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PMT15-03520
City of Menifee Permit No.: PMT15-03520 29714 HAUN RD. �ACCEL.A7. MENIFEE,CA 92586 Type: Residential Re-Roof MENIFEE Date Issued: 11/1 012 01 5 PERMIT Site Address: 29611 GREENHILL DR, MENIFEE, CA Parcel Number: 338-221-010 92586 Construction Cost: $7,800.00 Existing Use: Proposed Use: Description of REMOVE EXISTING LAYER, INSTALL NEW MALARKEY HIGHLANDER SHINGLES DOVE WHITE Work: "CRRC#0850-DO14" Owner Contractor RICHARD PISAPIA ENVISION ROOFING INC 29346 OLD WRANGLER ROAD 24370 CANYON LAKE DR N STE 11 CANYON LAKE, CA 92587 CANYON LAKE, CA 92587 Applicant Phone:9512448200 MIKE HEARTZ License Number: 993434 ENVISION ROOFING INC 24370 CANYON LAKE DR N STE 11 CANYON LAKE, CA 92587 Fee Description Oft Amount ISI 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_Template.rpt Page 1 of 1 City Of Menifee LICENSED DECLARATION ❑ I am exempt from licensum under the Contractors'State License Law for thr 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 II Professions Code ridgy/cans s in full force and effect. which I must have resided for at least one year prior to completion c License Class / 1 V Uoense No. g 9 3 .S f improvements covered by this permit, I cannot legally sell a structure that I haw Expires ( 3b P011- Signature built as an owner-building if it has not been constructed in its entirety by license( contractors. I understand that a copy of the applicable law, Section 7044 of thi WORKERS'COMPENSATION DECLARATION 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; htti),Ih w leoinfo ca aov/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 propert ❑ 1 have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read thi: 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 compY permit is issued.Myworkers'compensatiJon insurance carrier and policy number are: with all applicable city and county ordinances and state laws relating to building 5�/�s'r� f ✓f' �/ construction.I authorize representatives of this city or county to enter the above Carrier identified property for the inspection purposes. Policy# '[�11 011 S-�— Expires Date Properly Owner orAuthprized Agent (This section need not be completed if the permit is for City Business License# one-hundred dollars($100)or less) HAZARDOUS MATERIAL DECLARATION ❑ 1 certify that in the performance of the work for which this permit is issued,I 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 forthwi ly with those provisions. DYES ❑NO Applicant; Date; �0 �S Will the intended use of the building by the applicant or future building occupant require a permit for the consWcton 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 ❑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 DYES O NO 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 perrmitiing 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 OYES ❑NO I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date License Law for the reasons)indicated below by the checkmadr(s)I have placed PROPERTY OWNER OR AUTHORIZED AGENT next to the applicable item(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 firms and comply with she is exempt from Iicensure 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 theproperty, or m ern to employees with wages as their sole www.epa.gov/lead or contact the National Lead Information Center at Y P Y 9 1-800424-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 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 Firm Certification No.: purpose of sale). ❑ 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 BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION ;: 163 Menifee DATE — PERMIT/PLAN CHECK NUMBER �J— TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION OELECTRICAL Ow1ECHANICAL O NEW O PLUMBING E-ROOF-NUMBER OF SQUARES e�'I 9! DESCRIPTION OF WORK gWOV& ONEGA G(L©r- S14 ^^Coles NS'-/+ C., A'LA r2V-c—Y^^ 4i ol-1 ,4ivdat ,shiN 1es aOV0 Wh t+e. PROJECTADDRESS CX (.o�[ 2EE/V 1-1j& . ASSESSOR'S PARCEL NUMBER LOT TRACT OWNERNAME R1� A- D PI SA-PiA ADDRESS (p Q /� G tZ /r0 G LOY& /20ad O(a� PHONE G� r — 5(+( (p ! EMAIL Building & Safety Dept. APPLICANT NAME ADDRESS NOV 10 2015 PHONE EMAIL CONTRACTOR'S NAME /442'TZ OWNER BUILDER? O YES400 BUSINESSNAME 2000-r ;JG rJC_ . ADDRESS Q CA-N pN L 41V-Cs 172 . A) . < I Cam`' DN C-4-k.t--- PHONE S?-00� / ,,/'EMAIL G dL/JSto�Coo C-"" 22't��{2or3,Af 'fi CONTRACTOR'S�STATE LIC NUMBER 9C73` 5 `' LICENSE CLASSIFICATION ✓— `,5 / VALUATION$ / 00O . 0G/ SOFT d-700 LSO FT APPLICANT'S SIGNATURE DATE U / DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN 1 SMIP X INVOICE /] PAIDAMOUNT AMOUNT 1 1�[]. Q O CASH O CHECK p O CREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT OCASH OCHECKN 0 CREDIT 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 Houn Rd. 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