PMT16-01169 City of Menifee Permit No.: PMT16-01169
29714 HAUN RD. Type: Residential Re-Roof
<A_CCEUA_ MENIFEE, CA 92586
MENIFEE Date Issued:
04/18/2016
PERMIT
Site Address: 26362 LAZY CREEK RD, MENIFEE, CA Parcel Number: 338-224-010
92586 Construction Cost: $7,500.00
Existing Use: Proposed Use:
Description of REMOVE EXISTING 1 LAYER ROOF SHINGLES& FELT&REPLACE NEW FELT&MALARKEY COOL
Work: ROOF SHINGLES, BRONZED MESA, REPLACE WOOD AS NEEDED
Owner Contractor
DERRICK&CARRIE O'KEEFE
26362 LAZY CREEK RD
MENIFEE, CA 92586
Applicant License Number:
Fee Description 3t1' Amount I$)
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_Perrnit_Template.rpt Page 1 of 1
CITY OF MEN EE
LICENSED DECLARATION roperty 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 Iicensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class License No. By mysignature below I acknowledge that,except for my personal residence
Expires 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 copy of the applicable law,Section
have and will maintain a certificate of consent of self-insure for worker's 70"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.leginfo.caRoy/calaw.htmi.permit is issued.
Policy# Date
❑I have and will maintain workers 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
number are: application and the information I have provided is correct.I agree to comply
Carrier with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# Expires enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred p V/Qt[ S Date OWVIAJ � 1
dollars($100)or less PROPERTY OWNER OR AUTHORIZE GEM
❑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#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes ❑No
UNLAWFUL,AND SHALL SUBIECr 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($1013,000),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 forguidelines
CONSTRUCTION LENDING AGENCY ❑Yes ❑No
1 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
NER 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
Contractor's License Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oYes ❑No
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 PROPERTY OWNER 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 Contractor's 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 Iicensure 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 prectices.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.epa.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-80"24-LEAD(5323).
Code;The Contractor's State License Law does notapply to an ownerof a ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through em ployees'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 Contractor's 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
4.'
14
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 PRE-ROOF-NUMBER OFSQUARES APPu,2,P
DESCRIPTION OF WORK E' .V
S W i 7 H tj ^K--2
PROJECT ADDRESS f> &O (a-
ASSESSOR'S PARCEL NUMBER 73��a "O 10 LOT TRACT
OWNER NAME E2e C A f
ADDRESS Zy QD. -
PHONE RS) „2 1 1, D7,) EMAIL OD f}/L
APPLICANT NAME DE 4-L 4A'
11:5-
ADDRESS o7 (p rp Z�61�
PHONE 9�S-) ,,2J7 EMAIL C4109�� fJ-iL .D
CONTRACTOR'S NAME OWNER BUILDER? S ONO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ —1 c5m SQ FT L SO FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION ro CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I SMIP
INVOICE q PAIDAMOUNT
AMOUNT ` 0CASH OCHECKR OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 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 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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'0 J SOLAR REFLECTANCE TECHNICAL DATA City of M. n'"
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Ecoasis'"Premium, Ecoasis'"Sol, Highlander"'Dove e,an Dura-Seal°
Dove White are listed with the Cool Roof Rating Council(CRF (Cjnda� <r(t1t
ENERGY STAR certified. Ecoasis'"Costa and Highlander"'pp$bk A}}�n er4aSe
rJ CRRC listed.All shingles have tested to these radiative property values:
ENERGY m', SOLAR REFLECTANCE THERMAL EMITTANCE SOLAR RERECTW REL.
" PRODUCT ID
INITIAL WEATHERED INRIAI WEATHERED INITIAL WEATHERED
Od AGAVE ECOASIS'PREMIUM 0.27 0.25 0.92 0.96 29 28 0850-awn
04 MESQUITE ECOASIS"PREMIUM 0.28 0.26 0.93 0.97 31 30 0850-0018 .
Od TUMBLEWEED ECOASIS"PREMIUM 0.26 0.26 0.93 0.94 28 28 0850-0019
OJ ADOBE ECOASIS"SOL 0.28 0.26 0.91 0.96 30 29 0850-0012 .
OJ AGAVE ECOASIS'SOL 0.25 0.25 0.92 0.96 26 28 0850-0015
04 MESQUITE ECOASIS'SOL 028 0.26 0.89 0.96 29 29 0850-0010
OJ TUMBLEWEED ECOASIS"SOL 0.26 0.25 0.91 0.97 27 28 0850-0017 •fir
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J BHDNTED MESA ECOASIS"COSTA 0.21 Pending 0.92 Pending 21 Pending 0850-0025 kCe
J COPPER OASIS ECOASIS"COSTA 0.20 Pending 0.92 Pending 20 Pending oa50-0027 i
k
e J FROSTED GRANITE ECOASIS"COSTA 0.22 Pending 0.92 Pending 22 Pending 0850-0026
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J WILLOW WOOD ECOASIS"COSTA 0.20 Pending 0.92 Pending 20 Pending os50-oo2e
04 DOVE WHITE HIGHLANDER' 0.27 0.27 0.90 0.96 28 31 0850-0014 y,_!
�! J GOLDEN AMBER HIGHLANDER' 0.21 Pending 0.94 Pending 22 Pending 0850-0024 1
".... OJ DOVE WHITE DURA-SEAL" 0.26 0.28 0.91 0.98 27 33 0850-0013
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Licensed Manufacturer ID:0850 Classification:Production Line
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40Ma1ar1SOLAR REFLECTIVE SHINGLES
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Roofing Products® Ecoasis'Sol • • • •
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Defining Excellence:' Distributed from: *Portland,OR
WWW.MALARKEYROOFING.COM 0south Gate,CA Oklahoma City,OK