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PMT16-03617 City of Menifee Permit No.: PMT16-03617 29714 HAUN RD. Type: Residential Re-Roof <ACrELA> MENIFEE, CA 92586 MENIFEE Date Issued: 11/07/2016 P E R M I T Site Address: 29542 MOUNT BACHELOR, MENIFEE, Parcel Number: 338-252-021 CA 92586 Construction Cost: $7,350.00 Existing Use: Proposed Use: Description of TEAR OFF ALL ROOFING, INSTALL NEW COOL ROOF SHINGLES Work: Owner Contractor LEE ADAME BAKER ROOFING CORPORATION 29542 MOUNT BACHELOR 29515 DUNKIRK STREET MENIFEE, CA 92586 MENIFEE, CA 92586 Applicant Phone:9512557237 LAWRENCE BAKER License Number:884731 BAKER ROOFING CORPORATION 29515 DUNKIRK STREET MENIFEE, CA 92586 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 $130.90 The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and specifications or from preventing builiding operations being carried on thereunder when in violation of the Building Code or of any other ordinance of City of Menifee.Except as otherwise stated,a permit for construction under which no work is commenced within six months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be forfeited. AA_B1dg_Permit Template.rpt Page 1 of 1 ————-----------------------------------------------------------— DATE -Z', 7 - 14 FMM177PLANQiRXNUM5MPMII0- TYPE EICOMMffUAL I3FMD2M DMULMAMILY EIMOEMLEHUME [IPOOUS:A []SCN SLJffrYPE MADDI�ON [:]jAL7EFA-RON E]DWOIJTION [:I aWMCAL []mB3-MIOML QNF-w E3RjjmEPNGRFER)oFLNum&RoFmuAFm af— DaMpnON OFVVOW — Le QZ 0—t( v1'r)-Q f::1'12 PRD=AMFM AaEMORSPARULNUMMR LOT TF;ACr a;;),i V -MaZE=Q0WM;MNAME zf za AMFES f- PHONE DQ S-3 EML APPIJCANTNAM AMRM L�A f PHONE EML cavrmcrogsNAME a j r- ERBULDER? EIMBONO BUSNESSNAME !ft- AMREM in _�,Cf 15 L� PHIONE �Z ;g EM'AL 00mmcmsswmucNumm� L-) jjmjffiCLM�OknON VAUJA'nON$ MFr LM Fr APPUCANrSSGNA7URE rAm Lttsxlmt:N "bTREURM BULIYNG FLAMNG MKEMNG RFF- GFEEN SWIP UIYQFM5WMVANM5UCff4ENLNWBER lwa AM PAJDMAaJNrr 0 ossi Da-mw 11CF433TWO VLWMC RANCHEMPEES RAIDAMOIAT Dcwi Oa-ex# Da;MTGMU )nsvmc UM%RBULDERVERRED ITYS El NO DLNUMeM NOFrAR2EDLEMR 0 �M 0 No MY of-NI'l-WIii ee Building& aafetty'D--Dt rLmv-,I- un r-�j. Z97 ma City Of Menifee LICENSED DECLARATION 0 1 am exempt from licensure under the Contractors'State License Law for the I hereby affirm under penalty or pedury that I am licensed under provisions of following reason: Chapter 9(commencing with section 7000)of Division 3 of the Business and By my signature below I acknowledge that, except for my personal residence in Professions Code and my license is in full force and effect. which I must have resided for at least one year prior to completion of License Class ('7�-79 LicenseNo.F ' 17!1 r7 13 1 improvements covered by this permit, I cannot legally sell a structure that I have Expires Signature -�;<_/Sc_- Z__ built as an owner-building if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law. Section 7044 of the WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request wheF this application is 13 1 hereby affirm under penalty of perjury one of the following declarations submitted or at the following Web site: I have and vAI maintain a certificate of consent of self-insure for workers; hftp.,//�.leginfo.ca.gov/caiaw.htmi. compensation,issued by the Director of Industrial Relations as provided for by Date Section 3700 of the Labor Code, for the performance of work for which this permit is issued. Properly Owner crAuthorized Agent Policy# 0 By my Signature below, I certify to each of the following: I am the property I have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read this section 3700 of the Labor Code. for the performance of the work for which this application and the information I have provided is correct, I agree to comply I permit is issued.Myworkers'wm nsallon insurance carder and policy number are; with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to enter the above- ....... identified property for the inspection purposes. Policy#G3�-=F4�72 Expires Date Property Owner orAuthofized Agent (This section need not be completed if the permit is for City Business License# Qx-� 4�-q Dne-hundred clollar�_($1 00)or less) 0 1 certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION shall not employ any persons In any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or a workers'compensation laws of Califorrinla, and agree that if I should become mixture containing a hazardous material equal to or greater that the subject to the workers'compensation provisions of Section 3700 of the Labor amounts specified on the Hazardous Materials Information Guide? Code,I shall forthwith comply with those provisions. DYES ()INO Applicant-2-S�/__ Date; Will the Intended use of the building by the applicant or future building occupant require a permit for the construction or modification from South WARNING: FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND D YES ( CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS .1130 ($100,000), IN ADDITION TO THE COST OF COMPENSATION Will the proposed building or modified facility be wlithin 1000 feet of the outer DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THj boundary of a school? LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES NO CONSTRUCTION LENDING AGENCY 76. 1 have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist.I understand my requirements under the State of agency for the performance of the work which this permit is issued (Section California Health&Safety Code,Section 25505 and 25534 concerning 3097 Civil Code) hazardopusjpaterial reporting. CIYES��b OWNER BUILDER DECLARATIONS I hereby affirm under penalty of perjury that I am exempt from the Contractorps Date License Law for the rpason(s)indicated below by the checkmark(s)I have placed PROPERTY OWNER OR AUTHORIZED AGENT next to the applicable item(s)(Section 7031.5. Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, EPA RENOVATION,REPAIR AND PAINTING(RRPJ or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the TheEPA Renovation,Repair and Painting(RRP)Rule requires contractors provisions of the Contractor's State License Law(Chapter 9(commencing with receiving compensation for most work that disturbs paint in a pre-1 978 Section 7000)of Division 3 of the Business and Professions Code)or that he or residence or childcare facility to be RRP-certified fins and comply with she is exempt from licensure and the basis for the alleged exemption. Any required practices.This includes rental property owners and property violation of Section 7031.5 by any Applicant for a permit subjects the applicant to managers who do the paint-disturbing work themselves or through their a civil penalty of not more than($500).) employees.For more Information about EPNs Renovation Program visit: www.epe.gov/iead or contact the National Lead Information Center at 1, as owner of the property, or my employees with wages as their sole 1-800-424-LEAD(5323). compensation,will do( )all of or( ) porting of the work, and the structure i's not intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's State License Law does not apply to an o%vner of a pmperty 0 An EPA Lead-Safe Certified Renovator will be responsible for this project who, through employees' or personal effort, builds or improve$ the property, proAded that the improvements are not intended or offered for sale.If,however, Certified Firm Name: the building or improvement is sold within one year of completion,the Owmer- Builder Will have the burden of proving that it was not built or improved for the Firm Certification No.: purpose of sale). El 1. as owner of the property an exclusively contractiAg with licensed 0 No EPA Lead-Safe Certified Firm is required for this project because: contractors to construct the project(Section 7044, Business and Professions Code:The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who contracts for the projects with a z (D L) Z UX �u 0 110 Lu u a sL 00 Cl E E E -t z E E UC 0. 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