PMT16-02090 City of Menifee Permit No.: PMT16-02090
29714 HAUN RD. Type: Residential Re-Roof
�ACCELX_> MENIFEE, CA 92586
MENIFEE Date Issued: 07/01/2016
PERMIT
Site Address: 29796 PARK CITY AVE, MENIFEE, CA Parcel Number: 339-231-024
92584 Construction Cost: $6,500.00
Existing Use: Proposed Use:
Description of TEAR OFF EXISTING ROOF, REROOF WIOWENS CORNING COOL ROOF IN SIERRA GRAY
Work:
Owner Contractor
HIPPOZE BULK INVESTMENT, LLC
29796 PARK CITY AVE
MENIFEE, CA 92584
Applicant License Number.
HIPPOZE BULK INVESTMENT, LLC
29796 PARK CITY AVE
MENIFEE,CA 92584
Phone:9099007580
Fee Description r3,yt 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 forthe 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. 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 I
WORKER'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 following declarations:I 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 worker's 7044 cf the B . e d Professions Code,is available upon request when
compensation,issued by the Director of Industrial Relations as provided for j
this appIt io s fitted or at the following website:
by Section 3700 of the Labor Code,for the performance of work for which www I in pv c lIttedaw r a
this permit is issued. 1`\
Policy# I I Date `l l \ \
o 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 I ❑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 inf atton I have provided is correct.I agree to comply
I with all appli e c and c ty ordinances and state laws relating to
Carrier ( building co ru o . thorize representatives of this city or county to
Policy# Expires 'enterth bov tifr property for inspection purpose . t`
(This section need not to be completed is the permit is for one-hundred Date l \C
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
❑I certify that in the performance of the work for which this permit is issued,
I shall not employ any persons in any marAT"044mYgltssubject 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 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 greaterthat the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes ❑No
UNLAWFUL,AND SHALLSUBIECTAN 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,D00),IN
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)7 See permitting checklist
forguidelines
CONSTRUCTION LENDING AGENCY ❑Yes ❑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) ❑Yes ❑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 California Health&Safety Code,Section 25505 and 25534 concerning
hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oyes ❑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 asigned statement
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING MRP)
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting RAP)Rule requires contractors
Business and Professions Code)orthat 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
4tthan($500). managers who do the paint-disturbing work themselves or through their
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 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 ❑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:
❑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 nut comply with EPA RRP rule please fill out the RAP
Acknowledgement.
SAFETYBUILDING & PERMIT/PLAN CHECK APPLICATION
Menifee
DATE (� �z l� PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL IC RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
PROJECFADDRESS
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME
ADDRESS Z27k6, \l'L
PHONE J%—ct.l�Q-'LS�1 a EMAIL -t f'--
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILDER? YES O NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION �j OL1 '— S 6 L SQ FT `
APPLICANT'S SIGNATURE ' -- DATE �r ( Z�t\ k,-
- -_
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP
INVOICE I PAID AMOUNT
AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC
OWNER BUILDERVERIFIED OYES O NO DLNUMBER 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 951-246-6113
City of Menifee
Building & Safety Dept.
JUL 0 1 2016
Received
C_
State of California q
_
Secretary of State `
I , DEBRA BOWEN , Secretary of State of the State of
California, hereby certify:
That the attached transcript of page(s) has been compared
with the record on file in this office, of which it purports to be a copy, and
that it is full, true and correct.
eeAL.aT�y$ IN WITNESS WHEREOF, I execute this
�P ,••eo R E K q'•. certificate and affix the Great Seal of the
4) T
?, State of California this day of
w
• L, r m
i o ( t
CACIFORN�A
DEBRA BOWEN
Secretary of State
SeclState Form CE-107(REV 112007) o 06 ev�
2 06 81 57102 � �°
,y 4 LLC-1 File#
•' ,M State of California
Secretary of State Nate QRjj ED Ala f Q
' Cal fo
of the State of
JUN - 33008
LIMITED LIABILITY COMPANY city of Menifee
ARTICLES OF ORGANIZATION Building & Safety Dept.
JUL 01 2016
A$70.00 filing fee must accompany this form.
IMPORTANT—Read instructions before completing this form. C 4BIVM+ r Fling Use only
ENTITY NAME (End the name with the words'Llmked Liability Company;or the abbreviations'LLC'or'LL.C.' The words'Limited'and'Company'
may be abbreviated to'Ltd.'and'Co.;respectively.)
1. NAME OF LIMBED LIABILITY COMPANY
Hippoze Bulk Investments, LLC
PURPOSE (The following statement is required by statute and should not be altered.)
2. THE PURPOSE OF THE LIMITED LIABILITY COMPANY IS TO ENGAGE IN ANY LAWFUL ACT OR ACTIVITY FOR WHICH A LIMITED LIABILITY
COMPANY MAY BE ORGANIZED UNDER THE BEVERLY-KILLEA LIMITED LIABILITY COMPANY ACT.
INITIAL AGENT FOR SERVICE OF PROCESS (If the agent is an Individual,the agent must reside in California and both Items 3 and 4 must be
completed. If the agent is a corporation,the agent must have on file with the California Secretary of Stale a certificate pursuant to Corporations Code
section 1505 and Item 3 must be completed(leave Item 4 blank).
3. NAME OF INITIAL AGENT FOR SERVICE OF PROCESS
Kurt Tiedt
4. [FAN INDIVIDUAL,ADDRESS OF INITIAL AGENT FOR SERVICE OF PROCESS IN CALIFORNIA CITY STATE LP CODE
1627 Via Roma Corona CA 92801
MANAGEMENT(Check only one)
5. THE LIMITED LIABILITY COMPANY WILL BE MANAGED BY:
ONE MANAGER
® MORE THAN ONE MANAGER
ElALL LIMITED LIABILITY COMPANY MEMBER(S)
ADDITIONAL INFORMATION
6. ADDITIONAL INFORMATION SET FORTH ON THE ATTACHED PAGES,IF ANY,IS INCORPORATED HEREIN BY THIS REFERENCE AND MADE APART
OF THIS CERTIFICATE,
EXECUTION
7. 1 DECLARE 1 AM THE PERSON WHO EXECUTED THIS INSTRUMENT,WHICH EXECU�MY ACT AND DEED.
June 2,2008
DATE SIGNATUR OF ORGANIZER GF��—.�"T
Kurt Tiedt
TYPE OR PRINT NAME OF ORGANIZER
LLC-1(REV 0412007) APPROVED BY`S4ft ATE
Bernice Rivera
From: Kurt Tiedt <titanreol@aol.com>
Sent: Friday,July 01, 2016 11:59 AM
City of Safety
e
To: Bernice Rivera Building 8 Safetyy Dept.
Subject: Permission to pull permits
Attachments: imageljpeg; ATT00001.txt JUL 0 1 2016
Hello Bernice, Received
My name is Kurt Tiedt and I am the managing member of Hippoze Bulk Investments.
would like to give Luis Torres permission to pull permits for re roofing, for the property located at 29796 Park City Ave.
Menifee, 92584.
Attached is a copy of my drivers license.
If you have any questions, please contact me at 951-751-6892.
Thank you,
Kurt Tiedt
1
r
. I-IC /.
� � Y
1EM NONE
Dept.ELL city of Menifee
Building & Safety
• - • : : JUL 0 1 2016
y Received
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