Loading...
PMT15-03153 City of Menifee Permit No.: PMT16-03153 29714 HAUN RD. 4ACCEL_A MENIFEE, CA 92586 Type: Residential Re-Roof MENIFEE Date Issued: 1 010 9/2 01 5 PERMIT Site Address: 28763 CARMEL RD, MENIFEE, CA 92586 Parcel Number: 337-215-019 Construction Cost: $10,200.00 Existing Use: Proposed Use: Description of REMOVE&REROOF WASHPHALT FIBERGLASS DIMENSIONAL SHINGLES,`•NOTA COOL Work: ROOF-INSPECTOR PLEASE VERIFY R-38INSULATION" Owner Contractor JOHN ROUSSOPULOS GARRETT CONTRACTING SERVICES 6 DELLA CAVA LN 288 VIA DE AMO LAKE ELSINORE. CA 92532 FALLBROOK, CA 92028 Applicant Phone:6266654384 RICK GARRETT License Number:536485 GARRETT CONTRACTING SERVICES 288 VIA DE AMO FALLBROOK, CA 92028 Fee Description O_yt Amount ISl Building Permit Issuance 1 27.00=. Inspections not specified 98 98.00 GREEN FEE 1 1.00 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_aldg Permit Templatespi Page 1 of 1 City Of Menifee LICENSED DECLARATION ❑ lam exempt from licensure under the Contractors'State License Law for the I hereby affirm under penalty or perjury that I am licensed under provisions of following reason: 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 Code and my license is in full force and effect. which I must have resided for at least one year prior to completion of License Class Ci 3—Hj c License No. S 3 G AycSr Improvements covered by this permit, I cannot legally sell a structure that I have Expires D, C . Signature,6-L_ J uilt 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'COMPENSATI ON DECLARATION 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 the following declarations, httpJ/www.leginfo.ca.gov/calaw.html. I have and will maintain a certificate of consenttforwo 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 section 3700 of the Labor Code, for the performance of the work for which this application and the information I have provided is correct. 1 agree to comply permit is issued.My workers'compensation insurance carrier and policy number are: with all applicable city and county ordinances and stale laws relating to building construction.I authorize representatives of this city or county to enter the above- Carrier fA-F S i h C / identified property for the inspection purposes. Policy# lti ttJ 3157s'J'Y'Expires �/71/E Property Owner or Authorized Agent Date (This section need not be completed if the permit is for City Business License# one-hundred dollars($100)or less) ❑ 1 certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION shall not employ 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 compensation provisions of Section 3700 of the Labor amounts specified on the Hazardous Materials Information Guide? Code,I shall forthwith comply with those provisions. ❑YES PJO Applicant ----'Dade; 19I/S` 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 DYES ;FNO 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,�o+f��a school? LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES XNO 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.I understand my requirements under the State of agency for the performance of the work which this permit is issued (Section California Health&Safety Code,Section 25505 and 25534 concerning 3097 Civil Code) hazardous material reporting. OWNER BUILDER DECLARATIONS NgES ❑NO I hereby affirm under penalty of perjury that I am exempt from the Contractors —p'—per��� Date License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OWNER OR AUTHORIZED AGENT next to the applicable Rem(s)(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 firths 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 I, 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). ❑ I, as owner of the property an exclusively contracting with licensed ❑No EPA Lead-Safe Certified Finn 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 Actmowledcament. BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION ; Q 1 Y "1 Menifee ` DATE PERMIT/PLAN CHECK NUMBER TYPE: C COMMERCIAL ESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PLUMBING VRE-ROOF-NUMBER OF SQUARES ajd- DESCRIPTION OF WORK + voi= A4✓f = ti 4 t PROJECTADDRESS ,5 /�,Cv911-444FLCRF�D uN cl— t q.2CW ASSESSOR'S PARCEL NUMBER " /0pa -al .-DO LOT 10(0 TRACT V OWNER NAME v rt 0V(S cU Pv L vS ADDRESS G - c. f4 ci ) PHONE / ZA _ �Z� 6,��� EMAIL APPLICANT NAME •5 /� =[,cw ADDRESS PHONE EMAIL CONTRACTOR'S NAME ¢12>Zr'^jr OWNER BUILDER? O YESeX'NO BUSINESSNAME ¢ ZtoTl' o TsiAct�nt (r �l1.c.iccrS ADDRESS A.ST: ck, cI11.02 PHONE /'16•- /96c 'f'3g'Jf- EMAIL CONTRACTOR'S STATE LIC NUMBER S'3E LICENSE CLASSIFICATION 13 "C3? -H c VALUATION$ j p0 Z O v SQ FT L SO FT APPLICANT'S SIGNATURE c l-s�------�DATE vl`7%sT OTYSTAFFUSEONLY DEPARTMENT DISTRIBUTION CITYOFME i NIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN 1� SMIP INVOICE - PAID AMOUNT AMOUNT 0CASH 0CHECK# OCREDITCARD VISA/MC PLAN CHECK FEES PAID AMOUNT O CASH O CHECK It OCREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 ° < 9, :E z n nwn 'nD v f1 MO X C.w �•+ �+ 3 o n p c °o m ° O a �:7 an w A (p m 2. T J to '� m w N a ,m. O jp �= c m n —p m in A 3 H 3 f° .°. X m m mm -W o A o tin m m V ?f A 0 a 3 w O i r 9 d o N ° L m R M. V' D t` D y Z 0 S C to G 5 a O m 0 3 S n A in m o m a m A r = M ' O k^ - x p o �' v < .°., 3 n Q v v A m �+ O O. O m r> m o Q 3 N m N o 0 N p N y o m 0 fI < ~ m N S N m O O m m C M r 2 �D1 o '6 J n m ` < 1 Z 0 w y 0 m • O A r�i f') .l" O T O a w' 90n' o A m u z N N s o w N 2 m m ° v oo ti m N 3 0 S K 0 J n^ c m y J ,d, N i f i s d s m m _n J 0 o'm m a o fn 3 0 0 3 00 0 ' J .! 7 m 10 a r >• >• J o o x• m m n 0 G o m d N 3 a K m o3i V 3 0 C J. �• N n 'O a m m A fD m 0 ° a N N H O O j S O w £ W c O mm W N O Q. =+ J ro S o. o. 3 a J 'a �n m ° S N C m m J 2 a w o �^ 3 m m m o o ^ 3 --. A ° m M D 3 n » O � 2 n .pr mZm X m 3 3_ a a 2 w N w J O• m m (�l \ o0 0. c < c a c a 0 d 'o .1 3 S a A m N n w °• w m a m w o 3 i n. p m OG p a Q N J R O d N w "O N � O K � � \• C' A C T 9 N O O m p d � W Y ~ O n 6 � � i. X o A V V x 3 3 ti IrS J p N n a A V T < EL d m E. Q N S a. M ^ n w m m = A w (^ N z i m o_ R G� a m U � N vpi m LL O Q n c E 0 a m u0i E d -� d 00 C = 3 C m V a O L C1 W N } m U O LL 9 V u a m E p m m m 1 to - u p c E m ooa .0 v O J ` c m u s v tl ,� m m o °1 ti9 E o a > m a a c _ u a o N 6 N O 9 = W O`pl N U 6 w �' O V ym. O u V d a Z N T C y d G a d u W 0 M 6 '- O o ",' 9 6 Q m 0 p U N O W O >> C 0 m - ad+ m = n U m d p tl0 0 6 a C j C q U D d w U 9 li J d O O a yCj } u LL Q g K O V O O 0° N O. u 0 0_ m C C1 O m J z m O d m C N 0 N O m K O y W m m Z J r O pj vl d pdp C ~ y = d T o 'U d o y d d O O C d .p C « c a Yr c V O d T O m J0 y L H U o d 6' > m c E toi d `o m N L V O p 'O m a a Ui +' 0 m C 0 C y m p 10 E C d �• z v d V v_ m w m `o w 0' T m '° u .o. N m n Q d E ii u c .mr .2 v N 9 c Y m « U. d u d O 0 a 0 U m 0 $ 00 ; o t z° w a 0 a o g i E a c m m C Y o c n: m V' w u o L .o W �' V u w u m 'g = 3 0 e0 c c d a oo Z' a u `o w Ti 'm_ r u •- c E b e O U p -yd a d 3 V ¢ J o. d a p a d P d F O a =F m .d0 W d m w U y p « c - > � 6 0 v0i W c o Q c m «° ao j E ma or � °'. a v v' °' mw o y oo c E a ° a J dj LL o « ui m 0 d o f a 0 m m .� w 0 0 U c a o m E m ¢ u T e w w o y d m V ..m, d L v m q m a N i w V : Em C m c ; « O c uc+ c a d •� m e 5i ti m o 01 > d t: 0 �' f m �cJ d y K K z m d L O C t m m e .p p m W d d E C v pp U ` dQ jp Owd ym m d aY ucr -o 3 v�0no° E vc �uan ym o dE L y d d L jo Q m c m O d d c o o Od a o E o v u v omU A o d M J 11 f vmw m a O w t C - E vdi c Y v °u' E -�-' 333 > m o m f q ao Uv G o o m u c o w L ¢ ad' C umi 6 d ¢ u y J O N z U d �' C a d V 'p a s o a z N 11 z z d c d d 0 N M E E E O o u c 9 a w o. m m o. o. 9 c c c 't' o ~ « c Q a m c > 0 0 5 r. 0 o w h Z •• !t N c a` v i m ? a` a` 3 f I c !Z c A H N ci .-i ri m O Z u u E to E W ` V Ili ri W 01 .i ei .-I .i z O - m O L u o o z u Q 'u LL ACCWbe CERTIFICATE OF LIABILITY INSURANCE DATE(MMWNYYY) �/ 0 8/1 212 01 5 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pol(cy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such end°rsement(s). PRODUCER CONTACT NAME' LIZBETH RUIZ A&J Insurance Agency Inc. PHONE FAX 1381 E. Las Tunas Dr.#7 L ' (626)286.3410 ac No:(626)286-6502 E-MAIL L:m@ajins.com Gabriel , CA 91776 ADDRESS: a'ins.com License#: OD10261 INSURERS AFFOROINGCOVERAGE NAICR INSURERA: Builders and Tradesmens Insurance nce INSURED INSURERS: RICHARD GARRETT DBA: GARRETT CONTRACTING SERVICES INSURERC: 288 VIA DE AMO INSURERD: FALLBROOK,CA 92028 INSURERE: NSURERF: COVERAGES CERTIFICATE NUMBER: 00026632.17160 REVISION NUMBER: 2 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. �S TYPE OF INSURANCE L9UBR POLICY NUMBER MMNO� MMNCOYYIPY LIM" GENERAL LIABILITY EACH OCCURRENCE 5 COMMERCVIL GENERAL LIABILITY AGE TO REN7110— PREMISES Ea pmarenrs $ CLAIMS-MADE ❑OCCUR MEDEXP(Alryoneparscn) 5 PERSONAL&ADV INJURY $ GENERALAGGREGATE b GEN'LAGGREGATE UM IT APPLIES PER PRODUCTS-COMPIOP AGG 5 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE UNIT Ea acGdenl b ANY AUTO BODILY INJURY(Porperson) S ALL OWNED SCHEDULED BODILY INJURY(PoraccldenU 5 AUTOS AUTOS NON-OWNED PROPERTY DAMAGE 5 HIRED AUTOS AUTOS PerarrJdenl UMSRELIAUAB OCCUR EACH OCCURRENCE $ EXCESS UAS CWIMS.MAOE AGGREGATE $ DELI I I RETENTIONS 5 A WORMERS COMPENSATION WWC3157554 06/0712015 0810712016 X WC srATu OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOWPARTNER/EXECUOVE YIN E.L EACH ACCIDENT $ 1,000,000 OFFICERAIEMBER EXCLUDED? � NIA (Mandatory in NH) EL DISEASE-EA EMPLOYO 5 1000000 If as,descritre under DESCRIPTION OF OPERATIONSbelm EL DISEASE-POLICY UMIT S 1,000,000 MF DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(AeaoO ACORD 101,Additional Remarks Bel edule,If Mom space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE RICHARD GARRETT THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN DBA: GARRETT CONTRACTING SERVICES ACCORDANCE WITH THE POLICY PROVISIONS. 288 VIA DE AMOR FALLBROOK, CA 92028 AUTHORREDREPRESENTATIVE HLR) 01988-2010ACORDCORPOJiATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Printed by HLR on August 12,2015 at 09:40AM