PMT15-04020 City of Menifee Permit No.: PMT16-04020
29714 HAUN RD. Type: Residential Re-Roof
�ACCEL/� MENIFEE,CA 92586
MENIFEE Date Issued:
1213012015
PERMIT
Site Address: 26251 MCCALL BLVD, MENIFEE, CA Parcel Number: 337-031-006
92586 Construction Cost: $4,500.00
Existing Use: Proposed Use:
Description of REMOVE EXISITING 2 LAYERS&RE ROOF W/FIBERGLASS SHINGLES"`VERIFY RADIANT
Work: BARRIER(ASTM E84/ASTM 2599)
Owner Contractor
GARY MICHOVICH
3128 E 1ST STREET
MENIFEE,CA 90803
Applicant License Number:
GARY MICHOVICH
3128 E 1 ST STREET
MENIFEE,CA 90803
Phone:5624771958
Fee Description Qtv Amount t$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 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.
A4_e1dg_Permit_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ I am exempt from licegsT under the Cofi} ctors,gto_t`e LicenseI
I hereby affirm under penalty or perjury that I am licensed under provisions of following reason: l ,C..)iti2n 11.e. `� .
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 0
License Class License No. improvements covered by this permit, I cannot legally sell a structure that I havr
Expires Signature built as an owner-building if it has not been constructed in its entirety by licenser
contractors. I understand that a copy of the applicable law, Section 7044 of thr
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application Ir
submitted or at the following Web site:
❑ 1 hereby affirm under penalty of perjury one of the following declarations: htt J le info. a o ca rlaw. I.
I have and will maintain a certificate of consent of self-insure for workers' 1
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. Properly er or Authorized Agent
Policy# ❑ By my Signature below, I certify to each of the following: I am the propery
❑ 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 wmp11
permit is issued.My workers'compensation insurance carrier and policy number are: with all applicable city and county ordinances and state laws relating to bu'Idinc
construction.I authorize representatives of this city or county to enter the a ove
Carder !den" rt forth spa on puirposes.
Policy# Expires t' Date
Prope O ner or Authorized Agent
(This section need not be completed If the permit Is for
one-hundred dollars($100)or less) City Business License#
❑ 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. DYES -,&00
Applicant; Date; 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 1O�N0
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 T9410
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' g.
OWNER BUILDER DECLARATIONS T"' ❑r O-
I hereby affirm under penalty of perjury that I am exempt from the Contractor's L Date 3�
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPER 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:
❑ ro www.epa.govAead 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 Finn 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
APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK
DATE 12i29i2015 PERMIT/PLAN CHECK NUMBER — c 140
TYPE: ❑COMMERCIAL ❑✓ RESIDENTIAL MULTI-FAMILY MOBILE HOME POOL/SPA SIGN
SUBTYPE: ❑ADDITION []ALTERATION [-]DEMOLITION []ELECTRICAL MECHANICAL
❑NEW [-]PLUMBING ❑✓ RE-ROOF-NUMBER OF SQUARES P
DESCRIPTION OF WORK remove two layers of previous roofing and completely reroof with fiberglass shingles.
PROJECTADDRESS 26251 McCall Boulevard, Meifee, CA 92586
ASSESSOR'S PARCEL NUMBER p4re*t 337-b3j-CaM(0 LOT 96 TRACT 3643
PROPERTY OWNER'S NAME Gary Michovich and Henri Winters
^ity of Menifee
ADDRESS 3128 E 1st Street, Long Beach,CA 90803 Building& Safety De .
PHONE 562477-1958 EMAIL michovich@yahoo.com
APPLICANT NAME Gary Michovich
ADDRESS 3128 E 1st Street, Long Beach, CA 90803 ecesve
PHONE 562 477-1958 EMAIL michovich@yahoo.com
CONTRACTOR'S NAME OWNER BUILDER? ❑✓YES❑NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION $ 4,500 SO FT 2,500 L SO FT
APPLICANT'S SIGNATURE L DATE 1 212 9/2 01 5
DEPARTMENT DISTRIBUTION + CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN ` SMIP !,J(iJOLL'✓ ,7 ,/p(
INVOICE PAID AMOUNT �'
AMOUNT � --�-' I'2 0CASH 0CHECKN OCREDIi CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT OCASH 0CHECK# 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
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15 ARMA FOIL--Perforated Radiant Barrier Insulation AF0333-17
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12GOM15 ARMA FOIL^ -Perforated Radiant Barrier Insulation AF0333-17
Area: 333 f:2
Thickness: 4 mil
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Emissivity: 0.05(ASTM C1371)
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Shipping Weight: -8lbs More Information:
11 Spec Sheet
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