PMT15-03309 City of Menifee Permit No.: PMT15-03309
29714 HAUN RD.
�CCEL/47. MENIFEE, CA 92586 Type: Residential Re-Roof
MENIFEE Date Issued: 10/26/2015
PERMIT
Site Address: 27720 DECATUR WAY, MENIFEE, CA Parcel Number: 335-273-017
92586 Construction Cost: $8,380.00
Existing Use: Proposed Use:
Description of REMOVE EXISTING ROOF, REROOF W/30 YR FIBERGLASS CERTAINTEED COOL ROOF
Work:
Owner Contractor
WILLIAM WYRICK AMERICAN ROOFING
27720 DECATUR WAY P O BOX 5031
MENIFEE, CA 92586 HEMET,CA 92544
Applicant Phone:9513069387
SHAWN GLEASON License Number:853066
AMERICAN ROOFING
P O BOX 5031
HEMET, CA 92544
Fee Description QtV Amount I$)
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_61dg_Permit_Templats.rpt 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 it
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_('——M License No. .VS3644 improvements covered by this permit, I cannot legally sell a structure that I have
Expires /f Signatur built as an owner-building if it has not been constructed in its entirety by Iicensec
contractors. I understand that a copy of the applicable law, Section 7044 of the
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application ie
submitted or at the following Web site:
❑ 1 hereby affirm under penalty of perjury one the following declarations: http:/Aw .leginfo.ca.gov/calaw.htmi.
I have and will maintain a certificate of consentt 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 properll
JJ�� 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. I agree to comply
permit is issued.My workers'compensation insurance carer and policy number are: with all applicable city and county ordinances and state laws relating to buildinc
� construction,I authorize representatives of this city or county to enter the above.
Carrier identified property for the inspection purposes.
Policy# Expires `j16 Ll property Owner or Authorized Agent Date
(This section need noi 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 C NO
Applicant/ _/
th Date; /"12�1/f Will the intended use of the building by the applicant or future building
G�""� 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 [ 0
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 off school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYE S L3N0
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 Calif is Health&Safety Code,Section 25505 and 25534 concerning
3097 Civil Code) ha3Ardous material reporting.
OWNER BUILDER DECLARATIONS 17YESS ❑NO
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date o c
Zk
License Law for the reason(s)indicated below by the checkmark(s)I have placed PR ERTY OWNER OR AUTHORIZED AGENT
next to the applicable item(s) (Section 7031.5. Business and Professions Code: EPA RENOVATION.REPAIR AND PAINTING fRRPI
Any city or county that requires a permit to construct, alter, improve, demolish,
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
❑ I, as owner of the property, or my employees with wages as their sole www.epa.gov/lead or contact the National Lead Information Center at
compensation,will do( )all of or( )parting of the work, and the structure is 1-800-424-LEAD(5323).
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractors 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 purpose of sale). Firm Certification No.:
❑ I, 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.
ABUILDING & SAFETY PERMIT/PLAN CHECK
PPLICATION
Menifee
DATE CJ I a` PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL 06ESIDENTIAL 0 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 @6 RE-ROOF-N UMBER OF SQUARES s
DESCRIPTION OF WORK C'.(}'lD�! eXI 3 t.s
30
PROJECTADDRESS n .b Cler
�cs r WQ
ASSESSOR'S PARCEL NUMBER /yJ✓—Ot� �`�+1 / LOT TRACT
PROPERTY OWNER'S NAME 3 L�
ADDRESS
PHONE 949 7M 5 - y-) EMAIL
APPLICANT NAME ,
ADDRESS -D lie)e 5 253I 1,4 C.A 5
PHONE 01;5 1 - 3o6 cino? EMAIL
CONTRACTOR'S NAME I c j) S ,1 64B46e OWNER BUILDER? O YES pC`NO
BUSINESS NAME � pO ',
ADDRESS 0 6
a • o
PHONE 9-g' L —;30.f c!3;? EMAIL
CONTRACTOR'S STATE LIC NUMBER �cS3b6 LICENSE CLASSIFICATION -<3 Y
VALUATION$ $6 SO FT a� Srt L SO FT
APPLICANT'S SIGNATURE DATE L-*'!ZG/ts-
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF f�r9�,IE�{155S L ENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I SMIP
INVOICE pglD AMOUNT O
AMOUNT IOC O 0CASH CHECK# 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0CASH 0CHECK# 0CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 HDun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.Lis Inspection Request Line 951-246-6213
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