PMT16-03137 City of Menifee Permit No.: PMT16-03137
29714 HAUN RD. Type: Residential Re-Roof
<ACCECA> MENIFEE, CA 92586
MENIFEE Date Issued: 09122/2016
PERMIT
Site Address: 29891 CALLE EDMUNDO, MENIFEE,CA Parcel Number: 336-202-006
92586 Construction Cost: $7,500.00
Existing Use: Proposed Use:
Description of TEAR OFF EXISTING LAYTERS, INSTALL NEW COOL ROOF SHINGLES
Work: CRRC#0850-0017
Owner Contractor
ANNA RAMIREZ R&R ROOFING
29891 CALLE EDMUNDO 26338 RIM CREEK PATH
MENIFEE, CA 92586 MENIFEE, CA 92584
Applicant Phone'9512460695
R&R ROOFING License Number.934782
26338 RIM CREEK PATH
MENIFEE,CA 92584
Fee Description Qtv Amount($
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 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 commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AABIdgPermit Template.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 ci 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- 325 License No.64-3�A -78 2� — By my signature below I acknowledge that,except for my personal residence
Expires(A �Slgnaure(]&� 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
ci 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 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.IeRinfio.ca.Roy/caIaw.htmI.
this permit is issued.
Policy# ucl PROPERTY OWNER OR AUTHORIZED AGENT Date
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 forwhich o By my signature below I certilyto 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
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#C4 1 f4:;!K Expires enter the above identified property for inspection purposes.
. .L/ � - L
(Thissection need notto be completed isthe permit isforone-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
w/I certify that in the performanceof the work for which this permitisissued,
[shall not employ any persons in any mannersoasto become subject to the CITY BUSINESS LICENSE#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subjectto the worker's compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply 'h ns. Will the applicant or future building occupant handle hazardous material or a
ApplicandVAMT:�2W!! Date I N A1162 mixture containing a hazardous material equal to orgreater thatthe
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURETO SECURE WORKER'S COMPENSATION COVERAGE 15 a Yes o No
UNLAWFUL,AND SHALL SUILIECTAN EMPLOYER TO CRIMINAL PENALnES 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 COSTOF COMPENSATION,DAMAGES AS PROVIDED FOR CoastAlr Quiality Management District JSCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY o 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) ci 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 reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oYes o No
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED AGENT
issuance,also requires the applicant for the permitto file a signed statement
that he or she Is licensed pursuaritto the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING MRP)
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-certffiecl 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 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.aov/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 Uicense Law does not apply to an owner of a o 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. 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
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