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PMT16-03220 City of Menifee Permit No.: PMT16-03220 29714 HAUN RD. Type: Residential Re-Roof <ACCECA—> MENIFEE, CA 92586 MENIFEE Date Issued: 0912912016 P E R M I T Site Address: 28051 PEBBLE BEACH DR, MENIFEE, Parcel Number: 335-153-012 CA 92586 Construction Cost: $6,400.00 Existing Use: Proposed Use: Description of TEAR OFF ONE LAYER EXISTING SHINGLES, INSTALL NEW COOL ROOF SHINGLES Work: CRRC#0850-0025 Owner Contractor BARBARAJENKINS ABOVE ALL ROOFING 28051 PEBBLE BEACH DRIVE 21937 GARDENA LANE MENIFEE, CA 92586 VIALDOMAR, CA 92595 Applicant Phone:95116090246 JACOB ESCARCEZA License Number: 891263 ABOVE ALL ROOFING 21937 GARDENA LANE WILDOMAR, CA 92595 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. AA BidgPermit—Ternplate.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 contnictor(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 Contmctoes State License Law for Professions Code and my license is in full force and effect. the following reason: License Class C_3�7 License No. o)c? 2 1;, 3 By my signature below I acknowledge that,except for my personal residence Expires 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 DECLAI&TION 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 7D44 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.goy/caIaw.htmI. this permit Is issued. Policy# PROPERTY OWNER OR AUTHORIZED AGENT Date o I have and will maintain workees compensation insurance,as required by 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 5M-11E7 CC-1.0 Rq-0 building construction.I authorize representatives of this city or county to Policy# 1:T0 �_S57� Expires enter the above identfiled 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 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 UCENSE# 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 Labor Code,I shall forthwith c p VF*Ithi Those prow.sions. Will the applicant or future building occupant handle hazardous material or a 7R Date Vzqlj�, mixture containing a hazardous material equal to or greater that the Applicant !7UMP �� amounts specified on the Hazardous Materials Information Guide? WARNINVFN&�RE�T�O SECURE WORKER'S COMPENSATION COVERAGE IS ciYes ONO At UNLAW AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building A 7VIL FINES UP TOONE HUNDRED THOUSAND DOLLARS($3.00,000),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 SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines CONSTRUCTION LENDING AGEN oYes ONO 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) Oyes ONO 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. checkma rk(s)I have placed next to the applica ble item(s)(Section 7031.5 uYes a 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 Issua nce,also requires the a pplicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractoes 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 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 ci 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.eya.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. u No EPA Lead-Safe Certified Firm is required for this project because: ci 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 you r project does not comply with EPA RAP rule please fill out the RRP Acknowledgement ' ' :.�� BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION Menifee DATE PERMIT/PLAN CHECK NUMBER TYPE: 0 COMMERCIAL eIRESIDENTIAL 0 MULTI-FAMILY _0 MOBILE HOME 0 POOL/SPA 0 SIGN SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRICAL OMECHANICAL CNEW OPLUMBING 0 RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK je)Wok; c>�� Zq��z C_)�7 3�M4 OT&0Jgs�,"AL "V(-:-w 3(j,�e &11C C PROJECT ADDRESS zBogj phwc- 17,tzw�A 09MILIP ASSESSOR'S PARCEL NUMBER Sq8— LOT TRACT OWNER NAME I'�6,MM& ADDRESS 75OS-1 PC�A5QC- Rt-ACH PHONE 7V-2q4- 3 '-1(3 j EMAIL 0' n1le.9 _Wty )opt. Rg Mae OUIldf APPLICANT NAME '�;A`ro,& ADDRESS SEP 2 9 2016 PHONE EMAIL Roceived CONTRACIFOR'S NAME OWNERBUILDER? OYES e'NO BUSINESS NAME 4atf'- 4e( 4J,�(, ADDRESS ?039 6,4a,,;,J,4 /,,x/, Wicbomu CA , 920�- _Y PHONE EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION C 37 VALUATION e160 L SO FT I-APPLICANT'S SIGNATURE DATE U, 5311t T CITYSTAFF USE ONLY DEPARTMENT DISTRIBUTIO/hl� LI I Y Ut MLN111 EE BUSINESS LICENSE NUMBER BIJILD114G PL4NNING ENGINEERING FIRE I GREEN SMIP INVOICE PAIDAMOUNT L-7* 9 AMOUNT .0to I . 0 1 0 CASH 0 CHECK# OCREDITCARD VISAtMC PLAN CHECK FEES PAIDAMOUNT 0 U I I 1 0 CASH 0 CHECK# ''CREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES 0 No DLNUMBER NOTARIZEDLE17ER 0 YES 0 NO City of Menifee Building& Sofety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-6777 www.cityofrnenifee.us Inspection Request Line 951-246-6213 M w d z a (D 2, —Z 46 w c 0 0 b.0 cs c LLI rL ci -4 E E CIS w di z E W Lu F- C.) 0 1.- -M -2 u o T u E 0 w C3 C3 A < Cc W 0 w u M w v U. 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