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PMT16-02777 City of Menifee Permit No.: PMT16-02777 29714 HAUN RD. 4tXCCELX_1' MENIFEE, CA 92586 Type: Residential Re-Roof MENIFEE Date Issued: 08/24/2016 P E R M I T Site Address: 27690 CAMDEN WAY, MENIFEE, CA Parcel Number: 335-212-004 92586 Construction Cost: $6,000.00 Existing Use: Proposed Use: Description of TEAR OFF EXISTING COMP SHINGLES, INSTALL 30 YR COMP SHINGLES-MALARKEY AMBER Work: "NOT A COOL ROOF,VERIFY EXCEPTION D OF CFIR-ALT-01 E** Owner Contractor PATRICIA&DAVID CROUSE ERNESTO RAMOS ROOFING 27690 CAMDEN WAY 35557 VERDE VISTA WAY MENIFEE,CA 92586 VALDOMAR, CA 92595 Applicant Phone:9519068095 ERNESTO RAMOS License Number., 821005 ERNESTO RAMOS ROOFING 35557 VERDE VISTA WAY WILDOMAR, CA 92595 Fee Description Qtv Amount($ 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 buillding 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_Pemit Template.rpt Page 1 of 1 MY 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 a I am exempt from ficensure under the Contractoes State License Law for Professions Code and my license is in full force and effect. the following reason: License Class—(!�--:5!t License No. !;4 0 By my signature below I acknowledge that,except for my personal residence Expires-42-—k - k-99nature 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 a 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-insum for worker's 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 this permit is issued. www.Ieginfi:i.ca.00y1caIaw.htmI. Policy If Date PROPERTY OWNER OR AUTHORIZED AGENT ci I have and will maintain worker's compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which o 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 an the property owner's behalf.I have read this number are: application and the information I have provided is correct.I agree to comply Carrier ki V-^ with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy# C2 Expires /9 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 OWN ER OR AUTHORIZED AGENT o I certify that in the performance of the work for which this permit is issued, I she 11 not ern ploy a ny persons in a ny manner so as to become subject to the CITY BUSINESS LICENSE# 0 2dMo workees 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,I shall forthwith h those provisions. Will the applicant or future building occupant handle hazardous material or a Applicant_ 7t! Date mixture containing a hazardous material equal to or greater that the anno nts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVEM 210 o No UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Wifitheintencled use of the building by the applicant or future building AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($200,000),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 f 'guidelines CONSTRUCTION LENDING AGENCY ;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) o Yes o No OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD permitting checklist.I understand my requirements under the State of I hereby affirm under penalty of perjury that I am exempt from the California Health&Safety Code,Section 25505 and 25534 concerning Contractor's License Law for the reason(s)Indicated below by the hazardous material checkmark(s)I have placed next to the applicable ftem(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,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 Contractor's State EPA RENOVATION,REPAIR AND PAINTING(FIRP) 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 ficensure 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-certffied firms and com ply with an Applica nt for a permit subjects the applica nt to a civil penalty of not more required practices.This includes renta I property owners and property than($500). managers who do the paint-disturbing work themselves or through their a 1,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/fead 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 Uicense Law does not apply to an owner of a u An EPA Lead-Safe Certified Renovator will he 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 req uIred for this project beca use: o 1,as owner of the property a m exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractor's 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 APPLICATION enlTee DATE Ze:- I X- - PERMIT/PLAN CHECK INUMBERMTito� bp.-m TYPE: OCOMMERCIAL ORESIDENTIAL OMULTI-FAMILY CNIOBILEHOME OPOOL/SPA OSIGN SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRICAL OMECHANICAL ONEW OPLUMBING 0 RE-ROOF-N UMBER OF SQUARES DESCRIPTION OF WORK -T-6 A I::r- r�49 e( r I T-A L- '>O -q Cot PROJECTAIDDRESS (,A/A i) E Y ASSESSOR'S PARCEL NUMBER LOT TRACT L�4 OWNER NAME CA Trt I / A 1/ 0 A I ID ADDRESS tv M cir- PHONE 2,L4 q 5-7 EMAIL APPLICANT NAME rej,,I e� -r(:) A /-i cA ADDRESS 0�7-4 WAY VILOOMAC CA IL50r �- PHONE EMAIL CONTRACTOR'S NAME ILA d-t Q--( 44in§WNER BUILDER? ()YES "0 BUSINESS NAME Xt c— ADDRESS �L� r— PHONE EMAIL CONTRACrOR'S STATE LIC NUMBER 100 �, LICENSE CLASSIFICATION 75 VALUATION$ & . 0490 SQ FT s LSQFT ,I�PPLICANT`S SIGNATURE DATE CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION CJTY0FME�FE5 51-11MLNUNIftil BUILDING PLANNING ENGINEERING FIRE GREEN SM,P INVOICE I '�Q �, I PAIDAMOUNT AMOUNT I 1 0 CASH 0 CHECK# OCREDITCARD VISA/MC PLAN CHECK FEES PAIDAMOUNT I 1 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO City of I'vienifee Building & Safety Depprtment 2971-4 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityofmenifEe.us Inspection Request Line 951-246-6213 0� Ln > n 0;u�O M pm� 0 m 0 0 G) 0 CO) 00 M a 0 M w m n m — 50 z 'a m i. 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