PMT16-03619 City of Menifee Permit No., PMT16-03619
29714 HALIN RD. Type: Commercial Re-Roof
<A_CCELA> MENIFEE, CA 92586
MENIFEE Date Issued: 1110712016
P E R M I T
Site Address: 28005 BRADLEY RD,MENIFEE, CA Parcel Number: 337-302-016
92586 Construction Cost: $10,000.00
Existing Use: Proposed Use:
Description of REMOVE 15 SQ'S CAP SHEET, INSTALL SINGLE PLY THERMO PLASTIC MEMBRANE FOR
Work: CASTANEDA'S MEXICAN FOOD
Owner Contractor
SEVEN SEAS, INC. BERRY ROOFING INC
8835 E 11TH ST 3226 KLUK LANE
LOS ANGELES, CA 90023 RIVERSIDE,CA 92501
Applicant Phone:9519055116
KEN ALVARADO License Number.691947
BERRY ROOFING INC
3226 KLUK LANE
RIVERSIDE, CA 92501
Fee DescrIption Qtv Amount I$)
Building Permit Issuance 1 27.00
Inspections not specified 129 129.07
Inspections not specified 129 129.07
GREEN FEE 1 1.00
General Plan Maintenance Fee-Building 1 12.91
$299.05
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of effors in the plans and
specificallons 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_BIdg_Perrnit_Ternplate.rpt Page I 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)pursuantto the Contractors State License Law).
Chapter9(commencing With section 7000)of Division 3 of the Business and ci I am exemptfrom licensure underthe Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason;
License Class::::�, r-3 C4'- License no. 'g;ff��7 By my signature below I acknowledge that,except for my personal residence
Expires ///API/
,�r 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 DECL ARATION have built as an owner-builder if it has not been constructed in its entirety by
ci 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 worker's 7044 of the Business a nd 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
this permit is issued. www.IegInfo.ca.gov/caIaw.htmL
p If # 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 a By my signature below I certify to each of the following:I am the property
this perm it is issu ad.My worker's compensation insura nce carrier and policy owner or authorized to act on the property owner's behalf.I have read this
n um bar are; application and the information I have provided Is correct.I agree to comply
Carrier with all applicable city and county ord Ina nces and state laws relating to
building construction.I authorize representatives of this city or county to
Policy If Expires enter the a have 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
a I certify that in the performance of the work for which this permit is issued,
I shall not employ a ny 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 worker's 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 ///�7/,1:- mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS u 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 modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECHON 3706 OF THE LABOR CODE,INTEREST�AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY in Yes vNo
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) 0yes mNo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQUID
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 Ucense Law for the reason(s)indicated below by the hazardous marten.al orting.
checkmark(s)I have placed next to the applicable Item(s)(Section 7031.5 ciYes uNci
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 A049
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(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 exempt from ficensure receiving compensation for most work that disturbs paint in a pre-1978
a nd the basis f6r the alleged exemption.Any violation of Section 7031.5 by residence or childmre facility to be RRP-certified firms and corn ply 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($500). managers who do the paint-disturbing work themselves or through their
ci 1,as owner of the property,or my employee with wages as their sole employees.For more Information a bout EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.epa.gov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 70",Business and Professions 1-800-424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a ci An EPA Lead-Safe Certified Renovatorwfll be responsible forthis project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.if,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. No EPA Lead-Safe Certified Firm is required for this project because:
o 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
4y;'Menifee
A
DATE II/)II 'le PERMIT/PLAN CHECK NUMBER
TYPE: ErCOMMERCIAL []RESIDENTIAL []MULTI-FAMILY F]MOBILEHOME []POOL/SPA [—]SIGN
SUBTYPE: []ADDITION []ALTERATION []DEMOLITION []ELECTRICAL M�EHANICAL
[:]NEW []PLUMBING EhE-ROOF-NUMBEROFSQ
DESCRIPTION OF WORK
4m��
PROJECTADDRESS 29�w�;_ed
ASSESSOR'S PARCEL NUMBER LOT TRACT
PROPERTY OWNER'S NAME
ADDRESS 7R 5vO/��V&v
PHONE 7-/3 1,74/-7 EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME OWNERBUILDER? [:]YES2lq_0
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ /,--7,., ll�e"" SOL FT LSQFT
APPLICANT'S SIGNATURE DATE, 111)7A_
i� 0TVSTAFF USE ONLY
DEPARTMENT DISTRIBUTION ClITY OF ME IFEEB 5 ER
BUILDING PLANNING ENGINEERING FIRE GREEN 5 IP
= I ::�JPAIID AMOUNT 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC
PLAN CHECK FEES I PAIDAMOUNT OCASH '—'-'CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES (D No DL NUMBER NOTARIZED LETTER 0 YES 0 NO
Cih of Menifee Building & Safety Departil7ent 29714 Houn Rd, Menifee, CA 92586951-6:72-6717
www.cityofmenifee.Lis tt7spection Request Line 951-246-5213
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STATE OF CALIFORNIA
COMMISSIONING -DESIGN REVIEW SIGNATURE PAGE
CEC-NRCC-CXR-0S-E(Revised 08/16) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE Pt. NRCC-CXR-05-E
Commissioning-Design Review Signature Page (Page 2 of 2)
Project Name; /jo 07 Ni-, I Dateftp.red:
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify that this Certificate of Compliance documentation Is acc:04 a udcrbwleteli
Documentatlor,Au�horApe: �a Documentation Author Sign
C.Mpznr. Signature Date: /7 41f
Address: CEA/HERS Cerdlication Identification(if applicaible):
5z
city/starte/zip.. Phone:
e-F
RESPONSIBLE PERSON'S DECLARATION STATEMENT
I certify the followii ng 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,Pa rt I and Pa rt 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 vadth 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 recigired to be included with the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name; Responsible Designer Signature;
Company: DateSigned:
Address: License:
City/State/Zip: Phone:
CA Building Energy Efficiency Standards-2013 Nonresidential Compliance August 2015
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