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PMT16-01426 City of Menifee Permit No.: PMT16-01426 29714 HAUN RD. MENIFEE, CA 92586 Type: Residential Re-Roof MENIFEE Date Issued: 06/05/2016 PERMIT Site Address: 25622 ROANOKE RD, MENIFEE,CA Parcel Number: 339-042-024 92586 Construction Cost: $10,000.00 Existing Use: Proposed Use: Description of REMOVE EXISTING COMP SHINGLES, INSTALL NEW 30LB FELT AND NEW OWENS Work: CORNING-AMBER COOL ROOF COMP SHINGLES IN Owner Contractor MONTY HUFFINE FREEMAN AND SONS ROOFING 25622 ROANOAKE RD 28320 AGAVE WAY MENIFEE, CA 92586 MURRIETA, CA 92563 Applicant Phone:9516727500 VINCENT FREEMAN License Number:965749 FREEMAN AND SONS ROOFING 28320 AGAVE WAY MURRIETA, CA 92563 Fee Description Oft( Amount 1$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.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 o I am exempt from licensure under the Contractors State License Law for Professions Code and my license is in full force and effect.G [ the following reason: License Class Lic nse N U, ` By my signature below 1 acknowledge that,except for my personal residence ''__ Expires Signature in which 1 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 o 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 workers 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 tiwti,Ieainfo.ca.Jrov/calaw.html. this permit is issued. Policy# Date Wl�lbae 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 o 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 owners 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# Q©�412� Expires t2 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-/{ I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# _ 0 115:•••/// workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the rke compensation provisions of Section 3700 of the Labor Code,I sh ithwi co ith thus provisions. Will the applicant or future building occupant handle hazardous material or a Applica Date ti/ 1(A amixtureamounts sp;aining a hazardous material Ma equal In or shot thatGuide? the amounts spec on the Hazardous Materials Information Guide? WARNING: ETO SECUR ORKER'S COMPENSATION COVERAGE IS ❑Yes UNLAWFUL,AND SHALL SUBJECTAN 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 permitfor 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 guidelmey CONSTRUCTION LENDING AGENCY ❑Yes ifNo I hereby affirm that under the penalty of perjury there is 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 bound of a school? (Section 3097 Civil Code) ❑Yes it OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of Contractors License Law for the reason(s)indicated below by the California Health al Safety Code,Section 25505 and 25534 concerning hazardous material reporting. chsiness and I have placed next to the applicable items)(Section 7031.5 permit Business and Professions Cade).Any city or county that requires a permit to � u 1 -- �— Date construct,alter,Improve,demolish or repair any structure,prior to its p TY OWNER OR HORIZED 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(RRP) 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 orthrough their ❑1,as ownerof 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.gov/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(53Z3). 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: in 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. & SAFETY PERM IT/PLAN CHECK APPLICATION jMenifee DATE �J S ({) PERMIT/PLAN CHECK NUMBER low OI TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME 0' POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PLUMBING V'ICE-ROOF-NUMBER OFSQUARES 22v DESCRIPTION OF WORK (JC, PROJECTADDRESS 25(02-2- f� '�j..1 ..�� � //��.J- ASSESSOR'SPARCELLN/UM�BER�-�3 1 � `d� -41-0T JF5 TRACT OWNER NAME 1\4DIV N {- (SEt ADDRESS �� r � PHONE `��-��'�� EMAIL APPLICANT NAME ADDRESS PHONE EMAIL CONTRACTOR'S NAME � k OWNER BUILDER? O YES Lw'NO BUSINESS NAME �•-yv ADDRESS 2-'LO, 2 PHONE �(�1- VJ�Z^T EMAIL +nP dL N. <j\ 4� CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION$ - S L SQ FT APPLICANT'SSIGNATUR DATE G �tP DEPARTMENT DISTRIBUTION l^ CITY OFMENIFEE BUSIJS LICEj{ DUMBER FM3BUILDING PLANNING ENGINEERING FIRE GREEN oV SMIP 5 5 3 INVOICE I� C10 PAID AMOUNT AMOUNT O CASH O CHECK R O CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT I O CASH O CHECK# O CREDIT CARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZEDLE17ER O YES O NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 :E Z n n w n N D v n 0C. .Z1� m a O r9' 3c Qn a ° mn' M nn 0A m m A - o o m 2. z M. " N m O `Can m m D ro tim m ° 5 f0 m m m m 1 Z m m 3 o T M O D z_ m — 'm m n o F+ m < �, o' m O x ° x O N w a Z Z ^ < N v v 2 r K D n 3 ti, 9 3 w v n ° N 1 o m m A v .f°. 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