PMT16-03198 City of Menifee Permit No. PMT16-03198
29714 HAUN RD. Type: Residential Re-Roof
<A_CCE1_A> MENIFEE, CA 92586
MENIFEE Date Issued: 09/28/2016
P E R M I T
Site Address: 27520 EMORY CT, MENIFEE, CA 92586 Parcel Number: 335-261-034
Construction Cost: $10,950.00
Existing Use: Proposed Use:
Description of REMOVE ENTIRE ROOF, REPLACE W/30#FELT&NEW OWENS CORNING ANTIQUE SILVER COOL
Work; ROOF
Owner Contractor
ELAINE PUTNAM GARDNER ROOFING COMPANY
27520 EMORY CT 594 WEST SEVENTH STREET
MENIFEE,CA 92586 SAN JACINTO, CA 92382
Applicant Phone: 9516542794
LEE BLOOMER License Number., 528309
GARDNER ROOFING COMPANY
594 WEST SEVENTH STREET
SAN JACINTO, CA 92382
Fee Description Qtv Amount($1
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 effors 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 wifthin 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 Bldg_Permit Template.rpt Page 1 of I
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 wtth section 7000)of Division 3 of the Business and a I am exempt from licensure underthe Contractor's State License Lawfor
Professions Code and my license is in full force and effect. the following reason:
License Class :�--3(R License No. OR By my signature below I acknowledge that except for my personal residence
Expiresl2---2o(& Signature in which I must have resided for at least one year priorto 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 constnicted in its entirety by
o I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I underst;nd 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.Ieginfo.ca.gov/caIaw.htmL
this permit is issued.
Policy# 6?0—r 7�13 5?—I V Date
o 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 followmg: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 with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# Expires enter the above identified property for inspection purpo5m.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
o 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 com t,
V.9sa ion provisions of Section 3700 of the Labor
Code,I shall fortypithc y with those provisions. Will the applicant or future building occupant handle hazardous material or a
00p*r mixture containing a hazardous material equal to or greater that the
Applicant Date (?_F_F_A0 amounts specified on the Hazardous Materials Information Guide?
AARNING-FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS 0 Yes 00
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AN D CIVIL FINES UP TO ON E H UNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
ADD111ON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQUID)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguldelines
CONSTRUCTION LENDING AGENCY 0 yes on
I hereby affirm that under the pena Ity 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) Dyes KNO
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&Safe ode, ecti.on 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the haa.rdous m .
checkmark(s)I have placed nextto the applicable ftem(s)(Section 7031.5 s ous m orting.
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 46PERTY OWN ER OR AUTHORIZED AGENT
issuance,also requires the applica nt 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 IRRPI
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-certifted firms and comply with
an Applicant fo r a permit subjects the applica nt to a civil penalty of not more required practices.This includes rental property owners and property
then($500). managers who do the paint-disturbing work themselves or through their
o 1,as owner of the propen or my employee with wages as their sale employees.For more information about EPA's Renovation Program Visit;
compensation,will do( )all of or( )portion of the work,and the structure is www.epa.RoWlead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractor's State Ucense Law dam not apply to an owner of a 0 An EPA Lead-Safe Certified Renovator wifli be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements a na not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement Is sold within one year of Firm Certification No.:
com pletion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. o No EPA Lead-Safe Certified Firm is required for this project because:
o 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:Tile Contractor's State License Law does not apply to an owner of a If your project dam not comply with EPA RAP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATEQ PERMIT/PLAN CHECK NUMBER -Q:5 I Ll 9
TYPE: FICOMMERCIAL MRESIDENTIAL [:]MULTI-FAMILY [_]MOBILEHOME [:]POOL/SPA []SIGN
SUBTYPE: E]ADDITION r-JALTERATION E]DEMOLITION [-]ELECTRICAL FIMECHANICAL
[:]N EWE]PLUMBING Ej RE-ROOF-NUMBER OF SQUARES—
DESCRIPTION OF WORK ?C�tUf tAN-kiM Q* (34 F!) ahta 09L-0,M
. '711 �-I[AdiAIA C
c A
PROJEcTADDRESS C+-
ASSESSOR'S PARCEL NUMBER LOT '5L� TRACT Lo 9 4
PROPERTY OWNER'S NAME C'[44jjU PO4fnQM I I
ADDRESS 27:520 6MOCY C+- Men:A��- (SR q?-S$G
PHONE 2,--3 013 T EMAIL
APPLICANT NAME (�a(tJAW �Zw�RAA j'ayupoLov - Uee 6t oprv�
ADDRESS 4RLI W, tk 5t
EMAIL
PHONE
CONTRACTOR'S NAME OWNERBUILDER? [:jYESX[NO
13USINESSNAME j&CdW &C� CQMaWA(
ADDRESS 5qL( W , -7+�- !ESiW I 6k. 412-S55
PHONE &2_) 694-2-71q - EMAIL
CONTRACTOR'S STATE LIC NUMBER 577W:501 LICENSE CLASSIFICATION C-197
VALUATION$ _10 1150.9a sQ FT L SO.FT
i
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE USIN WnEIMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I 11(V SMIP C��9,
INVOICE I PAID AMOUNT
AMOUNT I I C CASH 0 CHECK# OCREDITCARD VISAIMC
PLAN CHECK FEES PAIDAMOUNT I I CCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DL NUMBER NOTARIZED LEITER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-5213
150
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