PMT16-03177 City of Menifee Permit No. PMT16-03177
29714 HAUN RD. Type: Residential Re-Roof
<A-CCEL MENIFEE, CA 92586
MENIFEE Date Issued: 09/2612016
P E R M I T
SiteAddress: 29410 WATSON RD, MENIFEE,CA 92585 Parcel Number: 327-260-005
Construction Cost: $12,000.00
Existing Use: Proposed Use:
Description of RE-ROOF NTH TEAR OFF LIKE FOR LIKE COMP SHINGLES RE-SHEET AS NEEDED.34 SHINGES
Work:
Owner Contractor
RUDY&HELEN VIALPANDO J D F CONSTRUCTION INC
29410 WATSON RD 1114 E TRUSLOW AVE
MENIFEE, CA 92585 FULLERTON, CA 92831
Applicant Phone:7145261120
TAYLOR RICHMOND License Number. 956749
1114 E TRUSLOW AVE
FULLERTON, CA 92831
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
specifirations or from preventing bulliding 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 BidgPermit Template.rpt Page 1 of I
CITY OF MENIFEE
LICENSED DECLARA71ON 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 am exempt from licensure underthe Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License 'ass re License�Nozf By my signature below I acknowledge that,except for my personal residence
in which I must have resided for at least one year prior to completion of
I
Expires S'g.'t' _4 improvements covered by this permit.I cannot legally sell a structure that I
TIO
'S COMPENSATION DE�C N have built as an owner-builder if it has not been constructed in its entirety by
o 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
this permit is issued. www.Ieginfo.ca.govJca1aw,.htm 1.
Date
PROPERTY OWNER OR AUTHORIZED AGENT
section 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 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 Emo19vez!fi — building construction.I authorize representatives of this city or county to
Policy# AT06676 OW Expires enter the above identified property for inspection purposes.
(This section need notto be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
01_11�rti�that In the performance of the work forwhich this permit is Issued,
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE If
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 LaDor
Code,I shall forth1withomply *hi th e provisiov. Will the applicant or future building occupant handle hazardous material or a
, owoa mixture containing a hazardous material equal to or greater that the
Applicant 0,a Date Y*O,�
_X IV amounts spe�Wd on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS Q Yes PC
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,GDO),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 forguidell
CONSTRUCrION LENDING AGENCY ci Yes W_
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 bound a school?
(Section 3097 Civil Code) 0 Yes
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements underthe 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 Ucense Law for the reason(s)indicated below by the huardous M .ai repo ing.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oYes 0
Business and Professions Code).Any city or county that requires a permitto Date
construct,alter,improve,demolish or repair any structure,prior to Its
issuance,also requires the applicant for the permit to file a signed statement
,,K0P&t'y OWNER OR AUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING(FIRM
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
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 I all of or I I 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 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. o No EPA Lead-Safe Certified Firm Is required for this project because:
o 1,as owner of the property am"elusively contracting with licensed
contractors to construct the project(Section 7D44,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
41"'Menifee
DATE J/m PERMIT/PLAN CHECK NUMBER Tw%-r iv c)q3 nol
00"
TYPE: OCOMMERCIAL W<ESIDENTIAL OMULTI-FAMILY OMOBILEHOME OPOOL/SPA O-SIGN
SUBTYPE: CADDITION OALTERATION -DEMOLITION OELECTIRICAL OMECHANICAL
O- NEW OPLUMBING *Itr-ROOF-NUMBER OF SQUARES 3-Y--
DESCRIPTION OF I- A +Car 04T, 0�rrorkke_
A -
PROI-CTADDRESS
ASSESSOR'S PARCEL NUMBER (4 0 - 0 K LOT TRACT
OWNER NAME PL+ t- Vialoqndv
ADDRESS �24?j�p UI&A�on rot
PHONE (471:ij EMAIL
�.)46GO -gffg3
APPLIICANTNAME �-Tavlor gl�,kw&nd
ADDRESS I/N iaw, F
Lzllfr-16i
PHONE EMAIL
CONTRACTOR'S NAME J, D. F J!fLjAS"6 OWNER BUILDER? 0 YES Dl<O
BUSINESS NAME J, a ecA
ADDRESS / J-j,,S1djk,' Alle, FU 11e40,*'j (�"O[
dqE. 7
PHONE
jd,V4;-&7,0 EMAIL
CONTRACTOR'S STATE LIC NUMBERqS6 7--l't? LICENSE CLASSIFICATION
VALUATION $ sc.FT 3,-/' 4v L SO FT
APPUICANT'S SIGNATURB,-,-00.6,la�oe ;;��� - DATE f�-
DEPARTMENT DISTRIBUTION i CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP I o3tot4ol-
INVOICE PAID AMOUNT 0 CHECK 9 0 CREDIT CARD VISA/MC
AMOUNT two ok 0 1 1 0 CASH
PLAN CHECK FEES I PAIDAMOUNT I I C CASH OCHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building& Safety DLpartment 29714 Houn Rd. Menifee, CA 92586 951-672-6777
,jvww.citVofmenifee.Lis Inspection RequestLine 951-246-6213
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