PMT15-03673 City of Menifee Permit No.: PMT15-03673
29714 HAUN RD. Type: Residential Re-Roof
�ACCELJ? MENIFEE, CA 92586
MENIFEE Date Issued: 11/25/2015
PERMIT
Site Address: 29886 SUN COUNTRY LN, MENIFEE, CA Parcel Number: 338-121-025
92586 Construction Cost: $7,985.00
Existing Use: Proposed Use:
Description of REMOVE 2 LAYERS, REROOF WITH CLASS A ASPHALT SHINGLES-COOL ROOF
Work: **CRRC-0890-0002
Owner Contractor
FRANK HARTMAN WEATHERTIGHT ROOFING INC
29886 SUN COUNTRY LANE P O BOX 5281
MENIFEE,CA 92586 HEMET, CA 92544
Applicant Phone:9519290557
GUY SCHEMBRI License Number:643691
WEATHERTIGHT ROOFING INC
P O BOX 5281
HEMET, CA 92544
Fee Description City Amount($1
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 Men'Ifee.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_eldg_Permit_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ lam exempt from licensure under the Contractors'State License Law for the
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 farce and a�c�., which I must have resided for at least one year prior to completion of
License Class �3 License No. 7 5(09/�9/ improvements covered by this permit, I cannot legally sell a structure that I have
Expires Signahv -�- �_�4 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
LT—
WORKERS'COMPENSATION 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 of the following declarations: htto://www.leainfo.p.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# we y7 eft 7 9-'io '5 ❑ By my Signature below, 1 certify to each of the following: I am the property
❑ 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 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'mmpensation insurance carrier and policy number are: with all applicable city and county ordinances and state laws relating to building
construction.I authorize representatives of this city or county to enter the above-
Carrier'��u ri< /Z_ identified property for the Inspection purposes.
Policy#k)dg75S(?9 Expires &—O/— �Lv Date
Property Owner or Authorized Agent
(This section need not be completed if the permit is for City Business License
one-hundred dollars($100)or less)
HAZARDOUS MATERIAL DECLARATION
I 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 forthwith comply with those provisions. DYES ❑NO
Applicant / Date; �I 7— S' (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 ONO
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 feetof the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES ❑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 conceming
3097 Civil Code) hazardous material reporting. /
OWNER BUILDER DECLARATIONS ❑YaFO NO
,,y GGGi.-ii Date l/—ZS- /
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the reason(s)indicated below by the checkmark(s)I have placed___-PR9P TY WNER 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 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 Finn Certification No.:
purpose of sale).
❑ 1, as owner of the property an exclusively contracting with licensed D 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.
CITY OF MENIFEE City of Ntenifea PLCK NO: Permit No:
Building & Safety Dept. S—
29714 Haun Road Date: Date:
Menifee, CA 92586 NOV 2 5 2015 111-Zs-- fs
Phone: (951)672-6777 Amount Arnt: a_0
Fax:(951)679-3843 Received Ck#: Ck#:
Building Combination Permit
To Be Completed By Applicant
Legal Description[i Tz - I �JZO�e'- 1y Lt2 Planning Case: F: L: Rt: R:
Pro��perty Pd�es�s: t n ` Assessors Parcel Number:
el ft LO S l..OlwT^t 1'� . z3 $ -lZI-[ :�z S
Projectrt'r t"�enant ame: , ` ax 1 Unit*. Floor#:
t�CcL\ I�Name:'_t..4Vt CiA'�Ifv1<<Vl ° I�°'lo'7 R-4A 23 Fax No,
Property Address: Unit Number ZipC de
Owner $ $�p SULv� b'
Email Address:
Na e: one o. Fax
Applicant dzss: Rip� i _ jk eve 1 C p G�St(tf Unit Number Zip Code
Email Address: 11 cam- LYE-' [ T pq
W¢!.�'hP�t'T; � Lh PC751�°9.2��0$✓r '� F 51 Ra5-�1U
Contractor gtldit,- a g 1 c stale zip Codas 5 4 V
oontr ctor s City uslness License No. Contractors City S ate of Callfomla License No. I Classification: n �G
Number of Squares: 1.:. I
Square FootageZ�,dtj
De cription° ork: 1t, Cost of Work:$
Y!�'✓' - C'eX"xoUQ 'C,XIS� ,n tu.�{Tvl (�'�aSS_ 9�Jri pC�
Appli Signatur _ ate:
To.Be Completed By Ctty Staff Only
Indicate As R-Received or N/A-Not Applicable
5 Completes se of fully dimensioned.drawn to sale plans which include: t set of documents which Include
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Geo Tech/Soils Report(on cd only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on B'/x 71)
❑ El Structural Calculations
Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Single Line diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration' Addition' Means/Methods
Work Type: Repair' Retrofit' Revision to Existing Per it Required? YES NO
Proposed Building Use(,): Existing Building Use(s):
#Buildings: #Units: #Stories: Will the Building Have a Basement? Y of N
Bldg.Code Occupancy Group Indicate Indicate if YES or NO Indicate all Geo-tech.Hez.Zone
At Project Construction Sprinklered that apply: Coastal Zone
Completion: Type(s): C Of O Noise Zone
Required? YES or NOF Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board Landmark Comm. Planning Comm.Zoning Administrator
Fee Exempt: City Project Elec.Vehicle Charger Landmark Seismic Retrofit 'pedal case:aldg.
Official Approval
Expedite Project(s): Child Care City Project Green Building I I Landmarkl I Affordable Housing
For Staff Use Only
Building/SafetyPermit Specialist I City Planning I Civil Engineering EPWM-Admin I Transportation MgML I Rent Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
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