PMT16-01325 City of Menifee Permit No.: PMT16-01325
29714 HAUN RD.MENIFEE, CA 92586 Type: Residential Re-Roof
�ACCELA7
MENIFEE Datelssued:
0412712016
PERMIT
Site Address: 27139 BLUE HILL DR, MENIFEE, CA Parcel Number: 336-102-005
92586 Construction Cost: $5,000.00
Existing Use: Proposed Use:
Description of FLAT ROOF: TEAR OFF, INSTALL MODIFIED TORCH DOWN
Work:
Owner Contractor
MARJORIE WATSON ARCADE CURVES ROOFING
27139 BLUE HILL DR P O BOX 9442
MENIFEE, CA 92586 ALTA LOMA,CA 91701
Applicant Phone:9493382869
DOMINIC VASQUEZ License Number: 797664
ARCADE CURVES ROOFING
P 0 BOX 9442
ALTA LOMA,CA 91701
Fee Description city Amount f$1
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 Permit_Template.rpl Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or Improves thereon,and who contracts forthe 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 my ' ense is in full force fect. the following reason:
License Class G e m. By my signature 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 7044 of the Business and Professions Cade,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,forthe performance of work for which www leainfo.ca.eov/calaw.html.
this permit is issued.
Policy# Date
ATFave 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 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 I have provided is correct I agree to comply
with all applicable city and county ordinances and state laws relating to
Carrier .p building construction.I authorize representatives of this city or county to
Policy# �y 1( 2 Expires —Z !07 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 2r
❑I certify that in the performance of the work for which this permit is issued, /��+/�./y7�
I shall not eo an rsons in any manner so as to become subject to the CITY BUSINESS LICENSE# oe5� JV
workers c,Zap
satio so California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to r ersco nsation provisions of Section 3700 of the Labor
Code,I sit orthwith co ply with those provisions. Will the applicant or future building occupant handle hazardous material ora
Applicant Date mixture containing a hazardous material equal to or greaterthat the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 ❑Yes V.No
UNLAWFUL,AND SHALL SUBIECTAN 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 forthe construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)7 See permitting checklist
IN SECrION 37060E THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY ❑Yes fNo
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 checkrstand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the
California He o ection 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the hazardous enal reporti (�
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 0yeS `�
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 PROPER NT
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 jRRP)
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 forthe 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($500). managerswho do the paint-disturbing work themselves orthrough their
❑I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( I portion of the work,and the structure is www.eoagov�ead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code,The Contractors State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
❑I;as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please Hill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
;;Nlenifee
DATE ,a 7-14�F, PERMIT/PLAN CHECK NUMBER 7H
TYPE: 0 COMMERCIAL 46RESIDENTIAL MULTI-FAMILY MOBILE HOME 0 POOL/SPA SIGN
SUBTYPE: C ADDITION O ALTERATION ", DEMOLITION ELECTRICAL C MECHANICAL
C NEW O PLUMBING k-RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
i��lf bor�N, p-y�j
PROJECT ADDRESS 2 '71 .3`I��//'��"E ����'�'
ASSESSOR'S PARCEL NUMBER :5%11 - l�� ' oOS LOT TRACT
OWNER NAME /��_10JQWX 02-f&
ADDRESS z�II3 y LC+F7' "" tG tdI2
PHONE �' , ?Z-9Q EMAIL
APPLICANT NAME V4$P 1"d"2�y
ADDRESS ,f6/I `�S—/Q�^T� CPIQ`!'� L+ 7A' Ct} `� �737
PHONE �7 ��7�y''Z�wS�'7 EMAIL
CONTRACTOR'S NAME I� � R✓�'s OWNER BUILDER? 0 YES kNO
BUSINESS NAME
ADDRESS 47^��$`/qL*rap P-wwON/0-YJ0041 47, 41,<f 9j?
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER �g`Z(GfP'/ LICENSE CLASSIFICATION
VALUATION $ �� (¢-IZP� L SO FT/
APPLICANT'S SIGNATURE DATE
L,I
DEPARTMENT DISTRIBUTION .00 CITY OF M NIF BU '�E�S LI NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIPL /'!J
INVOICE kp��
CID AMOUNT
AMOUNT ' CASH C%CHECK# 'OCREDITCARD VISA/MC
PLAN CHECK FEES ID AMOUNT OCASH %CHECK# O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES C NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-5777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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