PMT16-02798 City of Menifee Permit No.: PMT16-02798
29714 HALIN RD.
'5_A C __>
CELA. MENIFEE, CA 92586 Type: Residential Re-Roof
...... MENIFEE Date Issued: 08/2512016
P E R M I T
Site Address: 29344 PEBBLE BEACH DR, MENIFEE, Parcel Number: 338-072-008
CA 92586 Construction Cost: $6,000.00
Existing Use: Proposed Use:
Description of TEAR OFF ALL EXISTING LAYERS, INSTALL NEW COOL ROOF SHINGLES
Work: CRRC#0676-0097
Owner Contractor
MARTHA RAMOS ROOFTEK ROOFING&WATERPROOFING
29344 PEBBLE BEACH DRIVE 23991 VISTAWAY
MENIFEE, CA 92586 MENIFEE, CA 92587
Applicant Phone:9512448524
ROOFTEK ROOFING&WATERPROOFING License Number: 520957
23991 VISTAWAY
MENIFEE,CA 92587
Fee Description Div Amount($
Building Permit Issuance 1 2T00
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 effors in the plans and
specifications or from preventing builiding operations being carded 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 BidgPermit Ternplate.rpt Page 1 of 1
CITY 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 o I a in exempt from licensure under the Contriactoes State Ucense Law for
Professions Code and my license is In full force and effect. the following reason:
License Class c=�259 License No.5XG-j��__7 By my signature below I acknowledge that,except for my persona I residence
Expires I I 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 a n owner-builder if It has not been constructed in its entirety by
o I hereby affirm under pena Ity of perjury one of the following decla rations: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 workees 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.leginfo.ca.goy/calaw.html.
Policy# Date
ci I have and will me Intain worker's corn pensation insurance,as req ulred by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which a By my signature below I certify to each of the following:I a in the property
this permit is issued.My worker's compensation insurance ca rrier a nd policy owner or authorized to act on the property owner's beha If.I have read this
numberare: application and the information I have provided is correct.I agree to comply
Ca rder S—, with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Poficy#G5'Y-05-Oat)-�- -Expires k-It- enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for onehundred Date
dollars($100)or[us PROPERTY OWNER OR AUTHORIZED AG ENT
ci I certify that in the performance of the work for which this permit is issued,
I shall not emplay any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
workees compensation laws of California,and agree that If I should become HAZARDOU MATERIAL DECLARATION
subject to the worker's 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
mixture containing a hazardous material equal to or greater that the
Applicant Date amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS 0yes '51*0
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applica nt 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(SCAQM D)?See penmitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY 0 Yes IdNo
I hereby affirm that under the penalty of perjury them 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) a Yes �&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
a e;Section 25505 and 25534 concerning
I hereby affirm under penalty of perjury that I am exempt from the California Health&Safety CV
Contractoes License Law for the reason(s)indicated below by the hazardous mlaterial rep g.
checkmark(s)I haveplaced next to the applicable item(s)(Section7031.5 Ael No
Businessand Professions Code).Any city or county that requires a permitto t,
I 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 iRRPI
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
ci 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 I )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 n An EPA Lead-Safe Certified Renovator will be responsible for th is 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. ci No EPA Lead-Safe Certified Firm is required for this project because:
o 1,as owner of the property am 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 & SAFM PERMIT/PLAN CHECK APPLICATION
_��Mlenlfee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: DCOMMERCIAL EffRESIDENTIAL [-]MULTI-FAMILY EIMOBILEHOME [:]POOLISPA []SIGN
SUBTYPE: E]ADDITIONE]ALTERATION F]DEMOLITION F]ELECTRICAL [JMECHANIC.
AL
[-]NEW F]PLUMBING EIRE-ROOF-NUMBEROFSCtUARES=aj,422,S�
DESCRIP11ON OF WORK rr_ CLO-1 t o - 009
PROJECTADDRESS ,Rq54;(4 Pq0L[qjje, Z��rrA j6d�r) VC JD4�51%S
ASSESSOR'S PARCEL NUMBER LOT TRACT enj
t Lee,,P,.
-din y
Ci
EIJI g 7 a
PROPERTY OWNER'S NAME jq24_:x5
ADDRESS aEn=02� r
AUG 2 5 2N
PHONE EMAIL
APPLICANT NAME
ADDRESS ROOFTEK ROOFING
-o-qQql Vista Way
PHONE Menifee,OA4i7 EMAIL
CONTRACTOR'S NAME OWNER BUILDER? E:1YES No
BUSINESS NAME ROOFTEK ROOFING
23991 Vista Way
ADDRESS Manjfap CA 99687
PHONE 051.,RW 9->S�Cj EMAIL
CONTFIACTOR'S STATE LIC NUMBER 63 LICENSE CLASSIFICATION
VALUATION$ 1122— SQ FT __a16r3 LSQFT
APPUCANrS SIGNATURE DATE
W.
DEPARTMENr DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PL"ANNING ENGI I G RE GREEN SMIP
INVOICE
AMOUNT go PA AMOUNT CCASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PA A LINT 0 ASH 0 CHECK# C�CREDITCARO VISA/MC
OWNER BUILDER VERIFIED OYES C' NO DLNUMBER —NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityotmenifee.us inspection Reauest Line 951-246-6213
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