material equal to or greater that the
subject to the w a 'com nsation provisions of Section 3700 of the Labor amounts specified on the Hazardous Materials Information Guide?
Code, I shall rth ith cBmpl Ith those provisions. El YES l
Applicant; D te; ~---� Will the intended use of the building by the applicant or future building
occupant require a permit for the construction or modification from South
WARNING: FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND EYES ka
_ CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of f a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES EYES ENO- "
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist rLderstand. my requirements under the State of
agency for the performance of the work which this permit is issued (Section California He 4111 S fet ode, ction 25505 and 25534 concerning
3097 Civil Code) hazardous ateriale-portiri
OWNER BUILDER DECLARATIONS 'R-YES ❑ - "'`-- F
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date '(_
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OW '6RIZED AGENT
next to the applicable ileri(Section 7031.5. Business and Professions Code:
Any city or county that requires a permit to construct, alter, improve, demolish, EPA RENOVATION REPAIR AND PAINTING(RRP)
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 The EPA Renovation, Repair and Painting(RRP)Rule requires contractors
provisions of the Contractor's State License Law (Chapter 9 (commencing with receiving compensation for most work that disturbs paint in a pre-1978
Section 7000)of Division 3 of the Business and Professions Code)or that he or residence or childcare facility to be RRP-certified firms and comply with
she is exempt from licensure and the basis for the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than ($500).) employees. For more information about EPA's Renovation Program visit:
www.epa.govflead or contact the National Lead Information Center at
❑ 1, as owner of the property, or my employees with wages as their sole 1-800-424-LEAD(5323),
compensation, will do( )all of or( ) porting of the work, and the structure is
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 NO EPA Lead-Safe Certified Renovator will be responsible for this project
who, through employees' or personal effort, builds or improves the property, .4"C ot&c cl— �P. /EZ5
provided that the improvements are not intended or offered for sale.If,however, Certified Firm Name: r'•`""-fie'
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 Firm Certification No.:
purpose of sale).
❑ I, as owner of the property an exclusively contracting with licensed El No EPA Lead-Safe Certified Firm is required for this project because:
contractors to construct the project(Section 7044, Business and Professions
Code:The Contractor's License Law does not apply to an owner of a property
who builds or improves thereon, and who contracts for the projects with a
licensed contractor(s)pursuant to the Contractors State License Law). If your project does not comply with EPA RRP rule please f11 out the RRP
Acknowledgement.
i
__0BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
,.*, Menifee
DATE PERMIT/PLAN CHECK NUMBER H I s—m g'
TYPE: 0 COMMERCIAL kRESIDENTIAL 0 MULTI-FAMILY Ci MOBILE HOME 0 POOL/SPA 0 SIGN
SUBTYPE: 0 ADDITION O ALTERATION O DEMOLITION O ELECTRICAL Co MECHANICAL -
ONEW C. PLUMBING E-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
r .�r�-yN� qD t-/-,ct�
PROJECT ADDRESS •�ej1 g1'_/ 14 ( p
ASSESSOR'S PARCEL NUMBER
pp7J�' ;G40 005 LOT TRACTe�—
OWNER NAME
ADDRESS
PHONE EMAIL
APPLICANT NAME ' /i5� `' ''Z
ADDRESS vYU /`�`" G�f�'� 2�
PHONE EMAIL
CONTRACTOR'S NAME �L OWNER BUILDER? UYES CPNO
BUSINESS NAME`"% `E"/1�,t���"�1
ADDRESS /? � C !�
PHONE �� 2��/ EMAIL,
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION c1_5
VALUATION $ 1.7— �/ 2 L SO,FT
/�
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENTDISTRIBUHUN CI1Y0FN1EE E 4SSGIC SE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I SMIP (/ "J ,
INVOICE -y
AMOUNT �/�� O PAID AMOUNT :.CASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT :; CASH OCHECK4 OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES " NO DL NUMBER NOTARIZED LETTER `D YES O 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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