PMT16-03730 City of Menifee Permit No.: PMT16-03730
29714 HAUN RD.
'5A_CCJELA_> MENIFEE,CA 92586 Type: Residential Re-Roof
MENIFEE Date Issued: 1111812016
P E R M I T
Site Address: 28160 WINDSOR DR, MENIFEE, CA Parcel Number: 337-174-003
92586 Construction Cost: $8,000.00
Existing Use: Proposed Use:
Description of TEAR OFF EXISTING LAYERS, REROOF W/MALARKEY HIGHLANDER DOVE WHITE COOL ROOF
Work: WORK DONE W(OUT PERMIT*
Owner Contractor
WILLIAM HAMM
28160 COMO ST
WILDOMAR, CA 92596
Applicant License Number,
WILLIAM HAMM
28160 COMO ST
WILDOMAR, CA 92595
Phone: 9512567632
Fee Description Qtv Amount
Building Permit Issuance 1 27.00
Inspections not specified 98 98.00
Inspections not specified 98 98.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Building 1 9.80
$233.80
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 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_Pemi1_Ternplate.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 ci 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 License No. By my signature below I acknowledge that,except formy personal residence
Expires_Signature in which I must have resided for at least one year priorto completion of
Improvements covered bythis permit.I cannot legallysell 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-insure for workees 7044 of the Business a nd Professions Code,is available upon req uest when
compensation,issued by the Director of Inclustria I 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.leginfo.m.goy/calaw.htmi.
Policy# Date
PROPERTY OWNER OR AUTHORIZED AGENT
a 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 com pensatilon insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
number am: 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# Expires enter the above Identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred \0 '&-)C\OArlv� Date
dollars($1.00)or less PROPERTY OWNER OR AUTHORIZED AGENT
o I certify that in the performance of the work for which this permit Is Issued,
Ishallnoterincil 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 workees compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKERS COMPENSATION COVERAGE 15 uYes oNo
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 oYes oNo
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 30137 Civil Code) a Yes o 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 aYes o No
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 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 Contractoes State EPA RENOVATION,REPAIR AND PAINTING IARPI
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 childca re facility to be RRP-certffied firms and comply with
an Applica nt for a permit subjects th e 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
o 1,as owner of the property,or my employee with wages as their sole employees.For more information about EPA!s Renovation Program visit:
compensation,will do I I all of or I )portion of the work,and the structure Is www.ecia.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 a An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,th rough 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 build ing 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. o No EPA Lead-Safe Certified Firm is required for this project because:
ci 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 ou"he RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
r�jty U1 IV
afeWbept.
�,-Alding &
z
2016 ...'Menifee
DATE F ad PERMIT/PLAN CHECK NUMBER
UV
TYPE'. COMMERCIAL ORESIDENTIAL OMULTI-FAMILY OMOBILEHOME 0 POOL/SPA 0 SIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRICAL MECHANICAL
ONEW OPLUMBING ORE-ROOF-NUMBEROFSQU..1.-5
DESCRIPTION OF WORK q)%�,b-�
PROJEcTADDRESS c�_R),LL, w� `� , C—
ASSESSOR'S PARCEL NUMBER 1"I- [14-tpa LOT TRACT
OVINERNAME wllsj,64yy�
ADDRESS Vj\,\,S\F
PHONE tcs g- EMAIL
APPLICANT NAME
.ADIDRESS
PHONE EMAIL
CONTRACTOR'S NAME OWNERBUILDER? OYESONO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S5TATE LIC NUMBER LICENSE CLASSIFICATION
ALLIATION $ C)0 SO FT s . , L SO FT
APPLICANT'S SIGNATURE 1\J0 F rVVV%� DATE
DEPARTMENT DISTRIBUTION too CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE to I PAIDAMOUNT
AMOUNT 19,63. — 1 � OCASH OCHECK4 OCREDITCARD VISA/MC
PLAN CHECK FEES I PAID AMOUNT I 1 0 CASH 0 CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityojmet7ifee.us Inspection Request Line 951-246-6213
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