PMT16-03620 City of Menifee Permit No.: PMT16-03620
29714 HALIN RD.
'5A_CCELA> MENIFEE, CA 92586 Type: Commercial Re-Roof
MENIFEE Date Issued: 11107/2016
P E R M I T
SiteAddress: 26820 CHERRY HILLS BLVD, MENIFEE, Parcel Number: 337-310-016
CA 92586 Construction Cost: $11,000.00
Existing Use: Proposed Use:
Description of INSTALL 65 SQ'S OF APOC 252 WHITE COATING
Work:
Owner Contractor
SEVEN SEAS, INC. BERRY ROOFING INC
8835 E 11TH ST 3226 KLLIK LANE
LOS ANGELES, CA 90023 RIVERSIDE, CA 92501
Applicant Phone:9519D55116
KEN ALVARADO License Number 691947
BERRY ROOFING INC
3226 KLUK LANE
RIVERSIDE, CA 92501
Fee Description Amount
Building Permit Issuance 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 requidng the correction of errors in the plans and
specifications or from preventing bulliding 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,_l31dg_PerrnjtTemp1ate.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 is rider 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 a 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 Classi::�, License No. '6fz�%7 By my signature below I acknowledge that except for my personal residence
Expires
Z;r Signature in which I must have resided for at least one year priorto completion of
I 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
a I hereby affirm under penalty csiperjury one of the following declarations:I licensed contractors.I understa[rid that a copy of the applicable law,Section
have and will maintain a certificate of consent of self-Insure forworker'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 welosite:
by Section 3700 of the Labor Code,forthe performance of work forwhich
this permit is issued. www.IeRInfio.ca.gov/calaw.htmL
P fi # Date
;7h1ve 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 ci 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 an the property owner's behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
Carrier with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy It Expires 4z-/-/7 enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-In undred Date
dollars($100)or less PROPERTY OWN ER OR AUTHORIZED AGENT
o I certify that in the performance of the work for which this permit is issued, - -11v
Ishallnotermil any persons in any manner so as to become subject to the CITY BUSINESS UCENSE#
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 ccrrnp�.vilth those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date /'J4r/'1r mixture containing a hazardous material equal to or greater that the
amounts specifflied onthe Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes a 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 SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguldelines
CONSTRUCTION LENDING AGENCY o Yes 9rNo
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) oYes oNo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements underthe State of
I hereby affirm under penalty of perjurythat 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 in I " I orting.
checkmark(s)I have placed next to the applicable Itern(s)(Section 7031.5 oYes wN
Business and Professions Code).Any city or county that requires a permit to Date
construct,a Iter,improve,demolish or repair any structure,prior to its �w
issuance,also requires the applicant for the permit to file a signed statement PROPERTY OWNER OR AUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING fiRRP)
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-1978
and the basis for the alleged exemption.Any Violation of Section 7031.5 by residence or childcare facility to be RAP-certifled firms and comply with
an Applicant for a permit subjects the applicant to a civil pena Ity of not more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing workthemselves or through their
o 1,as owner of the property,or my employee with wages as their sole employees.For more information about EPA!s Reno"tlon Program visit:
compensation,Will do( )all of or( )portion of the work,and the structure is www.epa.gov/`lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code,The Contractor's State License Law does not apply to an owner of a o An EPA Lead-Safe Certified Renovator will be responsible for this project
p ropertV who,through em ployees'or personal effort,builds or Inn proves the
property provided that the Improvements are not Intended or offered for Certified Firm Name:
sa le.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. _/No EPA Lead-Safe Certified Firm Is required for this project bemuse:
o 1,as owner of the property am exclusively contracting With licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RAP
Acknowledgement.
& SAFETY PERM IT/PLAN CHECK APPLICATION
Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: WCOMMERCIAL ORESIDENTIAL OMULTI-FAMILY OMOBILEHOME 0 POOL/SPA 0 SIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRICAL OMECHANICAL
ONEW OPLUMBING 0 RE-ROOF-N UMBER OF SQUAIRES_
DESCRIPTION OF WORK
AF1
PROJECTAIDDRESS
ASSESSOR'S PARCEL NUMBER '�)f 0-ORO LOT TRACT -50019
OWNER NAME
ADDRESS
PHONE EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILDER? 0 YES 0 NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
�z
VALUATION$ SO FT L SO FT
APPLICANT'S SIGNA URE 4�L DATE 1,11711�-
DEPARTMENT DISTRIBUTION SMIP CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN
= I :::] PA�DAMOUNT 0 CASH 0 CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES I PA D AMOUNT 0 CASH 0 CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES () NO DLNUMBER NOTARIZEDLETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofirnenifee.us Inspection Request Line 951-246-6213
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STATE OF CALIFORNIA
COMMISSIONING - DESIGN REVIEW SIGNATURE PAGE
CEC-NRCC-CXR-05-E(Ravlaed 08/15) (?aU1 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-CXR-05-E
Commissioning-Design Review Signature Page (Page 2 of 2)
P.JW N..s: D.WPI.pved:
4'1�c
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify that this Certificate of Compliance clocumentation tftk��TJ Zorriplete.
Documentation Author Documentation Auth 51 n t
company: Signature Date:
75yC1
Address: CIA/HERS Certification Identification(if applicable);
Z-Al,
City/State/Zip: phone:
Cw- gLL';'-'z ;0�1� . :S�;/C-
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 perni 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 required 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: License:
City/State/Zip: Phone:
CA Building Energy Efficiency Standards-2013 Nonresidential Compliance August 2015
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