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PMT16-02806 City of Menifee Permit No.: PMT1 6-02806 29714 HAUN RD. Type: Residential Re-Roof cAi�I_A> MENIFEE, CA 92586 C--A t�.t MENIFEE Date Issued: 08/2612016 P E R M I T Site Address: 28294 AVENIDA FRANCESCA,MENIFEE, Parcel Number: 336-321-003 CA 92585 Construction Cost: $5,400.00 Existing Use: Proposed Use: Description of REMOVE EXISTING TILE ROOF, INSTALL NEW FELT PAPER, RE-INSTALL EXISTING TILE Work: Omer Contractor BRUCE GEDDES RANDY'S CLASSIC ROOFING 28294 AVENIDA FRANCESCA 32960 DAILY DR MENIFEE, CA 92585 MENIFEE,CA 92584 Applicant Phone:9516729411 SUZIE BALL License Number: 726425 RANDY'S CLASSIC ROOFING 32960 DAILY DR MENIFEE,CA 92584 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.3ldg_Perrmt Template.ript 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)pursuarittothe Contractors State License Law). Chapter9(commencing with section 7000)of Division 3 of the Business and a I am exempt from ficensure under the Continictoes State License Law for Professions Code and my license is in full force and effect. the following reason: License Class c3 '9 U ;e No 60 By my signature below I acknowledge that,except for my personal residence Expires / 7 Signature In which I must have resided for at least one year prior to completion of ?Paa 0 improvements covered by this perm it.I ca nnot legally sell a structu re that I WORKER'S COMPENSATION DECLARATION have built as an owner-builder if It has not been constructed in its entirety by u I hereby affirm under pena Ity of perjury one of the following clecla rations:I licensed contractors.I understand that a copy of the applicable low,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 www.leginfo.ca.Roy/calaw.h1ml. this permit is issued. Policy# Date PROPERTY OWNER OR AUTHORIZED AGENT have and will maintain worker's compensation insurance,as required by ection 3700 of the Labor Code,for the performance of the work for which ci By my signature below I certify to each of the following:I am the property this permit is issued.My workees compensation insurance carrier and policy owner or authorized to act on the property ownerrs 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# VeQL'06 2 xpires 7— 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 ci I certify that in the performance of the work for which this permit is issued, Ishallnotemplo any persons In any manner so as to become subject to the CITY BUSINESS LICENSE# 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,I shall fortipNith 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 Applica Date 5c; amounts specified on the Hazardous Materials Information Guide? WARNING:FAILUFVO SECURE W I ORKER'S COMPENSATION COVERAGE IS 0 Yes PM UN LAWFUL,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($100,000),IN occupant require a permit for the consh-uction or modification from South ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQM D)?See Perm itting checklist IN SECTION 3706 OF TH E LABOR CODE,INTEREST,AND ATIORN EYS FEES forguidelines CONSTRUCTION LENDING AGENCY 0 Yes 5114. I hereby affirm that under the penalty of perju ry there is a construction Will the proposed building or modified facility be within 1000 feet of the lending agency for the performa nm of the work which this permit is issued outer boundary of a school? (Section 3097 Civil Code) 0 Yes P<O— 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 m erial reporting. checkma rk(s)I have placed next to the a pplicable ftem(s)(Section 7031.5 'A, Business and Professions Code).Any city or county that requires a permit to oYes AJINo W111,wi,_;�Ja Date construct,alter,Improve,demolish or repair any structure,prior to its PROPERA�ONER 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(RRP) 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 remiving compensation for most work that disturbs paint In a pre-1978 a nd the basis for the alleged exern ption.Any violation of Section 7031.5 by residence or childcare facility to be Rlip-certified firms and comply with an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes renta I property owners a nd property than($500). managers who do the paint-disturbing work themselves or through their o 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( I portion of the work,and the structure is www.epa.govIlead 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 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 Certific:ation 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: a 1,as owner of the property am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractoes State License Law does not apply to an owner of a If your project does not comply with EPA RRP role please fill out the RRP Acknowledgement. & SAFETY PERMIT/PLAN CHECK APPLICATION "�"M e n i fee DATE 2��L, z/0 PERMIT/PLAN CHECK NUMBER TYPE: OCOMMERCIAL JORESIDENTIAL OMULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRICAL OMECHANICAL ONEW OPLLIMBING 0 RE-ROOF-NUMBER OF SQUARES—U�- DESCRIPTION OF WORK -14 � I-0- PROJECTADDRESS ASSESSOR'S PARCEL NUMBER LOT �7 TRACT OWNERNAME ADDRESS PHON 16 0 EMAIL APPLICANT NAME 5:�nc_ 2-��o A,// ADDRESS 6 V 4)a "'/7 PHON 6 77-- CONTRACTOR'S NAME & OWNERBUILDER? OYESkNO BUSINESS NAME A F ADDRESS ted Mgjt:�Z C, -j !2 PHOJft�/j EMAIL rj&S-�fC(L)D ri W 4D -D CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION C VALUATION$ C9 SQFT LSQFT APPLICANIT'S SIGNATURE DATE CITY STAFF USE ONLY awl DEPARTMENT DISTRIBUTION ------ SMIP LIIYUV MENTrMINESS LICLN�E NUMBER BUILDING PLANNING ENGINEERING FIRE [GREEN INVOICE PAID AMOUNT CHECK# 0 AMOUNT A 0 CASH 0 CREDIT CARD VISA/MC P PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 9SI-672-6777 www.city,oftnenifee.Lis Inspection Request Line 951-246-5213