PMT16-01785 City of Menifee . Permit No.: PMT16-01785
_ 29714 HAUN RD. Type: Residential Re-Roof
�A\CCEL/_> MENIFEE, CA92586 yp
MENIFEE Date Issued: 0 6/0 912 01 6
PERMIT
Site Address: 28604 AMBORELLA WAY,MENIFEE, CA Parcel Number: 364-213-005
92584 Construction Cost: $3,500.00
Existing Use: Proposed Use:
Description of REMOVE EXISTING ROOF TILE AND STACK IT FOR RE-USE,TEAR OFF EXISTING FELT PAPER
Work: AND INSTALL 2 LAYERS OF 30#FELT PAPER OVER EXISTING ROOF SHEATHING, RELAY THE
EXISTING ROOF TILES WITH APPROVED FASTENERS
Owner Contractor
HILDA BRITO-GONZALEZ CHRISTIANSON ROOFING INC
28604 AMBORELLA WAY 1566 7TH STREET
MENIFEE, CA 92584 RIVERSIDE, CA 92507
Applicant Phone: 9517867663
VICTOR CHRISTIANSON License Number: 359888
CHRISTIANSON ROOFING INC
15667TH STREET
RIVERSIDE, CA 92507
Fee Description City Amount($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
with a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of
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 mylicense is in full force and effect. the following reason:
License Class 1:5 7- 5 ,-V License No. G5Q 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
RKER'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 fallowing 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 ww,m.leeinfa.ca.eov/calaw.html.
this permit is issued/.�J/, /
Policy GH'H/��/��+/�� Date
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: 6 application and the information I have provided is correct.I agree to comply
�f�i/OOO ��/��"�i�/lS,4L i'�/ with all applicable city and county ordinances and state laws relating to
Carrier building construction.l authorize representatives of this city or county to
Policy q /_'�/_ /.9 /�� o'r'res � I enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred
dollars($100)or less Date
PROPERTY OWNER OR AUTHORIZED AGENT
o 1 certify that in the performance of the work for which this permit is Issued, 077 rle2�
I shall not employ any persons In any manner so as to become subject to the CITY BUSINESS LICENSE M /�f/�'�
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
o e,I shall forthwith comply with those 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
amo nts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS � o No
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(SC construction
or modification
permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forgst Alir es
ua
CONSTRUCTION LENDING AGENCY ;Z o No
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) Q`Yes c 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
Contractors License Law for the reason(s)indicated below by the Califor is Health&Safety Code,Section 25505 and 25534 concerning
dous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5
Businessand Professions Code).Anycity or countythat requiresa permitto ins
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 RRPcertifred 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 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.eoa.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-guilder 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 bemuse:
o 1,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 role please fill out the RRP
Acknowledgement.
I � V - a �=tD1 o�F - h o f a � � �Xo ♦�. Y �•
,riq� �MYea, �. , u, �6p�•1�� � 1�..�����c f � _�, �uf".. ?t"1�
DATE 06/08/2016 PERMIT/PLAN CHECK NUMBER Oki 9C5
TYPE: ❑COMMERCIAL ❑✓ RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ❑SIGN
SUBTYPE: [—]ADDITION []ALTERATION []DEMOLITION []ELECTRICAL ❑MECHANICAL
❑NEW []PLUMBING ❑RE-ROOF-NUMBER OF SQUARES 13sq
DESCRIPTION OF WORK Remove existing roof file and stack it for re-use. Tear off the existing felt paper and install two
layers of 30#felt paper over the existing roof sheathing. Relay the existing roof tiles with approved fasteners.
PROJECT ADDRESS 28604 Amborella Way. Menifee,Ca.92584
ASSESSOR'S PARCEL NUMBER 5(o4 LOT L-til TRACT ;kN
PROPERTY OWNER'S NAME Hilda Brito-Gonzalez
ADDRESS 28604 Amborella Way. Menifee, Ca.92584
PHONE (951)313-8390 EMAIL wenndy_gonzalez@hotmail.com
APPLICANT NAME Victor Christianson
ADDRESS 1566 7th St. Riverside, Ca. 92508
PHONE (951)212-7225 EMAIL Victor@christiansonroofing.com
CONTRACTOR'S NAME Christianson Roofing INC. OWNER BUILDER? ❑YES❑J NO
BUSINESS NAME
ADDRESS 1566 7th St. Riverside, Ca.92508
PHONE (951)786-7663 EMAIL Victor@chrisbansonroofing.com
CONTRACTOR'S STATE LIC NUMBER 359888 LICENSE CLASSIFICATION C39
VALUATION$ $3,500.00 SO FT 1300 L SO FT
APPLICANT'S SIGNATURE DATE
fl,s .vP�r9 ak oL!l,
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I SMIP o "(.13
INVOICE �O PAID AMOUNT
AMOUNT Imo• `)CASH _%CHECK# 'CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES :) NO
City of Menifee Building&Safety Department 29714 Noun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213