PMT16-03848 City of Menifee Permit No.: PMT16-03848
29714 HAUN RD. Type: Residential Re-Roof
<A_CCELA_> MENIFEE. CA 92586
41-1 SMZ� MENIFEE Date Issued: 1113012016
P E R M I T
Site Address: 28227 CORTE RETIRO, MENIFEE, CA Parcel Number. 336-272-025
92586 Construction Cost: $4,350.00
Existing Use: Proposed Use:
Description of TEAR OFF OLD SHINGLES, INSTALL NEW COOL ROOF MALARKEY IN WILLOWOOD
Work:
Owner Contractor
DENNIS FRENCH BAKER ROOFING CORPORATION
28227 CORTE RETIRO 29515 DUNKIRK STREET
MENIFEE, CA 92586 MENIFEE, CA 92586
Applicant Phone: 9512557237
LAWRENCE BAKER License Number: 884731
BAKER ROOFING CORPORATION
29515 DUNKIRK STREET
MENIFEE, CA 92586
Fee Description 22 Amount
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 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 BidgPermit Ternplate.rpt Pagel oil
City Of Menifee
LICENSED DECLARATION 0 1 am exempt from ficensure under the Contraclors'State License Law for the
I hereby affirm under penalty or.perjury 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 and my license is in full force and effect. which I must have resided for at least one year prior to completion of
License Class -3 LicenseNo.?F Ll r7<3 I improvements covered by this permit,I cannot legally sell a structure that I have
Expires Signature r__ _ built as an owner�builcfinq if it has riot 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 whdn—thig application is
submitted or at the following Web site:
0 1 hereby affirin under penalty of perjury one of the following declarations: hftp:ttwww.leginfo.m.gov/calaw.html
I have and will maintain a certificate of consent of self-insure for workers'
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# 0 By my Signature below. I certify to each of the following:I am the property
C'rI have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owners behalf I have read this
echon 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.My workers'comwnsation insurance carrier and policy number are: with all applicable city and county ordinances and slate laws relating to building
construction.I authorize representatives of this city or county to enter the above-
identified Rroperty for the inspection purposes.
Policy#63a_=Ie�CC, Expires Date
Property Owner orAuLhodzed Agent
(This section need not be completed If the permit is for City Business License#
one-hunchred dollars($100)or less)
0 1 certify that in the performance of the work for which this permit Is issued.1 HAZARDOUS MATERIAL DECLARATION
shall not emoloy any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or a
v�orkers'compensaflon laws of California. and agree that if I should become mixture containing a hazardous material equal to or greater that the
subject to the workers'compensation provisions of Section 3700 of the Labor amounts specified on the Hazardbus Materials information Guide?
Code,I shall-forthwith comply with those provisions. [I YES ONO
Applicant.,/- Date; Will the intended use of the building by the applicant or future building
occupant require a permit for ihe construction or modification frorn South
WARNING: FAILURE TO SECURE WORKERS' Coast Afir Quality Management District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND OYES (
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS aO
($100,000), IN ADDITION TO THE COST OF COMPENSATION Will the proposed building or modified facility be within 1000 feet of the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF TH9 boundary of a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES 11 YES!NO
CONSTRUCTION LENDING AGENCY d
I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm that under the penalty of perjury there Is a construction lending p imrifflin i rh-cklirt.I understand my requirements under the State of
agency for the performance of the work which this perml!is issued(Section California Health&Safety Code,Section 25505 and 25534 concerning
3097 Civil Code) hazardous Material reporting.
OWNER BUILDER DECLARATIONS
I hereby affirm under penalty of perjury that I am exempt from the Contractors Date
License Law for the reason($)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 permit to construct,alter, Improve, demolish, EPA RENP�VATION.REPAIR AND PAINTING(RUP
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 the 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 8 pre-1 978
Section 7000)of Division 3 of the Business and Professions Code)or that he or residence or childcare facility to be RRP-certified firms and comply with
she is exempt from licensure and the basis for the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 7031.5 by any Applicant for a permit subjects the applicant G managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than($500).) employees.For more information about EPA!s Renovation Program visit
www.epa.govAead 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( )porting 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, Certified Firm Name:
the building or improvement 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 contractiAg 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 build-q or imnmves therpnn 2nd who nontnant-q fnr thk nmfpr.tq valith n
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