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PMT15-02827
I i i s City of Menifee Permit No.: PMT15-02827 29714 HAUN RD.MENIFEE, CA 92586 Type: Residential Re-Roof MENIFEE Date Issued: 0911112016 I PERMIT Site Address: 27615 BOSTON DR, MENIFEE, CA 92586 Parcel Number: 335-273-036 Construction Cost: $7,500.00 V 9 Existing Use: Proposed Use: Description of REMOVE EXISTING 2 LAYERS, REROOF W/COOL ROOF SHINGLES Work: Owner Contractor KELLIE KING D N L CO 27615 BOSTON DR 1307 W 6TH STE 218 '.. MENIFEE, CA 92586 CORONA, CA 92882 Applicant Phone: 9518237987 DUSTYN HOWARD License Number: 1000529 DNLCO 1307 W 6TH STE 218 CORONA, CA 92882 - Fee Description Qtv Amount is B l s ce1 110. 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 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_Bidg_Permit_Templatespt Page 1 of 1 City Of Menifee LICENSED DECLARATION ❑ I am exempt from licensure under the Contractors'State License Law for the I hereby affirm under penalty or perjury that I am licensed de`r provisions of following reason: Chapter 9 (commencing with section 7000)of Division 3 o the us mass and By my signature below I acknowledge that, except for my personal residence in Professions Code and my license is in full force and which I must have resided for at least one year prior to completion of License Classy � License�tf L improvements covered by this permit, I cannot legally sell a structure that I have Expires 1 I'?:ei/t�-- 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 DECLARAZY N Business and Professions Code,is available upon request when this application is submitted or at the following Web site: ❑ I hereby affirm under penalty of perjury one of the following declarations: htto�//www leoinfo.ca oov/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 edify to each of the following: I am the property El have and will maintain workers' compensation insurance, as required by owner or authorized to ct on he property owner's behalf. I have read this section 3700 of the Labor Code, for the performance of the work for which this application and the info motion have provided is correct. I agree to comply permit is issued.My workers'compensation insurance carrier and policy number are: with all applicable city a it county ordinances and state laws relating to building construction.I authorize epresen atives of this city or county to enter the above- Carrier � x!^- identified prope or lh 'nspect in purposes. Policy# el t_�V S.-sr� -A Expires —7--�"` Property Owr?er u-F io (zed Agent Date (This section need not be completed if the permit is for one-hundred dollars($100)or less) City Business License# 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 workers'cPTensation provisions of Section 3700 of the Labor amounts specified on the Hazardous Materials Information Guide? Code, I shall fort p y with those provisions. ❑YES ❑/NO Applicant; Date; vv 1 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 guidelirpes SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND ❑YES ❑ NO 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.a school? LABOR CODE, INTEREST,AND ATTORNEYS FEES ❑YES E�'NO CONSTRUCTION LENDING AGENCY I have read the Hazardou M tedal Information Guide and the SCAQMD I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist. I and rsta d my requirements under the State of agency for the performance of the work which this permit is issued (Section California Health&Safety Cod ,Section 25505 and 25534 concerning 3097 Civil Code) hazardous material r orti g. OWNER BUILDER DECLARATIONS ❑YES 7 N I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date W I v� License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY QWN R AUTH RIZED AGENT next to the applicable items)(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.gov/lead 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 ❑An EPA Lead-Safe Certified Renovator will be responsible for this project who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale. If,however, Certified Firm Name: 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). ❑ 1, as owner of the property an exclusively contracting with licensed 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 fill out the RRP Acknowledgement. BUILDING & SAFETYPERMIT/PLAN CHECK APPLICATION 4 y �`"` Menifee DATE q \ PERMIT/PLAN CHECK NUMBER TYPE: 0, COMMERCIAL SIDENTIAL O MULTI-FAMILY O MOBILE HOME <.- POOL/SPA �01 SIGN SUBTYPE: ',"." ADDITION O ALTERATION O DEMOLITION OELECTRICAL, O MECHANICAL 0 NE i:I PLUMBING RE-ROOF-NUMBER FSQUARES DESCRIPTION OF WORK �< PROJECTADDRESS Z� ASSESSOR'S PARCEL NUMBER w LOT TRACT OWNER NAME ADDRESS Z ` 22 >✓ PHONE APPLICANT NAME ADDRESS PHONE �-{ , Z�� EMAIL CONTRACTOR'S NAME OWNER BUILDER? 0 YES TM% BUSINESS NAME ADDRESS PHONE at ( EMAIL CONTRACTOR'S STATE LIC NUMBER t© LICENSE CLASSIFICATION VALUATION$ L SO FT APPLICANT'S SIGNATURE DATE CITY STAFF USE ONLY t DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINEtINSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE 0 PAID AMOUNT AMOUNT ' : CASH '; CHECKH is CREDITCARD VISA/MC PLAN CHECK FEES PAID AMOUNT CASH ''CHECKN ;>CREDIT CARD VISA/MC OWNER BUILDER VERIFIED C,YES C NO DL NUMBER NOTARIZED LETTER 0 YES O NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92585 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-245-6213 a S 3J. 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