PMT16-00481 City of Menifee Permit No.: PMT16-00481
29714 HAUN RD.
�A_CCEL/� MENIFEE,CA 92586 Type: Residential Re-Roof
MENIFEE Date Issued:
02I25/2016
PERMIT
Site Address: 26730 W BERKEY CT, MENIFEE,CA Parcel Number: 337-343-002
92586 Construction Cost: $4,900.00
Existing Use: Proposed Use:
Description of REMOVE EXISTING COMP SHINGLES, REROOF W/OWENS CORNING SHASTA WHITE COOL
Work: ROOF
Owner Contractor
NORMA JACKSON FREDERICK RICHARDSON CONSTRUCTION
26730 W BERKEY CT 11187 TWILIGHT WAY
MENIFEE,CA 92586 MORENO VALLEY, CA 92555
Applicant Phone:9516536132
JOHN RICHARDSON License Number:643209
FREDERICK RICHARDSON CONSTRUCTION
11187 TWILIGHT WAY
MORENO VALLEY,CA 92555
Fee Description ,OQt Amount ISl
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 staled,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_Perrnit_TempIate.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
I hereby affirm under penalty of perjurythat I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License law).
Chapter!)(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure under the Contractor's State License law for
Professions Cod end my license is in full force and act. the following reason:
License Class ��9 Lice se �U� By my signature below l acknowledge that,except for my personal residence
Expires W/A Signature— in which imust have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
❑I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section
have and will maintain a certificate of consent of self-insure for worker's 7044 of the Business and Professions Code,is available upon request when
compensation,issued by the Director of Industrial Relations as provided for this application is submitted or at the following website:
by Section 3700 of the labor Code,for the performance of work for which www.IeRinfo.ca.gov/caIaw.htmI.permit is issued.
Policy H Date
�I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
ction 3700 of the Labor Code,for the performance of the work for which ❑By my signature below I certify to each of the following:I am the property
this permit is issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this
number are: application and the information l have provided is correct.I agree to comply
�� {�VIv� with all applicable city and county ordinances and state laws relating to
Carrier ��(( —? building construction.I authorize representatives of this city or county to
Policyfl �`t 7� Expires ��� �� enter the above identified property for inspection purposes.
(This section need not to be completed Is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWN ER OR AUTHORIZED AGENT
❑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 CITY BUSINESS LICENSE if er/�!/�✓D
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
su ctto the ork w ena[ion provisions of5ection 3700 of the Labor
CQ\�d1e,I shall f i rth co 11
/y�(v5dh tho a provisions. Will the applicant orfuture building occupant handle hazardous material or a
App' nt Y/ �/� Date��16 mixture containing a hazardous material equal to or greater that the
amounts r��pe�a Red on the Hazardous Materials Information Guide?
WARNI :FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 ❑Yes Y
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the appliant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguiclaQiV es
CONSTRUCTION LENDING AGENCY ❑Yes 0
1 hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 10oo feet of the
lending agency for the performance of the work which this permit is issued outer bou¢¢dary of a school?
(Section 3097 Civil Code) ❑Yes Ao
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklisL 1 understand my requirements under the State of
California Health ty Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the a adou m anal re
m
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,prior to its PR ERTY OWNER ORAUTHO ZED AGENT
issuance,also requires the applicant for the permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRP)
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)or that he or she is exempt from licensure receiving compensation for mostwork that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with
an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
❑I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure Is www.eoa.¢ov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code,The Contractors State License Law does not apply to an owner of a o An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certifration No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
❑I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
�'��Menifee
DATE oZJ �� PERMIT/PLAN CHECK NUMBER Iln-� OQ
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICALP MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES�
DESCRIPTION OF WORK QQ4Z- 1 I+may CO" - 11 A(,S U2 •I 1 `
ash
PROJECTADDRESS &_7�oD Gll• �fT
ASSESSOR'S PARCEL NUMBER
��/3 3
3#1�✓41004 LOT � TRACT
OWNER NAME /7 6t'�-t-
ADDRESS N.
(� '7
PHON 1.7� C (I , p EMAIL
JON
APPLICANT NAME �7 �C�i' S` �,�,�`�•°,�. ` p �� Q
ADDRESS /1�0e �UIbItit6- �l Tyz.-�-c'v✓ \�`-i �,(� (�.�5�
PHONE C(�/� ^�«2c� EMM�AIIL
CONTRACTOR'S NAME lG(U'N`�-'�' L[Ya� � OWNER BUILDER? OYES O
l� s� C.LJ�SrQCL�..J
BUSINESS NAME 77 /� �L.(ctzlvw-� p �� A.f Q ��j
ADDRESS ��, f�v Code \ 'Ct `(70 12�� /
PHONE -( 2�z �2Z 7 EMAIL q
CONTRACTOR'S STATE LIC NUMBER �j;;20 QQ ICENSE CLASSIFICATION
VALUATION$ � SQ FT //U� L SQ FT
APPLICANT'SSIGNAT RE DATE
DEPARTMENT DISTRIBUTION ro CITY OF MENIF2EE BUSINESS LIE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN ( SMIP 5b J
INVOICE I /{,�610 PAID AMOUNT O
AMOUNT ��// O CASH CCHECKk CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNIT OCASH OCHECKN OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. INenifee, CA 92586 951-672-6777
www.cityofineni fee.us Inspection Rep nest Line 951-246-6213
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