PMT16-03192 City of Menifee Permit No.: PMT16-03192
29714 HALIN RD. Type: Residential Re-Roof
<A_CCIELA_> MENIFEE,CA92586
MENIFEE Datelssued: 0912712016
P E R M I T
Site Address: 29629 PARK CITY AVE, MENIFEE, CA Parcel Number: 339-223-022
92584 Construction Cost: $5,000.00
Existing Use: Proposed Use:
Description of TEAR OFF EXISTING LAYERS, INSTALL NEW COOL ROOF SHINGLES
Work: CRRC#0668-0056
Owner Contractor
BILL HOWARD DONNOR ENTERPRISES INC
29629 PARK CITY AVE 20221 PEAR CIRCLE
MENIFEE, CA 92584 PERRIS, CA 92570
Applicant Phone: 9519433344
RON HEARTZ License Number:800984
DONNOR ENTERPRISES INC JARCO ROOFING
20221 PEAR CIRCLE
PERRIS,CA 92570
Fee Description Oty Amount($
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 builicling 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_l31dg_PermitTernplate.rpt Page I 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 Divisilon 3 of the Business and o I am exempt&am licensure under the Contractor's State Ucensis Law for
Professions Code and my license is in full force and effect. the following reason:
License Class i`� � . r, By my signature below I acknowledge that,except for my personal residence
�!�-X License No.A (9 to 9 C_ 4
Expires Signature in which I must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legailysell a structure that I
WORKER'S COMPENSATION DECLARATION(/' have built as an owner-builder if it has not been constructed in its entirety by
ri 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.leginfo.ca.gov/caIaw.html.
Policy# Date
a 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 n 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 an the property owners behalf.I have read this
numberare: application and the information I have provided is correct.I agree to comply
Carrier— I,- with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# 14 (Q�'7q 1-1 QA Odxpbes enter the above identified property for inspection purpose,s.
(This section need not to be completed is the permit is for Ole-hundred' Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
a 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 compe ti I s of Calif mia and agree that if I should become HAZARDOUS MATERIAL DECLARATION
,P," -
subjecttothewor "m7,pen,,t:,.0 �O
vons-ofSection 3700 of the Labor
Code,I s bw comply ---Ose rovisions. Will the applicant or future building occupant handle hazardous material or a
/I mixture con ring a hazardous material equal to orgreater thatthe
5 'w'�
p
imnt Date amounts 7si cified on the Hazardous Materials Information Guide?
I
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ci Yes No
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 req uire a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR CoastKirQu lity Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guideli
CONSTRUCTION LENDING AGENCY 0yes
.0 No
I herebyaffirm thatunderthe penaltyof pedurythereisa 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 outerbo 6aryofaschool?
(Section 3097 Civil Code) o Yes 7NO
OWNER BUILDER DECLARATIONS I have mad 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 a in exem pt from the California Health&Sa!e�Vcle,Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the h rd fateria p ing.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 layZa 01170
Business and Professions Code).Any city or county that requires a permit to Date L-=12
construct,alter,improve,demolish or repair any structure,prior to its PROPEWOWNEb6R AUTHORIZED AGEiF--
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 IRRP)
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 childmire 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 )all of or( I portion of the work,and the structure is www.epa.goy/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-80(I-424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a ci 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. in 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 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.
& SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL ARESIDENTIAL OMULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION CIELECTRICAL OMECHANICAL
11
ONEW OPLUMBING ��REROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK oc_�- 110�X%
PROJECTADDRESS A !2(1X P"k (fl � :j Ame ceov4
ASSESSOR'S PARCEL NUMBER LOT --cT4Ag '@Ri!ee
OWNER NAME Building & afety Dept.
ADDRESS SEP 2 7 .2016
PHONE EMAIL
Rieceived
APPLICANT NAME —4k v- 0 tl 17 0 e
ADDRESS C2Qagj Pea Pw t,-/- 3
PHONE EMAIL
CONTRACTOR'S NAME e-z-0 OWNERBUILDER? OYESAO
BUSINESS NAMIE/
ADDRESS V4
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER (Z LICENSE CLASSIFICATION
VALUATION$ L SO FT
APPLICANTS SIGNATURE T//
DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS UCENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE
AMOUNT PAIDAMOUNT (1 0 CASH 0 CHECK It 0 CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT CASH 0 CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 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
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