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PMT16-00051 City of Menifee Permit No.: PMT16-00051 29714 HAUN RD. Type: Residential Re-Roof <ACCEL/> MENIFEE, CA 92586 MENIFEE Date Issued: 01/06/2016 PERMIT Site Address: 28280 NORTHWOOD DR, MENIFEE, CA Parcel Number: 337-181-007 92586 Construction Cost: $5.777.00 Existing Use: Proposed Use: Description of TEAR OFF EXISTING SHINGLES, INSTALL 30#MOISTURE BARRIER AND NEW ASPHALT SHASTA Work: WHITE COOL ROOF SHINGLES Owner Contractor MIKE&MARTHA NAZEMI R H CONSTRUCTION ENTERPRISES INC 28280 NORTHWOOD DR 39311 CAMINO DEL VINO MENIFEE,CA 92586 TEMECULA, CA 92592 Applicant Phone: 9517128970 ANTHONY MARTINEZ License Number.426827 R H CONSTRUCTION ENTERPRISES INC 39311 CAMINO DEL VINO TEMECULA, CA 92592 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 carded 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 Permit_Template.rpt Page 1 of 1 City Of Menifee LICENSED DECLARATION ❑ lam exempt from licensure under the Contractors'Stale 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 in 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 1j License No. improvements covered by this permit. I cannot legally sell a structure that I have Expires Signature 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 WORK OMPENSATION 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 the following declarations: htto://www.leoinfo.ca.aovlcalaw.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 ❑ By my Signature below, I certify to each of the following: I am the property I have and will maintain workers' compensation insurence, 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, agree to comply permit is issued.My workers'compensation insurance carver and policy number are: with all applicable city and county ordinances and state laws relating to building s � �Ofy/pf5'gripr construction.I authorize representatives of this city or county to enter the above- Carrier Zi(1 /f/el/L� identified property for the inspection purposes. Policy# 9rtll�/l��?i Expires �>7/f 4 Date Property Owner orAuthorized Agent (This section need not be completed if the permit is for City Business License# Qt75 70 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 containi 'a hazardous material equal to or greater that the subject to the workers'compensation provisions of Section 3700 of the Labor amounts!Podfied on the Hazardous Materials Information Guide? Code,I shall forthwi comply with those provisions. / DYES NO 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 guidelin 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 propose uilding or modified facility be within 1000 feet of the outer DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of chool? 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 the list.I understand my requirements under the State of agency for the performance of the work which this permit Is issued (Section Callfomi allh&Safety Code,Section 25505 and 25534 concerning 3097 Civil Code) haz pus material re �rg. OWNER BUILDER DECLARATIONS YES ❑NO 1 hereby affirm under penalty of perjury that I am exempt from the Contractor's to License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OW ER OR AUTHORIZED AGENT next to the applicable items)(Section 7031.5.Business and Professions Code: EPA RENOVATION.REPAIR AND PAINTING RRP Any city or county that requires a permit to construct, alter, improve,demolish, (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 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 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 roe www-epa.gov/lead or contact the National Lead Information Center at - property,rty, 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). ❑ 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 A d,..,...ava,.e...e.a BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION Menifee DATE w / PERMIT/PLAN CHECK NUMBER PH ( t S� TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION ZMOUTION O ELECTRICAL O MECHANICAL O NEW O PLUMBING Q E-ROOF-NUMBER OF SQUARES lr DESCRIPTION OF WORK %SAX g5P,--� R PROJECT ADDRESS •;,e /ylE�iff G'�f ASSESSOR'S PARCEL NUMBER �j31 �Ib I (�Ll, LOT ��)O TRACT OWNER NAME 161!�o 2152�plr / ADDRESS PHONE " EMAIL APPLICANT NAME ADDRESS PHONE -�1si`3�S y3�% EMAIL CONTRACTOR'S NAME psi ti*�•OWNER BUILDER? 0 YES "rN0 BUSINESS NAME l/ ADDRESS 3�l�I� � /J/y0 492L A//�TJ tG�L/� G ' PHONE 9SL"lS�� ^9'�'� 'j EMAIL •�-- CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION.Yh S 77 SO FT L SO FT or APPLICANT'S SIGNATURE DATE CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION CITY OF�BOUS�E55 LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP D INVOICE PAIDAMOUNT AMOUNT I I -CASH 0CHECK# OCREDITCARD VISA/MC PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Deportment 29714 Houn Rd. 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