PMT16-03628 City of Menifee Permit No.: PMT16-03628
29714 HAUN RD. Type: Residential Re-Roof
<A--CCELJ MENIFEE,CA 92586
MENIFEE Date Issued: 1110812016
P E R M I T
Site Address: 25771 LANCASTER DR, MENIFEE, CA Parcel Number: 335-092-DO1
92586 Construction Cost: $5,600.00
Existing Use: Proposed Use:
Description of REMOVE EXISTING LAYERS, INSTALL NEW COOL ROOF SHINGLES
Work: CRRC#0890-0011
Owner Contractor
JUDYAPPEL FREDERICK RICHARDSON CONSTRUCTION
25771 LANCASTER DRIVE 111871WLIGHTWAY
MENIFEE, CA 92586 MORENO VALLEY, CA 92555
Applicant Phone:9516536132
FREDERICK RICHARDSON License Number.,643209
FREDERICK RICHARDSON CONSTRUCTION
11187TVMLIGHTWAY
MORENO VALLEY, CA 92555
Fee Description Amount
Building Permit Issuance 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 orfrorn preventing builiding operations being carried on thereunderwhen 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_Perrnit_Template.rpt Page I of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds orimproves thereon,and who contracts forthe 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 u I am exempt from licensure under the Contractor's State License Law for
Profess' C d d k�4ioense is in full force and e the following reason:
License Class Z-�—Ucens By my signature below I acknowledge that,except for my personal residence
ExpT,eA LS—' S nature in which I must have resided for at least one year prior to completion of
MT 1
improvements covered by this permit.I cannot legally sell a structure that I
WORKEWS COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
in 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-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.Ieginfo.ca.gov/caIaw.htmI.
this permit is issued.
Policy# Date
PROPERTY OWNER OR AUTHORIZED AGENT
I ave and will maintain worker's compensation insurance,as required by
Jdsl�,tron 3700 of the Labor Code,for the performance of the work for which ri By my signature below I certify to each of the following:I am the property
this permit is issued.My workees compensation insurance carrier and policy owner or authorized to act on the property ownees behalf.I have read this
number are: application and the information I have provided is correct.[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;714732� —Expires enter the ab ove 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 empi any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
W zkees�co�r�ensatlon Ilaws of California'and agree that if I should become HAZARDOUS MATERIAL DECLARATION
so I e w;ker'f compe s tion pro isions of Section 3700 of the Labor
Core, shalitfontrm Nfth thos rovisions. Will the applicant or future building occupant handle hazardous material or a
/ �/ I -- mixture containing a hazardous material equal to or greater that the
A:1icant ,4'y n :9 amounts specified on the Hazardous Materials Information Guide?
Z e5VVI�e -- Pate
WARNING/FAILURE TO SECURE WORKEWS COMPENSATION COVERAGE IS cr 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 forguidelines
CONSTRUCTION LENDING AGENCY o Yes tr No
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) ciYe5 oNo
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 75505 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 ayes 0 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 IRRP)
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 childicare facility to be RRP-certified firms and comply With
an Applicant for a permit subjects the applica nt to a civil pena ItV 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
cr 1,as owner of the property,or my employee with wages as theirsole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )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 sale.(Section 7044,Business and Professions 1-80D-424-LEAD(5323).
Code,The Contractor's State License Law does not apply to an owner of a a An EPA Lead-Safe Certified Renovator will be responsible for this 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. o 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 Contractoes State License Law does not apply to an owner of a If your project does not comply with EPA FRY rule please fill out the RRP
Acknowledgement.
'0,
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
t
- ,"N.enifee
D A T E A/9//(0 PERMIT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL ORESIDENTIAL KMULTI-FAMILY CIMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: 0 ADDITION -ALTERATION 0 DEMOLITION 0 ELECTRICAL 0 MECHANICAL
ONEW OPLUMBING )<RE-ROOF-NUMBER OF SQUARES al
DESCRIPTION OF WORK PL5HOV15 60'S_Ft-NA
eo�p EK4,"6t(n:a " 01" e,,fc e
')6-7'7t Buildlng aQ'S-Mafety Dept.
PROJECTADDRESS ,
ASSESSOR'S PARCEL NUMBER �5!5.Cft-Cnj LOT TRACT NOV 0 8 2016
OWNER NAME JLJIN�4 /4PP&_
ADDRESS L2�5-7'7( I L*__�Clk,_5TC_je_ ReeeivE d
PHON4?�-54&--5X? EMAIL
APPLICANT NAME
ADDRESS IL197 7—b'9lL'e_'(.0-16JAY
PHONErQe5l) EMAIL
coNTRAc-roFt'S NAME 06CI CC---f G210-Vj?-Y:�C" '(OWNER BUILDER.? 0YESV`NO
BUSINESS NAME -��A �4e
ADDRESS L414 17-2t55�
PHON(_ EMAIL
CONTRACTOWS STATE LIC NUMBER 49q_8a(_)q LICENSE CLASSIFICATION
�y
VALUATION$ L SO FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEEPJNG FIRE GREEN SMIP
INVOICE I Ift.qC21 PAIDAMOUNT
AMOUNT 0 CASH 0 CHECK# OCREDITCARD V15AIMC
PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC
[OWNER BUILDER VERIFIED OYES 0 No DLNUMBER NOTARIZEDLETTER 0 YES 0 NO
City of Menifee Building&Safery Department 29714HOLI17Rd. Menifee, CA 92586 951-672-G7177
www.ciryofnienifee.us Inspection Request Line 951-246-6213
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