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
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