PMT16-00498 City of Menifee Permit No.: PMT16-00498
29714 HAUN RD. Type: Residential Re-Roof
�CCEL/_> MENIFEE,CA 92586
MENIFEE Date Issued: 02/29/2016
PERMIT
Site Address: 28640 SNEAD ST, MENIFEE, CA 92586 Parcel Number: 337374-009
Construction Cost: $8,000.00
Existing Use: Proposed Use:
Description of TEAR OFF EXISTING ROOF, REROOF W/OWENS CORNING COOL ROOF ANTIQUE SILVER
Work:
Owner Contractor
JACKIE RICHARDS VILLAREAL ROOFING CO
28640 SNEAD ST P 0 BOX 1581
MENIFEE,CA 92586 COLTON,CA 92324
Applicant Phone:9093701000
GILBERT VILLAREAL License Number:802689
VILLAREAL ROOFING CO
P 0 BOX 1581
COLTON,CA 92324 -
Fee Description Qtv Amount f91
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_Pennil Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
with a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that 1 am under provisions of
O I am exempt from licensure under the Contractors State License Law for
Chapter9(commencing with section 7000)of Division 3 of the Business and
Professions Code and my license is in full force and effect. rp b the following reason:
License(lass C— 3 Licei se No. Gg 91 By my signature below I acknowledge that,except for my personal residence
Expires /-3/- It Signature in which I must 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.Iegmfo.ca.aov/calaw.htmi.
this permit is issued.
Dale
Policy# PROPERTY OWNER OR AUTHORIZED AGENT
md'have and will maintain worker's compensation insurance,as required by
section 3700 of the Labor Code,for the performance of the work for which ❑By my signature below 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 owner's behalf.I have read this
number are: / application and the information I have provided is correct.I agree to comply
S r��� �/�yrJ with all applicable city and county ordinances and state laws relating to
Cartier pf building construction.I authorize representatives of this city or county to
Policy#1-9_�71' Expires /D Z,� 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 OWNER OR AUTHORIZED AGENT
❑Icertify that in the performance of the work for which this permit is issued, O Jq O dl�;p I
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers comppensation provisions of Section 3700 of the Labor Will the applicant or future building occupant handle hazardous material or
code,I shall thwi c bly j h rhos rovisions.
mixture containing a hazardous material equal to or greater thatthe
Applicant amounts 'filed on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS OYes �",
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant 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 for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes cko
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer boun of a school?
(Section 3097 Civil Code) ❑Yes o
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the California Health&Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the ha3pdous material reporting.checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 ONgs,f o N'� a�/}7✓ IC
and Professions Code).Any city or county that requires a permit to 7 f .b/r Z&111� Date
construct,alter,improve,demolish or repair any structure,prior to its PROP TY OWN R OR AUTHORIZED AGENT
issuance,also requires the applicant for the permit to file a signed statement EPA RENOVATION REPAIR AND PAINTING IRRPI
that he or she is licensed pursuant to the provisions of the Contractors State
License Law(Chapter 9(commencing with Section 7900)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 most work 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.eoamov/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 ❑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 Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
❑No EPA Lead-Safe Certified Finn is required for this project because:
not built or improved for the purpose of sale.
❑I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contactors 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.
APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK
Menifee
DATE �—a — I PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL u'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 (2,-fE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK ,—"r off i14/ % / L.12
PROJECTADDRESS 0 5;velho
S
ASSESSOR'S PARCEL NUMBER ;5'5 (' 1?14-OD I LOT (O J TRACT
OWNER NAME ^ `
ADDRESS 9-�C ter-' wv C f CA
PHONE 95/-3pl ` 0la-1 EMAIL
APPLICANT NAME Y-/- I` / r{ l
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME Y/' ` / /'.Ziq OWNER BUILDER? O YES O NO
BUSINESS NAME 4 i rJ
ADDRESS 11210 97 6i*,t'd Vie,% C-c- /3
PHONE Gfp�- 370'-1D(N EMAIL 2- O d�rGO
CONTRACTOR'S STATE LIC NUMBER 7 Odb D 9 LICENSE CLASSIFICATION C- 3
VALUATION$ cJ SQ FT !� �Q(J L SQ FT
APPLICANT'SSIGNATUR DATE a'C;L -�
DEPARTMENT DISTRIBUTION I CITY OF MENPE B SIN'S LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP .• ����
INVOICE I�}1 PAID AMOUNT V, n
AMOUNT ✓VV CASH OCHECKp CREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT OCASH OCHECK# 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. Menifee, CA 92586 951-672-6777
www.cityofineniiee.Lis Inspection Request Line 951-246-6213
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