PMT16-03264 City of Menifee Permit No.: PMT16-03264
29714 HAUN RD. Type: Residential Re-Roof
<A_CCiELA" MENIFEE,CA 92586
MENIFEE Date Issued: 1010512016
P E R M I T
Site Address: 28770 SNEAD DR, MENIFEE, CA 92586 Parcel Number: 337-391-001
Construction Cost: $8,000.00
Existing Use: Proposed Use:
Description of TEAR OFF EXISTING ROOF, REROOF WITH OWENS CORNING COOL ROOF IN AMBER
Work:
Owner Contractor
FREDRICKA VOYLES HOUSETOP ROOFING
28770 SNEAD DR 31760 BRIGGS ROAD
MENIFEE,CA 92586 MENIFEE, CA 925134
Applicant Phone: 9516798369
RICH CARROLL License Number:371783
HOUSETOP ROOFING
31760 BRIGGS ROAD
MENIFEE,CA 92584
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 effors 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 Bldg Perryfit—Template.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 contractor(s)pursuant to the Contractors State License Law).
Chapter!)(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure under the Ctmtractoes State License Law for
Professions Code and my license is in full force and effect. the following reason:
I
License Class 'q License No._311 I.P-3 By my signature below I acknowledge that,except for my personal residence
Expires/;// Signature In which I most have resided for at least one year prior to completion of
Improvements covered by this permit.I cannot legally sell a structure that I
WORKI RAi?Nr have built as an owner-builder if it has not been constructed in its entirety by
c 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 vvww.IeRinfo.ca.Rov1caIaw.htmL
this permit is issued.
Policy 4 Date
>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 a 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 ovimer's behalf.I have read this
number are: application and the information I haw provided is carrect.I agree to comply
C with all applicable city and county ordinances and state lam relating to
Carrier I—L"f'J building construction.I authorize representatives of this City or county to
Policy N Expires enter the above identified property for inspection purposes.
(This section need not to be completed is the permit i;for one-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 If
worker's compensation laws of California,and agree that if I should become 14AZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those Provisions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
Applicant Date 3&Z& amounts specified on the Hazardous Materials Information Guide?
WARNING:KAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS oYes JIM0
UNLAWFUL,AND SHALL SUBJECr 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($100,00),IN occupant require a permit for the construction or modificallon from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQM Dj?See permitting checklist
IN SECrION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCrION LENDING AGENCY aYes 00
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 10DO 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) 0 Yes AND
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 Umnse Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 �Wes 0 0
Bumess and Professions Code).Any city or county that requires a permit to I-e e�l'� Date
construct,alter,improve,demolish or repair any structure,prior to Its PROPr OWNER OR AUTHORIZED AGENT
Issuance,also requires the applicant for the permit to file a signed Statement
ENO
that he or she is licensed pursuant to the provisions of the Contractor's State EPA ENOVATION,REPAIR AND PAINTING lRFpj
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-1979
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 Applica nt 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
n 1,as owner of the property,or my employee with wages as their sole employees.For mom information abou I EPKs Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.epa.gowlead 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 u 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.It,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will haw the burden of proving that it was
not built or Improved for the purpose of sale. u No EPA Lead-Safe Certified Rrm 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 RAP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
' 2`Menifee
DATE
/Z 1:� PERMIT/PLAN CHECK NUMBER
IF
TYPE: COMMERCIAL *IlrESIDENTIAL 0- MULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRICAL OMECHANICAL
ONEW OPLUMBING X<E-ROOF-NUMBER OF SQUARES--.2,0-
DESCRIPTION OF WORK
PROJECTADDRESS ? 40
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME
ADDRESS
PHONE 02-0 '0 EMAIL
APPLICANT NAME
ADDRESS 7,0 0 ae,0kZ-
PHONE EMAIL 1,41 S--Zt'
CONTRACrOWS NAME —Xlel�l OWNER BUILDER? ',') YES ONO
BUSINESS NAME
ADDRESS
PHONE EMAIL 00/
I f 4 .-cc
CONTRACTOR'S STATE LIC NUMBER 37/79P_3 LICENSE CLASSIFICATION (?
VALUATION$ goao SOFT L SQ FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP I
INVOICE I 1-�k, 0101 PAIDAMOUNT OCASH OCHECK# Q CREDIT CARD VISA/MC
AMOUNT
PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 No DILNUMBER NOTARIZEDLETTER 0 YES 0 N:O:::�
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92585 951-672-6777
wwi,v.CitvOfmemfEe.us Inspection Request Line 951-245-6213
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