PMT16-02366 City of Menifee Permit No.: PMT16-02366
29714 HAUN RD.
"ACCELA_> MENIFEE, CA 92586 Type: Residential Re-Roof
MENIFEE Date Issued:
07I22f2016
PERMIT
Site Address: 26181 FALSTERBOR DR, MENIFEE, CA Parcel Number: 337-112-003
92586 Construction Cost: $3,760.00
Existing Use: Proposed Use:
Description of REROOF BACK SOUTH SIDE ONLY, REMOVING EXISTING ROOFING, REROOF W/COOL ROOF
Work: SHINGLES
Owner Contractor
URIEL SALAS WEATHERTIGHT ROOFING INC
1011 QUAIL KNOLL RD P O BOX 5281
FALLBROOK,CA 92028 HEMET, CA 92544
Applicant Phone:9519290557
GUY T SCHEMBRI License Number:643691
WEATHERTIGHT ROOFING INC
P O BOX 5281
HEMET, CA 92544
Fee Description City Amount
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
Chapter!)(commencing with section 7000)of Division 3 of the Business and ❑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 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 71344 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.leginfo.ca.gov/mlaw.html.
this permit is issued.
Policy# Date
PROPERTY OWNER OR AUTHORIZED AGENT
❑I have and will maintain workers compensation insurance,as required by
section 3700 of the Labor Code,forthe 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
with all applicable city and county ordinances and state laws relating to
Carrier building construction.I authorize representatives of this city or county to
Policy# Expires enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
❑I certify that in the performance of the work for which this permit is issued,
1 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 forthwith com ply with those provisions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
Applicant Date amounts specified an the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 ❑Yes ❑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($300,000),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 for guidelines
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 Cade,Section 25505 and 25534 concerning
hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oyes o No
Business and Professions Code).Any city or county that requires a permitto Date
construct,alter,improve,demolish or repair any structure,priorto 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 pursuantto the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRPJ
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 Iicensure receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Anyviolation 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 workthemselves 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 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 forthe purpose of sale. ❑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 not comply with EPA RAP rule please fill out the RRP
Acknowledgement.
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
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 underthe Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class 0--Z Li e se No. 4,43 l0 1q � By my signature below I acknowledge that,except for my personal residence
Expires ff Signature .4 inwhich l musthave 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 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 of the Business and Professions Cade,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.leginfio.ca.Roy/cala%v.htm1.permit is issued.
Policy It Date
teI have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
ction 3700 of the Labor Code,for the performance of the work for which D By my signature below I certify to each of the following:I am the property
this permit is issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
number are: r application and the information 1 have provided is correct.I agree to comply
API
Carrier hC
�Ar `IPL/ with all applicable city and county ordinances and state laws relating to
rh Ctlr.1/1.
qq rJ building construction.l authorize representatives of this city or county to
Policy dd; LI'l'�'7< Expires row 7.d77 enter the above identified property for inspection purposes.
(This section need not to be 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, �✓J..,r-1mil i-s
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# y 'P✓ %/�
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,Ishal orthhwith com{��,y with t/Fipos�epprovzslpnsr Will the applicant or future buildingoccupant handle hazardous material or
A licant� i/LG s •[i/. - /oJ!/ln-�e d�e2P ] 4/ mixture wntaininga hazardous material equal to or greater that the
pp amounts specified an the Hazardous Materials Information Guide?
WARNING:FAILURETO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes 1 ,No
UNLAWFUL,AND SHALL SUBIECTAN 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 ilNo
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) ciYes Vo
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 underthe State of
California Health al Safety Code,Section 25505 and 25534 concerning
Contractor's 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 7032.5
➢tYes to ate d7 4,
Business and Professions Code).Any city or county that requires a permit to Z
construct,alter,improve,demolish or repair any structure,prior to its PR PERTY 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 Contractor's State EPA RENOVATION,REPAIR AND PAINTING IRRP)
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 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 Contractor's 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 N 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. n No EPA Lead-Safe Certified Firm is required for this project because:
❑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 rule please fill out the RRP
Acknowledgement
BUILDING & SAFETY PERMIT/PLAN CHECK A P PLICATION
Menifee
DATE O �Vz Z PERMIT/PLAN CHECK NUMBER
TYPE: []COMMERCIAL QRESIDENTIAL El MULTI-FAMILY ❑MOSILEHOME ❑POOL/SPA ❑SIGN
SUBTYPE: []ADDITION []ALTERATION []DEMOLITION ❑ELECTRICAL ❑MECHANICAL
[—]NEW ❑PLUMBING ❑✓ RE-ROOF-NUMBEROF5QUARES 11.33
DESCRIPTION OF WORK Reroof back South side only-removing the existing roofing. Roof with 25 yr. (3-Tab) Class A
shingles.New roofing to tie into the existing at the ridge, installing new ridge. coo.f•-
PROJECTADDRESS 26181 FalsterborDr. gt"Cy; '�a
ASSESSOR'S PARCEL NUMBER 337-112-003 LOT 90 TRACT 2544
PROPERTY OWNER'S NAME Uriel Salas
ADDRESS 1011 Quail Knoll Rd. - Fallbrook, CA. 92028
PHONE (949)375-3245 EMAIL
APPLICANT NAME
ADDRESS P.O. Box 5281 - Hemet, CA. 92544
PHONE (951)929-0557 EMAIL weathertightroofinginc@gmail.com
CONTRACTOR'S NAME Guy T. Schembri OWNER BUILDER? ❑YES ✓❑NO
BUSINESS NAME Weathertight Roofing, Inc.
ADDRESS P.O.Box 5281 - Hemet, CA. 92544
PHONE (951)929-0557 EMAIL weathertightroofinginc@gmail.com
CONTRACTOR'S STATE LIC NUMBER 643691 LICENSE CLASSIFICATION C-39
VALUATION$ $3,760.00 SQ FT 1133 L SQ FT
APPLICANT'S SIGNATURE / A' DATE
DEPARTMENT DISTRIBUTION ( CITY OF MENIFEE BUSINESS UEENSE NUMBER
Bu/LD1NG PLANNING ENGINEERING FIRE GREEN SMIP C) 15 7
INVOICE ' �' U pAID AMOUNT
AMOUNT .0 CASH 'D
CHECK# ' CREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT DCASH (0 CHECKq CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED YES C NO DL NUMBER NOTARIZED LETTER Q YES O NO
City of Menifee Building&Safety Department 29714 kaun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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