PMT16-03625 City of Menifee Permit No.: PMT16-03625
29714 HAUN RD. Type: Residential Re-Roof
MENIFEE, CA 92586
MENIFEE Date Issued: 11/0812016
P E R M I T
Site Address: 26704 OAKMONT DR, MENIFEE, CA Parcel Number: 337-353-028
92586 Construction Cost: $7,500.00
Existing Use: Proposed Use:
Description of TEAR OFF ALL EXISTING LAYERS, INSTALLING NEW COOL ROOF SHINGLES
Work: CRRC#0676-0033
Owner Contractor
JRND TRUST H C GROUP PARTNERSHIP
1411 S RIMPAU AVE,#205 1411 S RIMPAU AVENUE SUITE 207
CORONA, CA 92879 CORONA, CA 92879
Applicant Phone:9092891145
MARIO CHANG License Number: 1009664
H C GROUP PARTNERSHIP
1411 S RIMPAU AVENUE SUITE 207
CORONA, CA 92879
Fee Description Qtv Amountl$)
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 firom 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_Bldg_Pemft Template.rpt Page 1 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)pursuant to the Contractors State License Law).
Chapter9(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 Class 6��'47'e ytz I License No. 00,17 0(a By my signature below I acknowledge that,except for my personal residence
Expires I? 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 DECLARATION have built as an owner-builder If it has not been constructed in its entirety by
o 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-InSUM 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 www.leginfo.ca.gov/calaw.htmi.
this permit is issued.
Policy# Ig i 2 19 6 a:2" Date
PROPERTY OWN ER OR AUTHORIZED AGENT
o 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 ci By my signature below I certify to each of the following:I am the property
this permit is issued.My worker's corm pensation insurance carrier a nd policy owner or authorized to act on the property owners 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 44f_ (ow .1"3'�t A 6"f7 --1, 1—P-o-7,C. building construction.I authorize representatives of this city or county to
Policy# '�?l 9,q5 1--; Expires 13-2V_/-2 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
a I certify that in the performance of the workfor which this permit is issued,
Ishallnotemplo 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 worker's compensation provisions of Section 3700 of the Labor
Code,I shall forth ith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant �7;'l ID —Date mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORAS COMPENSATION COVERAGE 15 n 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 for guidelines
CONSTRUCTION LENDING AGENCY ciYes oft
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) a Yes n 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 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 material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 uYes o 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(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
a nd the basis for the alleged exemption.Any violation of Section 7031.S by residence or childcare facility to be RRP-certified firms and comply With
a n Applicant for a permit subjects the applicant to a civil pena Ity of not more required practices.This includes renta I property owners a nd property
than($500). managers who do the paint-disturbing work themselves or through their
o 1,as owner of the property,or my employee with wages as their sole employees.For mom information about EPXs Renovation Program visit:
compensation,wiill do( I all of or( )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 Contractor's State License Law does not apply to an owner of a o An EPA Lead-Safe Certified Renovator will be responsible forthis project
property who,through employeee 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. ci 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 7W,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
.."Menifee
DATE PERMIT/PLAN CHECK NUMBERR�nu -C)&gPS
TYPE: OCOMMERCIAL PRESIDENTIAL 0MULTI-FAMILY OMOBILEHOME 0 POOL/SPA 0 SIGN
SUBTYPE: OADDITION 0ALTERATION 0DEMOUTION OELECTRICAL OMECHANICAL City of Aenifee
ONEW OPLUMBING &RE-ROOF-NUMBER OF SQUARES Building & Safety Dept.
DESCRIPTION OF WORK 0-0 ogjgc -gioll, OC 61LO - NOV ( 8 2016
9 li-,a c IE i ve d
PROJECT ADDRESS W0471' �et cl(�4�
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME
ADDRESS KNte 'gac� (-py--nn CA 9D <(��79
PHONE 9S/ - a7-� - 09 EMAIL
APPLICANT NAME T I: c) 60 94
ADDRESS \/AA C�0,,j v- &f!UUYW0�1 2�,
PHONE PC-/ EMAIL ACk II, CQ)4
Iq I -�G0 , -2
CONTRACTOR'S NAME C 6it;Qj,0 por+)Id OWNERBUILDER? 0 YES (ONO
BUSINESSNAME --T;7jv1JQj 1AatY)Q//,47-
ADDRESS �\05% �ko(jlcwA
PHONE � S— EMAIL
CONTRACTOR'S STATE LIC NUMBER (00C?&bq LICENSE CLASSIFICATION
VALUATION$ 500, SO FT L SO FT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
CITY OF MENIFEE BUSINESS LICENSE NUMBER
DEPARTMENT DISTRIBUTION 7sm I P T',e
BUILDING PLANNING ENGINEERING FIRE � GREEN71-
INVOICE PAIDAMOUNT 0 CASH 0CHECK# 0 CREDIT CARE) VISAIINIC
AMOUNT 1-50-An I
PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK 4 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DILNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.Us Inspection ReqUest Line 951-246-6213
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