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
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