PMT16-01635 City of Menifee Permit No.: PMT16-01635
29714 HAUN RD. Type: Residential Re-Roof
�A_CCELA_ MENIFEE, CA 92586
MENIFEE Date Issued: 05/26/2016
PERMIT
Site Address: 29130 DEL MONTE DR, MENIFEE, CA Parcel Number: 338-084-003
92586 Construction Cost: $2,505.78
Existing Use: Proposed Use:
Description of TEAR OFF EXISTING LAYERS, INSTALL NEW COOL ROOF SHINGLES
Work: "CRRC#0890-0012"
Owner Contractor
JEAN MARSHALL
29130 DEL MONTE DRIVE
MENIFEE, CA 92586
Applicant License Number:
JEAN MARSHALL
29130 DEL MONTE DRIVE
MENIFEE, CA 92586
Fee Description ON 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.
AA_Blog_Permlt_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 D I am exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full force and effect the following reason:
License Class License No. 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 1
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
D 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.leeinfo.ca.eov/calaw.html.
this permit is issued.
Policy#
Date
D 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 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# Expires enter above identi aroperty for inspection purposes.
(This section need not to be completed is the permit is for one-hundred a12A Dale O�(o
dollars($100)or less PROPERTY O1 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#
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 foh Lth comply wtfJtii se 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 T( •CURE WORKER'S COMPENSATION COVERAGE IS ayes ONO
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 forguidelines
CONSTRUCTION LENDING AGENCY D Yes o 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) ayes ❑No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
1 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 25S05 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed nextto the applicable item(s)(Section 7031.5 oyes D 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 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
❑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.gov/lead/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. ❑No EPA Lead-Safe Certified Firm is required for this project bemuse:
D 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.
BUILDING & SAFETY-12MMaLRI-AN CHECK APPLICATION
Menifee
DATE Q G� PERMIT/PLAN CHECK NUMBER
TYPE: ❑COMMERCIAL ESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ❑SIGN
QT men fee
SUBTYPE: ❑ADDITION []ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑MECHANI�QNding & Sate y Dept.
❑NEW ❑PLUMBING 153 RE-ROOF-NUMBER OF SQUARES
MAY 016
DESCRIPTION OF WORK
C //,, a • e d
1
PROJECTADDRESS o - 00 - mo&4t De cAv
ASSESSOR'S PARCEL NUMBER W- 0&W 6 LOT 1✓ TRACT
PROPERTY OW
N
ER'S NAME
I�
ADDRESS Aj C{�
PHONE // EMAIL
APPLICANT NAME l -L I✓
ADDRESS qaL I q D iElq b/U V IIU
PHONE /� )✓/ - / y j - /i3� EMAIL
CONTRACTOR'S NAME O NER BUILDER? VIYES❑NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ 5 S L SO FTv,
APPLICANT'S SIGNATURE DATE (2S 6
DEPARTMENT DISTRIBUTION ( CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN \ SMIP
INVOICE PAIDAMOUNT QQJ� O O
AMOUNT 1:/�J•°l� •—l� OCASH CHECKq CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK a O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES 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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CU'I6 U5 C5 le:14 I Wells Fargo 31U3/(11UY >> Y516/Y5843 p 1/2
&J A 4N� 5/25/2016
I-lcllo Melly,
Fax: 951 -679-3843
'Phis is Jean Marshall at 29130 Del Monte .Dr. Surf City,
("A 92586. '1bi.s letter is regarding repairing the roo.l. by my
neighbor Chary. I authorize hire to represent me to do all the
paper works with the city. Please grant him the permit. City of Menifee
Building & Safety Dept.
Thank you very much for you]' help, MAY 2 6 2016
Jean Marshall
Gu'I6 u� L9 lL:'14 Wells Fargo 31U3/(11UY >> Y516(Y5643 P L/L
CALIFORNIA NOTARY ACKNOWLEDGMENT
For An Individual Acting In His/her Own Right:
A notary public or other officer completing this
certificate verities only the identity of the individual who
signed the document to which this certificate is attached,
and not the truthfulness,accuracy,or validity of that
document.
State of Cnlilbmia )
� /�
County of Q;'`y'-4
On S/S_f p �before me, Notary Public,personally appeared
who proved to me on the basis of satisfactory evidence to be the person(s)whose namc(s)is/arc subscribed to the
within instrument and acknowledged to me that Ire/she/they executed the same in his/her/their authorized
capaeity(ies),and that by his/her/their sigtnture(s)on the instrument the person(s),or the enfity upon behalf of
which the person(s)acted,executed Lite instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is
nve and correct.
WITNESS my hand and official seal
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[NOTARIAL SEAL]
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