PMT16-00966 City of Menifee Permit No.: PMT16-00966
29714 HAUN RD. Type: Residential Re-Roof
SnCCEL/_> MENIFEE, CA 92586
MENIFEE Date Issued: 04101/2 01 6
PERMIT
Site Address: 29041 GLEN OAKS DR, MENIFEE, CA Parcel Number: 338-022-002
92586 Construction Cost: $5,890.00
Existing Use: Proposed Use:
Description of REROOF ONLY BACK HALF W/COOL ROOF SHINGLES(50%OF ROOF)
Work:
Owner Contractor
BRIAN&CYNTHIA SORENSON WEATHERTIGHT ROOFING INC
29041 GLEN OAKS DR P O BOX 5281
MENIFEE, CA 92586 HEMET, CA 92544
Applicant Phone: 9519290557
GUY SCHEMBRI License Number:643691
WEATHERTIGHT ROOFING INC
P O BOX 5281
HEMET, CA 92544
Fee Description Oft( Amount($)
Building Permit Issuance 1 27.00
Inspections not specified 98 98.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 1.00
General Plan Maintenance Fee-Building 1 4.90
$131.90
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_Permit_Templale.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 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 ❑I am exempt from licensure under the Contractor's State License Law for
Professions Code and mylicense is in full force and effezctt3 to to'? the following reason:
License Class C -3- License No. flee By my signature below I acknowledge that,except for my personal residence
Expires o-Ile Signatur �� C in which)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 copy of the applicable law,Section
have and will maintain 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
this permit is issued. www.leginfo.ca.eov/calaw.html.
Polity tt Date
have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 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 workers compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
numberare: " — �` application and the information I have provided is correct.I agree to comply
Carrier _ZA '� with all applicable city and county ordinances and state laws relating to
''II _ building construction.I authorize representatives of this city or county to
Policy# 7'S &'-7g4—Q3 Expires /a-31" 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
❑I certify that in the performance of the work for which this permit is issued, O 1 shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE p
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shall fort) nh comply those ovis" s. Will the applicant or future building occupant handle hazardous material or a
� // mixture containing a hazardous material equal to or greaterthat the
�icant Date amounts specified on the Hazardous Materials Information Guide?
WARNING:Wt U 0 SECURE WORKER'S COMPENSATION COVERAGE 15 ❑Yes "o
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 guideline
CONSTRUCTION LENDING AGENCY ❑Yes
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 boundary of a school?
(Section 3097 Civil Code) ❑Yes �No
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
Contractor hazzardou
s License Law for the reasons)indicated below by the hazardous
Health al Safety Code,Section 25505 and 25534 concerning
u
hs material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Dyes N6 '/
Business and Professions Code).Any city or county that requires permit to �' Date 7 'l—/ty
construct,alter,Improve,demolish or repair any structure,prior to its _5ZP9TY NER OR AUTHORIZED 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 Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRP)
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 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.eoa.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 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.
CITY OF MENIFEE PLCKNo:
29714 Haun Road Date: Date•
Menifee, CA 92586
Phone: (951)672-6777 Amount: Amou�
Fax:(951)679-3843 Ck#: Ck#: (J
Building Combination Permit a
To Be Completed By Applicant
Legal Descripaon• Planning Case: F: L: Rt: R:
Property Address: Assessor's Parcel Number.
D 35-Fn.2 c n
ProjecUTen e:ant Na Unit#: Floor#:
Name: I` L b No. Fax No.
PropeOwnerty Address: ` • Uni umber Zip •de
C w
Email Address:
N me: Phone No. Fax No.
Applicant Address: Unit Number Zip Code
Email Address:
Name: NQ
C�
Contractor Add ss: City State Co>d
c� BE Fs
ontractor s ity Bushes /_G Contractor's Cit � t iz lifomia License No. Classification:
� � 9
Number of Squares: ��•,� ? 'S
Square Footage
Description of Work: Cost of Work:$
i O
Aipipli5§Lesi SigAlur Dale:
To Be Completed By City Staff Only
Indicate As R-Received or N/A-Not Applicable
5 Completes sets of fully dimensioned,drawn to sale plans which include: 1 set of documents which include
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Gen Tech/Soils Report(on ed only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8'/a x 11)
❑ Structural Calculations
❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Single Line diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan 8 Details ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration' Addition* Means/Methods
Work Type:El Repair' Retrofit* Revision to Existing Permit'Required? YES NO
Proposed Building Use(s): Existing Building Use(s):
#Buildings: #Units: it Stories: Will the Building Have a Basement?
Y of N
Bldg. Code Occupancy Group Indicate Indicate if YES or NO Indicate all Geo-tech.Haz.Zone
At Project Construction Sprinklered that apply: Coastal Zone
Completion:
Type(s): C Of O YES or NO Noise Zone
Required? Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board Landmark Comm. I I Planning Comm.Zoning Administrator
Fee Exempt: City Project Elec.Vehicle Charger Landmark Seismic Retrofit special case:Brag.
OlficialApproval
Expedite Project(s): Child Care City Project Green Building Landmarkl Affordable Housing
For Staff Use Only
Building/Safely Permit Specialist City Planning I Civil Engineering EPN/M-Admin I Transportation Mgmt. I Rent Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
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