PMT16-03618 City of Menifee Permit No.: PMT16-03618
29714 HALIN RD. Type: Commercial Re-Roof
<A_CCI=—I_A> MENIFEE, CA 92586
MENIFEE Date Issued: 1110712016
P E R M I T
Site Address: 28005 BRADLEY RD, MENIFEE,CA Parcel Number: 337-302-017
92586 Construction Cost: $4,000.00
Existing Use: Proposed Use:
Description of REMOVE 9 SQ'S CAP SHEET, INSTALL SINGLE PLY THERMO PLASTIC MEMBRANE FOR LIBERTY
Work: TAX
Owner Contractor
SEVEN SEAS, INC. BERRY ROOFING INC
8835 E 1 1TH ST 3226 KLUK LANE
LOS ANGELES, CA 90003 RIVERSIDE, CA 92501
Applicant Phone:9519055116
KEN ALVARADO License Number.691947
BERRY ROOFING INC
3226 KLUK LANE
RIVERSIDE, CA 92501
Fee Description 0tv Amount($)
Building Permit Issuance 1 27.00
Inspections not specified 129 129.07
Inspechons not specified 129 129.07
GREEN FEE 1 1.00
General Plan Maintenance Fee-Building 1 12.91
$299.06
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 buillding 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 Bidg_Permit—Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED C1ECLARA'nON property who builds or improves thereon,and who contracts for the projects
with a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I a m under provisions of
Chapter!)(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class:::�, fc`3 License No. 'g;-� By my signature below I acknowledge that,except for my personal residence
Expires lllkvl In which I must have resided for at least one year prior to completion of
ZX Signature-
414' improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
o I hereby affirm under pena Ity 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 workees 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 www.IeRinfc.ca.Rov/caIaw.htmL
this permit Is issued.
H Date
;7 PROPERTY OWNER OR AUTHORIZED AGENT
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 o By my signature below I certilyto each of the following:I am the property
this permit is Issued.My worker's compensation insurance carrierand 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 If Expires 17L-1 V 7 enter the above identified 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
c 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 workers compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comp�-.wlth those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date x/b-* mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Gulde7
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ci Yes o No
UNLAWFUL,AND SHALL SUBJECT 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($100,000),IN occupant require a permit for the construction or modiflotion 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 ;rNo
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified fadil I tV 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) u Yes j3 No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guideand 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 materi;al orting.
checkmark(s)I have placed next to the applicable ftem(s)(Section 7031.5 ciYes WNo 0,7r
Business and Professions Code).Any city or county that requires a permit to
.k 0 __Date.. j��L'lz
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED AGENT
issua nce,a Isc,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(RRP)
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 exam Fit from licensure receiving compensation for most work that disturbs paint in a pre-1978
a nd the basis for the a lleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and corn ply with
a n Applicant for a permit subjects the applicant to a civil penalty of not mom required practices.This includes rental property owners and property
then($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 EPXs Renovation Program visit:
compensation,will do( I all of or I )portion of the work,and the structure is www.epa.gov/lead or contact the National Lead Information Center at
not intended or offered for sa le.(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 ci An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,th rough employeee or personal effort,builds or improves the
property provid ad that the im provements are not intended or offered for Certified Firm Name.
sa le.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 sa le. /No EPA Lead-Safe Certified Firm is required for this limlect because:
o 1,as owner of the property am exclusively contracting with licensed
contra ctors 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.
Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: EICOMMERCIAL []RESIDENTIAL [:]MULTI-FAMILY [:]MOBILEHOME [:]POOL/SPA [—]SIGN
SUBTYPE: [—]ADDITION DALTERATION []DEMOLITION []ELECTRICAL []MECHANICAL
DNEW OPLUMBING [31E-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
PROJECTADDRESS -2 1��On5—
ASSESSOR'S PARCEL NUMBER LOT TRACT
PROPERTY OWNER'S NAME
ADDRESS .
PHONE -7—/-3 EMAIL
APPLICANT NAME
ADDRESS
PHONE
EMAIL
CONTRACTOR'S NAME QWNERBUILDER? OYES[aiV6
B USINESS NAME
ADDRESS 3; lei
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION z0e, SO.FT 5 & LSQFT
APPLICANT'S SIGNATURE DATE 11h A-
DEPARTMENT DISTRIBUTION SMIP CITY OF MENIFEE BUSINESS UCENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN
INVOICE PAID AMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
AMOUNT
PLAN CHECK FEES PAID OCASH OCHECKN 0 CREDIT CARD VISA/MC
-R VERIFIED 0 YES 0 No DLNUMBER NOTARIZED LETTER 0 YES 0 NO
Citv of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-6:72-6 7 7?
www.cityofmenifee.LIS InspectiDd Request Line 951-246-6213
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STATE OF CALIFORNIA
COMMISSIONING - DESIGN REVIEW SIG", TU�InfA�;
CEC-NRCC-CXR-05-E(Revised 08115) ty CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-CXR-05-E
Commissioning-Design Review Signature Page Nov (Page 2 of 2)
proleaName. 52�A/�-�5,1A C P,.,..d: 1117.x
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 191
1. 1 certify thatthis Certificate of Compliance documentation is accurate and complete.
Documentation Author Name- Documentation Author Signatu
Company; Signature DaW
/7 tllr
Address: Z-Z/� CW HERS certification Identification(if applicable):
Oty/State/Zip: Phone: 5741�
RESPONSIBLE PERSON'S DECLARATION STATEMENT
I certify the following under penalty of perjury,under the laws of the State of California:
1. The information provided on this Certificate of Compliance Is true and correct.
2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design
identified on this Certificate of Compliance(responsible designer).
3. The energy features and performance specifications,materials,components,and manufactured devices for the building design or system
design identified on this Certificate of Compliance conform to the requirements of Title 24,Part 1 and Part 6 of the California Code of
Regulations.
4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information
provided on other applicable compliance documents,worksheets,calculations,plans and specifications submitted to the enforcement
agency for approval with this building permit application.
S. I will ensure that a completed signed copy of this Certificate of Compliance shall be made available with the building permit(s)issued for the
building,and made available to the enforcement agency for all applicable Inspections.I understand that a completed signed copy of this
Certificate of Compliance is reqjired to be included with the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name: Responsible Designer Signature;
Company: Date Signed;
Address: Llc.ns�:
Oiy/State/Zlp: Phone;
CA Building Energy Efficiency Standards-2013 Nonresidential Compliance August 2015
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