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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. 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'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 rgnat c [NOTARIAL SEAL] Print time rr�� My commission oxpires: I O'S q ,,, *a'`Nt� tug IICLGSSOCA(I/IS) acc NGEI-�`����� �/111111111tt