PMT15-03557 City of Menifee Permit No.: PMT15-03557
29714 HAUN RD.
Type: Residential Re-Roof
�I-�CCEL/!�. MENIFEE,CA 92586
NOR...` MENIFEE Date Issued: 1 111 312 01 5
PERMIT
Site Address: 27286 HACIENDA DR, MENIFEE, CA Parcel Number: 336-232-020
92586 Construction Cost: $10,598.00
Existing Use: Proposed Use:
Description of ARCHITECTURAL SHINGLE INSTALL&HOT MOP PATIO ROOF INSTALLATION
Work:
Owner Contractor
JD PROPERTY MANAGEMENT, INC R&R ROOFING
3520 CADILLAC AVE. P O BOX 2162
COSTA MESA, CA 92626 SUN CITY, CA 92586
Applicant Phone:9512460695
RAUL JASSO License Number:934782
R&R ROOFING
P O BOX 2162
SUN CITY,CA 92586
Fee Description O_yt 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_Bldg_Pennit_Template.rpl 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 or
License Class C 39 License No. improvements covered by this permit, I cannot legally sell a structure that I have
Expires 0 17 Signature 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 DECLARATI Business and Professions Code,is available upon request when this application it
submitted or at the following Web site:
❑ 1 hereby affirm under penalty of perjury one of the following declarations: htto:!/www.leglnfo.ca.gov/calaw.html.
I have and will maintain a certificate of consent of self4risure 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 orAulhodzed Agent
Policy# ❑ By my Signature below, I certify to each of the following: 1 am the property
W I have and wit maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read thie
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 complt
permit is issued.My workers'compensation insurance carrier 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 Sd-W CADV XW' RNIP identified property for th inspection purposes.
x
Policy# °� 03 (p Expires lo� 5 1Io )c - - Date 1 b
Prope Owner rAutharized agent
(This section need not be completed if the permit is for I
one-hundred dollars($100)or less) City Business License#O$to 01
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 Califomia, 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 ply with those provisions. DYES E(NO
Applicant; Date; 1L/13��f Will the Intended use of the building by the applicant or future building
fff 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 AD
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 2 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 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 report) e
OWNER BUILDER DECLARATIONS II YES PrNO _
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date 1% 6
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY W R 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(RRPI
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 Stale 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 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:
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).
❑ 1, as owner of the property an exclusively contracting with licensed No EPA Lead-Safe Certified Firth 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 contractors)pursuant to the Contractors State License Law). If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
[BUILDING APPLIC:ATIO7N ::
A:*
Yy .
DATE 1 111 2/2 0 1 5 PERMIT/PLAN CHECK NUMBER
P -C4C -O 3SS �
TYPE: ❑COMMERCIAL ❑✓ RESIDENTIAL MULTI-FAMILY ❑MOBILE HOME POOL/SPA SIGN
SUBTYPE: ❑ADDITION ALTERATION ❑DEMOLITION []ELECTRICAL MECHANICAL
❑NEW ❑PLUMBING p✓ RE-ROOF-N UMBER OF SQUARES_
DESCRIPTION OF WORK Architectural Shingle Installation Patio Roof Installation-Hot Mop
PROJECTADDRESS 27286 Hacienda Dr.Sun City CA//
ASSESSOR'S PARCEL NUMBER 33(, LOT _�_ TRACT g•3 — '3
PROPERTY OWNER'S NAME JD Property Management,Inc
ADDRESS 3520 Cadillac Ave.Costa Mesa, CA 92626
PHONE 951-235 9777 EMAIL vniermann@sbcglobal.net Building & ga ggy Dept.
APPLICANT NAME Raul Jasso NOV 13 2015
ADDRESS 26338 Rim Creek Path, Menifee, CA 92584
PHONE 951-264-9207
EMAIL woody.jasso@randrroofing.net
NAME Raul Jasso UILDER?
❑YES❑✓ NOBUSINESS NAME R&R Roofing
ADDRESS 26338 Rim Creek Path,Menifee, CA 92584
PHONE 951-246-0695EMAIL menifeeroofing
CONTRACTOR'S STATE LIC NUMBER 934782 LICENSE CLASSIFICATION C-39
VALUATION$ 10,598.00
L SQ FT
APPLICANT'S SIGNATURE DATE 11/12/2015
'DEPARTMENT DISTRIBUTION' -
BUILDING PLANNING ENGINEERING FIRE GREEN 1 SMIP CITY OF ME Ql NIFEE BUSINESS LICENSE NUMBER
o
INVOICE u D
AMOUNT PAIDAMOUNT 4
1 0CASH 0CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT
O CASH O CHECK A O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER
NOTARIZED LETTER O YES O NO
_it;G1`;11enIjeEJEi.ii!dl C' SGj ei;% 13 ; G: ni-_j71 _
ii G'fl iT Q, lI�`lEIt1J2?, !-',!j 9 JSSC 951-0:2-C 77!'
UVWbe.Ci%1/Dj�^72i7Ij P2.US !?>`J?C';Oi7 R?gUr'Si Li/Te 951-246-6213