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PMT16-00440 City of Menifee Permit No.: PMT16-00440 29714 HAUN RD. Type: Residential Re-Roof '5A_CCELA_> MENIFEE, CA 92586 MENIFEE Date Issued: 0 212 212 01 6 PERMIT Site Address: 26017 LAZY CREEK RD, MENIFEE, CA Parcel Number: 338-271-001 92586 Construction Cost: $19,542.00 Existing Use: Proposed Use: Description of REMOVE EXISTING 1 LAYER, REROOF W/OWENS CORNING AMBER COOL ROOF Work: Owner Contractor RICHARD LOPEZ PACIFIC HOME WORKS INC 26017 LAZY CREEK RD 1602 LOCKNESS PLACE MENIFEE, CA 92586 TORRANCE,CA 90501 Applicant Phone:3105341033 JARED GARCIA License Number:784477 PACIFIC HOME WORKS INC 1602 LOCKNESS PLACE TORRANCE, CA 90501 Fee Description OQt Amount f51 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_Templatexpt Page 1 of 1 City Of Menifee LICENSED DECLARATION ❑ 1 am exempt from Iicensure 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 Cod a9�my lice se is in full force and effect. !� which I must have resided for at least one year prior to completion of License Clags � I License No. 7 7 improvements covered by this permit, I cannot legally sell a structure that I have Expires �1 6 (IO 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 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: httc):/Avww.leoinfo.ca.aov/calaw.html.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 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.Myworkers'compensation insurance carrier and policy number are: with all applicable city and county ordinances and state laws relating to building (J �J construction.I authorize representatives of this city or county to enter the above- Carder Fj Imo!/mot C �/ d identified property for the inspection purposes. Policy#R()(y-7'�O 5�j LaA Expires 20(� Date Property Owner or Authorized Agent (This section need pot be completed If the permit is for City Business License# O one-hundred dollars($100)or less) ❑ 1 certify that in the performance of the work for which this permit is issued, L RDOUS MATERIAL DECLARATION shall not employ any persons in any manner so as to become subject to the the applicant or future building occupant handle hazardous material or a workers compensation laws of California, and agree that if I should becometure containing a hazardous material equal to or greater that the subject to the workers' mpensation provisions of Section 3700 of the Laborount's seecified on the Hazardous Materials Information Guide? Code,I sh rthwith mpiy with those provisions DYES ES 1�NO !WARNI cant; Date; the intended use of the building by the applicant or future building It upant require a permit for the construction or modification from South FAILURE TO SECURE WORKERS' st Air Quality Management District(SCAQMD)?See permitting checklist COMP SATION COVERAGE IS UNLAWFUL, AND SHALLuidelines SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ANDDYES 0 CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, the oposed building or modified facility be within 1000 feet of the outer DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THEndary of a school? LABOR CODE, INTEREST,AND ATTORNEYS FEES ES �000NSTRUCTION LENDING AGENCYve read the Hazardous Material Information Guide and the SCAQMD I hereby affirm that under the penalty of perjury there is a construction lendingmitting checklist.I understand my requirements under the State of agency for the performance of the work which this permit is issued (Sectionifomia Health&Safety Code,Section 25505 and 25534 concerning 3097 Civil Code) ardous mate' portingOWNER BUILDER DECLARATIONS ES �NO -I hereby affirm under penalty of perjury that I am exempt from the Contractor'sDateLicense Law for the reason(s)indicated below by the checkmark(s)I have placedPERTY W ER 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(RRP1 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: ❑ 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 Stale 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 Finn 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 �-" Menifee DATE PERMIT/PLAN CHECK NUMBER TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL ONEW OPLUMBING RE-ROOF-NUMBER OF/rSQUARES DESCRIPTION OF WORK �•C. `G. v-u� PROJECTADDRESS © 1 l,i�GPi JIV ASSESSOR'S PARCEL NUMBER ?j 'oZ� (�I LOT TRACT OWNER NAMEn P o ADDRESS �/y—�PLyZ �yQ PHONE R S I ( Z [ X [(p EMAIL APPLICANT NAME ADDRESS PHONE qsr 3 5- EMAIL CONTRACTOR'S NAME OWNER BUILDER? O YES NO BUSINESS NAME ADDRESS v a PHONE f 95 9W-617,7 tt EMAIL CONTRACTOR'S STATE LIIC/N � y7 NUMBER 77 LICENSE CLASSIFICATION 6 `Q VALUATION$ ( ( �( G� SO FT ( � L SO FT 2 `ZZ/& APPLICANT'S SIGNATURE DATE DEPARTMENT DISTRIBUTION CITYO/E,M 55/ty/NSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN I SMIP �/ �; INVOICE AMOUNT • PAIDAMOUNT 0CASH 0 CHECK# OCREDITCARD VISA/MC PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER 0 YES O NO City of Menifee Building& Safety Department 29714 HaUO Rd. 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