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PMT16-03021 City of Menifee Permit No.: PMT16-03021 29714 HAUN RD. Type: Residential Re-Roof c;kCCEjjA_" MENIFEE. CA 92586 MENIFEE Date Issued: 09/1212016 P E R M I T Site Address: 26223 CRESTONE DR, MENIFEE, CA Parcel Number: 335-262-027 92586 Construction Cost: $8,500.00 Existing Use; Proposed Use: Description of REMOVE EXISTING ROOF, REPLACE WIOWENS CORNING AMBER COOL ROOF ASPHALT Work: SHINGLES Owner Contractor MARTA KAMALI I TRIANGLE ROOFING 26223 CRESTONE DR 1392 ENCHANTED TRAILS MENIFEE, CA 92586 SAN JACINTO, CA 92582 Applicant Phone:8003606771 MAYNOR ALVAREZ License Number!790599 TRIANGLE ROOFING 1392 ENCHANTED TRAILS SAN JACINTO, CA 92582 Fee Description Qty 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 enors 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 commenwd is suspended or abandoned for six months,shall expire,and fees paid shall be forfeited. AA BIdgPerrnit—Template.rpt Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION propertywho builds or improves thereon,and who contracts forthe projects I herebyaffirm under penalty of perjurythat I am under provisions of with a licensed contractors)pursuant to the Contractors State License Law). Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure under the Contractor's State License Law for Professions Code and my license is in full force and effect. the following reason: License Class C_S�) License No. 5 By my signature below I acknowledge that,except for my personal residence Expires iolsi!I,-7 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 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-insure for worker's 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 this permit is issued. www.Ieginia.ca.gov/mIaw.htmI. Policy# Date ci I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT 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 on 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 4:_V rJ with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy If Ljo 7SLI-L3 Expires 0 & 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, I shall not employ 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 workees compensation provisions of Section 3700 of the Labor Code,I shall forthwith am with those provisions. Will the applicant or future building occupant handle hazardous material or a cl� Applicant Date mixture containing a hazardous material equal to or greater that the amounts specified on the Hazardous Materials Information Guide? WARNING:FAIILU�E TOSECURE WORKER'S COMPENSATION COVERAGE 15 in Yes KNO 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($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 SEIETION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines CONSTRUCTION LENDING AGENCY oYes trNo 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) 0 Yes "a 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 Contractoes License Law for the reasons)indicated below by the hazardous material reporting. checkmarks)I have placed next to the applicable item(s)(Section 7031.5 niyes o�p Business and Professions Code).Any city orcounty that requires a permitto _;�_ zff2�__ Date construct,alter,improve,demolish or repair any structure,priorto its PROPERTY OWNER OR AUTHORIZED AGENT Issuance,also requires the applicant for the permittofilea signedstatement 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 receiving compensation for most work that disturbs paint in a pre-1978 and the basis for the alleged exemption.Any violation of Secrion 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 1,as owner of the property,or my employee with wages as their sale 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 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 for the purpose of sale. a No EPA Lead-Safe Certified Firm is required for this project bemuse; a 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 & SAFETY PERMIT/PLAN CHECK APPLICATION �'!�""Menifee AMIN't, 'axk"'F DATE 9 1)z PERM IT/PLAN CHECK NUMBER TMI(40- TYPE: OCOMMERCIAL *RESIDENTIAL 0MULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN SUBTYPE: CADDITION OALTERATION CIDEMOLITION CELECTRICAL OMECHANICAL ONEW OPLUMBING &RE-ROOF-N UMBER OF SQUARES -2-5 DESCRIPTION OF WORK 6.) C�, k- corv�� Z'3 k_i) PROJECTADDRESS Q__ ASSESSOR'S PARCEL NUMBER LOT TRACT Lr744 OWNER NAME ADDRESS PHONE (C>,Sj c;G1.0 — 'S 0 EMAIL APPLICANT NAME ADDRESS PHONE EMAIL CONTRACTOR'S NAME OWNER BUILDER? 0 YES a NO BUSINESSNAME ADDRESS PHONE (906) 3160 (0?-7 EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION$ SO FT LSQFT APPLICANT'S SIGNATURE— DATE DEPARTMENT ISTRIBUTION CITY OF FEE=INESS_QW&SE NUMBER BUILDING PLANNING ENGINEERING FIRE IGREEN I I SMIP I INVOICE PAIDAMOUNT AMOUNT mo.olo I I 1 0 CASH 0 CHECK# 0 CREDIT CARD VISAIMC 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 ' NO City of Menifee Building&Safety Department 29714 Haun Rd Menifee, CA 92586 951-672-6777 www.cityof,menifee.us Inspection Request Line 951-246-6213 O� 01 * * . . 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