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PMT16-03847 City of Menifee Permit No.: PMT1 6-03847 29714 HAUN RD. Type: Residential Re-Roof 'c��CCEUA_> MENIFEE, CA 92586 MENIFEE Date Issued 11/3012016 P E R M I T Site Address: 28217 CORTE RETIRO, MENIFEE, CA Parcel Number: 336-272-026 92586 Construction Cost: $4,350.00 Existing Use: Proposed Use: Description of TEAR OFF OLD SHINGLES, INSTALL NEW SHINGLES COOL ROOF MALARKEY IN VALLOWWOOD Work: Owner Contractor DEBORAH KRING BAKER ROOFING CORPORATION 28217 CORTE RETIRO 29515 DUNKIRK STREET MENIFEE,CA 92586 MENIFEE, CA 92586 Applicant Phone:9512557237 LAWRENCE BAKER License Number.8134731 BAKER ROOFING CORPORATION 29515 DUNKIRK STREET MENIFEE, CA 92586 Fee Description QtV Amount IS) 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 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.Bidg_Permit-Template.rpt Page 1 of 1 City Of Menifee LICENSED DECLARATION El I am exempt from licensure under the Contractors'State License Law for the I hereby affirin under penalty or pedury that I am licensed under provisions of following reason: Chapter 9(commencing With section 7000)of Division 3 of the Business and By my signature below I acknowledge that, except for my personal residence in Professions Code�jand my license Is in full force and effect, - which I must have resided for at least one year prior to completion of -7<3 ) License Class License o. r improvements covered by this permit, I cannot legally sell a structure that I have Expires Signature built as an owner-building if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law. Section 7044 of the WORKER&COMPENSATION DECLA.RATION Business and Professions Code.is available upon request whun—thig application is 0 1 hereby affirm under penalty of perjury one of the following declarations submitted or at the following Web site: I have and will maintain a certificate of consent of self-insure for workers; httn://www.leciinfo.ce.govlcalaw.htmi compensation,issued by the Director of Industrial Relations as provided for by Date Section 3700-of the Labor Code, for the performance of work for which this permit is issued. Property Owner orAuthorized Agent Policy# 13 By my Signature below, I ceilify to each of the following:I am the property I have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read this section 3700 of the Labor Code, for the performance of the work for which this application and the Information I have provided is correct. I agree to comply I permit is issued.Myworkers'com ensation insurance center and policy number are: with all applicable city,and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to enter the above- Carrier identified�roperty for the inspection purposes. Policy Expires Date Property Owner orAuthorized Agent. (This section need not be completed if the permit is for City Business License# ba;� one-hundred dollars($100)or less) HAZARDOUS-MATERIAL DECLARATION 0 1 certify that In the performance of the work for which this permit is Issued,I shall not employ any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or a workers'compensation laws of California, and agree that if I should become rrrixture containing a hazardous material equal to or greater that the subject to the workere compensation provisions of Section 3700 of the Labor amounts specified on the Hazardbus Materials Information Guide? Code.I shall forthwith comply with those provisions. DYES )ONO Applicant.,/- Date; Will the Intended use of the building by the applicant or future building occupant require a pernrilit for the construction or modirication from South WARNING: FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES (I!aO CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the outer DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of a school? LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES NO CONSTRUCTION LENDING AGENCY 76. I have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist.I understand my requirements under the State of agency for the performance of the work which this permit is issued(Section California Health&Safety Code,Section 25505 and 25534 concerning 3097 Civil Code) haze dous Material reporting. r'ous OWNER BUILDER DECLARATIONS DYES I hereby affirm under penalty of perjury that I am exempt from the Contra.ctor"s &k -,. Date License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OWNER OR AUTHORIZED AGENT next-to the applicable item(s)(Section 7031.5.Business and Professions Code. Any city or county that requires a permilt to construct,alter,improve, demolish, EPA RENOVATION,REPAIR AND PAINTING(RRPI or repair any structure, prior to Its Issuance. also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to [he The EPA Renovation,Repair and Painting(RRP)Rule requires contractors provisions of the Contractor's State License Law(Chapter 9(commencing with receiving compensation for most work that disturbs paint in 13 pre-1 978 Section 7000)of Division 3 of the Business and Professions Code)or that he or residence or childcare faciffity to be RRP-certffied firms and comply with she is exempt from ficensure and the basis for the alleged exemption. Any required practices.This includes rental property owners and property violation of Section 7031.5 by anyApplicant for a permit subjects the applicant to managers who do the paint-disturbing work themselves or through their a civil penalty of not more than(S500).) employees.For more information about EPA!s Renovation Program visit: www.epa.gov/lead or contact the National Lead Information Center at 13 1, as owner of the property, or my employees with wages as their sole 1-800-424-LEAD(5323). compensation,will do( )all of or( )porfing of the work,and the structure is not intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's State License Low does not apply to an owner of a property 0 An EPA Lead-Safe Certified Renovator will be responsible for this project who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale.If.however Cerfifled Finn Name: the building or iml�riivement is sold within one year of completion.the Owner- Builder will have the burden of proving that It was not built or improved for the Firm Certification No.: purpose of sale). 0 1. as owner of the property an exclusively contractlAg with licensed 0 No EPA Lead-Safe Certified Firm is required for this project because: contractors to construct the project(Section 7044,Business and Professions Code:The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon, and who contracts for the projects with a DATE FmruRANqiaxNummR TYM 13 OOMMUM 10 FMWaAL D MULB-FAMILY QMCHLEHOME R)OUTAE]S(3N aJMYM []ADrX'n I ON [:]ALTB;A-noN C]DEmal-noNE]BomcAL me3jAmm E:IMN EIPLUMEING [2WR0OF-NUMBRa=MUAFES OmO:;IFnoNoFvvow 'r V MDJ17AMFM 7- ASSEMSBORMNUMBIR 03k(O LCrr 1�r TPACr Ll QO�OWMFMNAME tv,- !�j ADDFM PHONE SML APPIJQANTNAM AMRSS _5 f ':j f r-, 4­4 P 21 PHONE & EMAIL f M—N-MCEORSNAME 1� ry C-,- 26-RBULOff VEIMBONO BUSNESSNAME Sit AMFEM n-L\4 -q-p PHONEq- 5) A 55- 3 ___? 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