PMT16-00857 City of Menifee Permit No.: PMT16-00857
29714 HAUN RD. Type: Residential Re-Roof
�ACCEU/ MENIFEE,CA 92586
MENIFEE Date Issued: 03/22/2016
PERMIT
Site Address: 29528 AVIDA DR, MENIFEE, CA 92584 Parcel Number: 339-223-005
Construction Cost: $15,482.00
Existing Use: Proposed Use:
Description of TEAR OFF EXISTING LAYERS, INSTALL NEW 30#FELT AND NEW COOL ROOF SHINGLES
Work: "CRRC#0668-0084
Owner Contractor
JOSHUA STITT PETERSEN-DEAN INC
29528 AVIDA DRIVE 39300 CIVIC CENTER DRIVE
MENIFEE, CA 92584 FREMONT, CA 94538
Applicant Phone:5103716500
DALLAS PEREZ License Number:468117
PETERSEN-DEAN INC
1820 CONTAINER CIRCLE
RIVERSIDE, CA 92509
Phone:9095227180
Fee Description 9tt( Amount 15)
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 named 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_Pernit_Template,rpt Page 1 of 1
CITY OF MEN IFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
1 hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter9(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 Code and my license is in full force and effect. C the following reason:
License a s U o. 71 By my signature below I acknowledge that,except for my personal residence
Expire 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
WORK R'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 dedar tions:I li tractors. u erst nd that a copy of the applicable law,Section
have and will maintain a certificate of consent of self-insure for worker's 7044 the sines d Prof ssions Code,is available upon request when
compensation,issued by the Director of Industrial Relations as provided for e
th' ppliwtio is sum edkIZEENT
g website:
by Section 3700 of the labor Code,for the performance of work for which .le info.c . o ca caw.this permit is issued. -Policy# Date❑I have and will maintain workers compensation insurance,as required by P OPERTYOW RAUTHsection 3700 of the Labor Code,for the performance of the work for which By my signature below I cee followin :I am the property
this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this
number are: F application and the information I have provided is correct.I agree to comply
Carrier L 5 L—/-7.�tL7� with ,ce a nd mu rdinances and state laws relating to
�t . x���(j/� / p _ buildingcon ction.l prize presen Fives ofthis city or county to
Policy#I.i.t L�/ ire, ant theabov identi dpra ertyf ins pedionpurposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less R PE W RA O A
certify that in the performance of the work for which this permit is issued,
all not employ any persons-i manner so as to become subject to the CITY BUSINESS LICENSE#
workers compenss of Califo ia,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to thew kers corn nsatlon � o ction 3700 the Labor
Code,I shall f0 h ith comply Kith th 4e visi Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greaterthat the
Applicant /' � Date amounts specified on the Hazardous Materials Information Guide?
WARNING. �L ECU W RKER'S MPENSATIONVERAG 6 ❑Yes [�Ao
UNIAWFUL,A SHALL SUB{ AN EMPL Y TO OR
VERAGIES Will the intended use of the building by the applicant or future building
AND OVAL FINES UP TO ONE(j DUD TH USA D DOLLARS($300,000),IN occupant require a perinit for the construction or modification from South
E AL
ADDITION 70 THE COST OF COMPENSATI ,DA GES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,IN ST ND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY O Yes 0
1 hereby affirm that under the penalty of perjury there Is a construction Will the 11posed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer bo ndary of a school?
(Section 3097 Civil Code) ❑Yes rNo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
hereby affirm under penalty of perjury that I am exempt from the per r[t�' c 'st.I nd my requirements under the State of
Contractors License law for the reason(s)indicated below by the Cal 'a, a Healt aPety gde,Se ion 25505 and 25534 concerning
hafarus a 'a re o m .
checkmark(s)I have placed next to the applicable Rem(s)(Section 7031.5 ❑ es
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 PRO OWNER OR ORIZED G
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 Contractors State EPA RENOVATION R IRRP1
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 exemptfrom 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-certffied 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
❑1,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.epa.eov/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 R was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project bemuse:
❑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 PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL * RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING RE-ROOF
APPLICATION NAME Q
DESCRIPTION OF WORK _ (J1A AM
�COI `L. E
PROJECTADDRESS CA qpR-K4
.5N I N
ASSESSOR'S PARCEL NUMBER City Of fety
LOT TPt�Tdin & Safe t Dept.
LOT
OWNER NAME
ADDRESS ay
�—�^ y
PHONE c ��� �SO p ZM-� EMAIL
APPLICANT NAME Z
ADDRESS I Igao Coi&)�
((�/� (y
PHONE "!'��^n '�I' V -! EMAIL wAff - Crw-
CONTRACTOR'S NAME Conic n OWNER BUILDER? O YES O
BUSINESS NAME
ADDRESS
PHONE Qom/ EMAIL
CONTRACTOR'S STATE LIC NUMBER vY LICENSE CLASSIFICATION
VALUATION$ ' SQ L SQ FT
APPLICANT'S SIGNATURE - DATE
CITY STAFF USE ONLY _
DEPARTMENT DI5TRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE SMIP -' REEN
INVOICE o pglD AMOUNT O
AMOUNT L OCASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO LICENSE 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
M T D v n .ZI
* Z n mm � �n O m
0 c. w m -i
w ti N m o m o a p -{ o 3 D :0 nmD
c 3 „0 0 c o m O w �- ' m 'n m .� f1
m of ^ = m o O z -_nw y 3- F+ mm m w a a Z i -m. -0
n O M rn C O n p 9 m b j n m 0 K O N A �Y f7 a m 0
o r an n 1 v a n m D � Z>
m a n a < m D m m m _r m m
0 3 n o' m N m' p m a m m A m '�0
m y. N m n o N m .< -On 2 C 6 ll m O
!gy�pp
Z
n n Q w D '° '•Z o A 3 m S n m < .". m 0 3 D Z D
.r -n �` o v a m n a w 0 ,� R z
n m
0 p D 3 D -n .w. c 0 w D 3 0'��
n O N N 10 o w 3 �^ N 'D m m^ a m £ G O m O
m v a n m Z
w w n O Z N w S in £ N o ^ O £ S O 11 m N
a m o a m ^ C
'o ; N , o a_ 3 w p 'o n n p ', 0 0 0 O
m m N .m-r m N -pi. _ N u0i O 3 C A ; X
m y 3 � p a A O 0 n c m 1, p rt n ^ O O Q
N ^ 9 Nz m^ S � � N ag Sd 3 n5
rt .p o, o m 3 0 o N 3 0 0° o n 'm K ( v O
i
F+ !D $ w m
N n i r
o M m O
m
H = o 3 0 O R. p N a rt m H A
c m # 3 w N °�° Z p ^w 4 0 3 c o < m N
,w.. p^ ^ n A o O S w m w m n C O
O 3 H o O O x• m N , y
M 'o'• £ 0, a c S o n 'aoo 'm o ID Ern O n _ F N — n in A
� m
Q -pw N 0 j A w .m.•
w N •.wi v n ^' G m' m j i m V
c w N m a w
m to p °•
o n N N m
0 o' o
O N t+ v O. 3 A
n ^ ig,
m ' O O ry x
M N J = m m a O
m O w 3 < O
O O M m OO p w
a 1 3
m 0 a a a
T T m j a 3 ,..
T < m c m w 0 � m n m w a °°
m m 3 a^ m
m .. m' 3
c c m
_ a 3 m w W
o m
-c 10 3 0
o m w .w. < 0 a o C
= H m < — O
m O n m
a 0 i O mo
a A a x a
C m
m 0 > A
3 n 0 p O
F+
y m n j p i
m o
c m o
m m
O N a m o 0 3 3 m
p 9 T 3 [Vll lVfl C N A
0 3 0 a m m a m <
_ n
V m 3 m �n ID 3
^ ^ 3 Oct
w
n m N O z
m
_ •^ n D n Z • v M
W R 3 3 n S O W N F~+ O 1O W J Ol V1 A N ;a
m -Jc <'"' (ail m m 333 £ va g _ a 'O .oaO' � •p
S
m a d D o� S 3 3 3 P o o °1 00 a o c c ?- n -D•1
O •' n -i n n C C C m (ND O N N
s
C In Z O (n�D Z N 0
w C m C O C G A m -+. �' 6 m = ; IA -�. ¢ m fD O
O 'A N m J
N I ^y 0 w N 6 6 O m j ry 'j w ° w n �! o y
as 1p rn 3 n O s w •� 3 m a d Imo^ o p c J m m m o d J :. 'm H A p— c O
JJ ' n o '° `° 3 3 0 .t 'n N m m m o o .-. T w m f Z
J d p p. J. ._. ..� n
w 3 D m m d m j m o m o a > ; m o y m A Z a w m
A -°+. � OJO ° N A
w Q a N C N
J ♦ 1\ N Z �' F• N 3 '� (D 3 umi N W N n d d C N W. w
i O• fn 1D c m y m T m "' n c m d c m m ,°I—, N N O
n w
am m
n 3 m ¢ c 3 o m K
d M Z C d O J m Np O J N rt ^ m d m m Q d �#
n V ^1 O J 3 .c* n m .�ur C p_ ° n n n ? p m DVA
_a m _ _ N — _ y ry 0 d 0. N. On a .< S O
C. 1O 0J-
� (\I � A M N Q d a N U J !C
y d p A 0 M
Z ''^r m n edi O vmi < a O. ref
c Z
m m ¢ ¢ T S 3 d -O O w CD
Qa n ^ o M. O < A m 0 fl S 2 p- C On O
c n 9 o o c c vy—i f° o °° '* a n m
m
y n m SL o m S 3 ry O G
.r n n d ti
d d Z A = C y F c n a IyD
M 0 O
C O C M d n JJ m 6 J M J
'• V a M K D v OO < K C 0 N p n
o a n rn ° d - -
x n d m m N• :2
o > >
1° o+
n
c n m —
1
m
3
N
Li
� an J
D K
fdl S m d uci O ¢
m c a =
J A m d ID
41 m 6 w -O d ee
n n n y o N
O m m N N 3 J O C7
9
m o ^
J
C. O N
a
m s w DZ < m
m
.me o
3 a N n 0 p m
D°q A
m n (D O
m
.r D O
3 m m m' O T
n a Z
a N N n
J O
N �