PMT16-03447 City of Menifee Permit No.: PMT16-03447
29714 HALIN RD. Type: Residential Re-Roof
<A_CCiEL:A_> MENIFEE, CA92586
MENIFEE Date Issued: 10/20/2016
P E R M I T
SiteAddress: 26098 MCCALL BLVD, MENIFEE, CA Parcel Number: 335-132-047
92586 Construction Cost: $8,600.00
Existing Use: Proposed Use:
Description of TEAR OFF EXISTING LAYERS, INSTALL NEW COOL ROOF SHINGLES
Work: CRRC#0890-0009
Omer Contractor
CARYN MCBEE GARDNER ROOFING COMPANY
26098 MCCALL BLVD 594 WEST SEVENTH STREET
MENIFEE, CA 92586 SAN JACINTO, CA 92382
Applicant Phone:9516542794
VINCE MACDONALD License Number: 528309
GARDNER ROOFING COMPANY
594 WEST SEVENTH STREET
SAN JACINTO, CA 92382
Fee Description QtV Amount($I
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 c:arried 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 wiithin 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 BidgPernfit—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 Uicense Law).
Chapter9(commencling With section 7000)of Division 3 of the Business and ci I am exempt from licensure underthe Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class Ucense No. CA By my signature below I acknowledge that,except formy 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 structurethatl
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 La bor Code,for the performance of work for which
this permit is issued. www.Ieginfc.ca.gov/caIaw.html.
Policy# 267 7,(Z, PROPERTY OWNER OR AUTHORIZED AGENT Date
c I have and will maintain worker's compensation insurance,as required by
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 a ni 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 building construction.I authorize representatives of this city or county to
Policy# Expires enter the above identified property for inspection purposu.-
(This section need not to be completed is the permit Is 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#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workees compensation provisions of Section 3700 of the Labor
Code,I shall forthwith c�ith those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNINAF�AIUJRE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes ci No
UNLAWFUL,AN D SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTI ES Will the intended use of the building by the applicant or furtu re building
AND CIVIL FIN ES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),1 N 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 AGENCY u Yes ci No
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) ci Yes a No
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 exemptfirorn 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.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oYes 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
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 MRPI
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RAP)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 renta I property owners and property
than($500). managers who do the paint-distu.rbing work themselves or through their
a 1,as owner of the property,or my employee with wages as their sole employees.For more information about EPAs Renovation Program visit:
compensation,will do( )all of or I 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 1-800-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a n An EPA Lead-Safe Certified Renovator will be responsible forthis 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 yearof 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. ci 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
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
iWenifee
-�IA.
DATE M-204Q PERMIT/PLAN CHECK NUMBERRM�-o ex544-1
TYPE: [:]COMMERCIAL tg[RESIDENTIAL DMULTI-FAMILY [:]MOBILEHOME [:]POOL/SPA [:]SIGN
SUBTYPE: [JADDITION E]ALTERATION E]DEMOLITION E]ELECTRICAL E]MECHANICAL
[]NEW []PLUMBING 14 RE-ROOF-NUMBER OF SQUARES-zq---
DESCRIPTION OF WORK The evkw, we 4- r4ciaLf wi--&. 344,ed+
rl CIty Of MenIfEG
�I 501IMny & Safety Dept.
PROIEcTADDRESS 095L a -"16
Ow 2
ASSESSOR'S PARCEL NUMBER LOT TRACT
PROPERTY OWNER'S NAME d2 .IV M
194. Ism d
ADDRESS 2-(a Q(j 6 JU.' t^tj,U . '14 1 1 AbjAe. (A
PHONE VC(- C1 EMAIL
APPLICANT NAME rO4, YjW IJ&Akej CoftagK_�
ADDRESS 6-qq ld 1. --Fti - 4q'Z5745-3
PHONE EMAIL
CONTRACTOR'S NAME 2WNERBUILDER? F-IYESMNO
BUSINESS NAME CaMAVoe I kA (QAA sl
ADDRESS :s6tq w 1 -74(- 5-�.
PHONE (qnj 4?!5q- 2,7qL4 EMAIL
CONTRACTOR'S STATE LIC NUMBER 5�2%23 q LICENSE CLASSIFICATION C—
T
VALUATION$ <9.600 SQF 2-q 0 1) LSQFr
DATE 10-90-1(e
APPLICANT'S SIGNATURE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP 1--v- I
INVOICE .0(0 PAIDAMOUNT OCASH CCHECK# OCREDITCARD VISAIMC
AMOUNT I
PLAN CHECK FEES PAIDAMOUNT I OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER 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 951-245-6213
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