PMT16-01634 City of Menifee Permit No.: PMT16-01634
29714 HAUN RD. Type: Residential Re-Roof
` A_CCELA'J' MENIFEE, CA 92586
MENIFEE Date Issued: 0512612016
PERMIT
Site Address: 27226 EL PICO LN, MENIFEE, CA 92585 Parcel Number: 336-030-014
Construction Cost: $7,000.00
Existing Use: Proposed Use:
Description of TEAR OFF EXISTING LAYERS, INSTALL NEW COOL ROOF SHINGLES
Work: *`CRRC#0890-0009**
Owner Contractor
CARMENCITA PARILLA PROTECTA ROOFING INC
27226 EL PICO LANE 929 NORTH MIDWAY DRIVE
MENIFEE, CA 92586 ESCONDIDO, CA 92027
Applicant Phone: 7608098791
LISA GONZALEZ License Number: 1002727
PROTECTA ROOFING INC
929 NORTH MIDWAY DRIVE
ESCONDIDO, CA92027
Fee Description QQt y Amount I51
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.
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CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts forthe projects
1 hereby affirm under penalty of perjurythat 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 underthe Contractor's State License Law for
Professions Code and my license Is in full force and effect. the following reason:
License Class C 3 /ic ice E No. (]J`J 2 7�7 By my signature below I acknowledge that,except for my personal residence
Expires �' 17 Signature in which Imust 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
a 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 www.Ieginfo.ca.Rov/caIaw.htmL permit is issued.
Po/f)c1'# 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 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.1 agree to comply
Carrier d with all applicable city and county ordinances and state laws relating to
// building construction.I authorize representatives of this city or county to
Polity# ��,� �lo 1&'4 Expires ,y l7 enter the above identified property for inspection purposes.
(This section need not to he completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
o 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 H
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the w k r' is tion provisions of Section 3700 of the labor
Code,Ishal for ith comp those thprovisions. Will the applicant or future building occupant handle hazardous material ora
mixture containing a hazardous material equal to or greater that the
Applican `•- Date amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE EC R SE OR 'S COMPENSATION OVERAGE IS o Yes ❑No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AN 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)7 See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY a Yes a No
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) in Yes o No
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
California Health&Safety Code,Section 25505 and 25534 concerning
Contractors 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 ciYes D No
Business and Professions Cade).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 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 or through their
o I,as owner of the property,or my employee with wages as theirsole 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 o 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. o No EPA Lead-Safe Certified Firm is required for this project because:
o I,as owner of the property am exclusively contracting with licensed
contractors to construct the pmject(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
Men ifee
DATE ^Z -'ZOlto PERMIT/PLAN CHECK NUMBER -0 lu 3 . �'Ity ()I Menifee
TYPE: []COMMERCIAL PTRESIDENTIAL MULTI-FAMILY ❑MOBILEHOME POOL/SPA ❑SIGN 29tyDept.
SUBTYPE: []ADDITION ❑ALTERATTI�IO�NN []DEMOLITION []ELECTRICAL ❑MECHANICAL MAY 6 �016
[:]NEW ❑PLUMBING L7nt-ROOF-NUMBER OF SQUARES_ (�
DESCRIPTION OF WORK e- j,s�l1 OV e-r;ct O ��i,e ved
PROJECTADDRESS 'Z -Z"Zt0 F/1 PVLO L-->1 • M2. ' -e2. C Z S db
ASSESSOR'S PARCEL NUMBER A-btp -0q0-nyu LOT TRACT
PROPERTY OWNER'S NAME G
ADDRESS '-2-q Z'Z1.(P i C VxWe �e e,,I�- 2- ZS fO ,y
PHONE QS) - C'11'Z-� "lj EMAIL rftfDItALR 43 @- 66 40i 1� ' 6
APPLICANT NAMEip��C�ADDRESS d L8 a ea q aoaq
PHONE 'lloo - -2 qq-2-0�qb EMAIL
CONTRACTOR'S NAME A/ o S OWNERBUILDER? ❑YES NO
BUSINESS NAME rL -}cc-- A- 1 ocU
ADDRESS ,C} , v 2 (p
PHONE ',lao-�R4-2gq,U EMAIL UeY{ev ho M4' 1 C
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION ram- 3 %-
VALUATION$ q r�J CO SQ FT ZF3 S L SQ FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE I
AMOUNT ,a0 PAID AMOUNT -L/� O v CASH GCHELK# OCREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER 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
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