PMT16-03900 City of Menifee Permit No.: PMT1 6-03900
29714 HAUN RD. Type: Residential Re-Roof
<ACCELi,.' MENIFEE, CA 92586
MENIFEE Date Issued: 12/0212016
P E R M I T
Site Address: 29360 CARMEL RD, MENIFEE, CA 92586 Parcel Number: 338-071-008
Construction Cost: $3.275.00
Existing Use: Proposed Use:
Description of REMOVE ROOF AT FRONT HALF REPLACE WITH OWENS CORNING COOL ROOF IN SHASTA
Work: WHITE
Owner Contractor
LOUISE BRANNEN WEATHERTIGHT ROOFING INC
29360 CARMEL RD P 0 BOX 5281
MENIFEE, CA 92586 HEMET, CA 92544
Applicant Phone:9519290557
GUY SCHEMBRI License Number.643691
WEATHERTIGHT ROOFING INC
P 0 BOX 5281
HEMET, CA 92544
Fee Description Qtv 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 building 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 Mmmenoed is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA B1dg_Perrnit_Temp1ate.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 fcarnmencling 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:
UicenseClass—c- .3 � License No. By my signature below I acknowledge that,except for my personal residence
Expires Signature In which I must have resided for at least one year priorto completion of
-----7 0— improvements covered bythis permit.I cannot legallysell a structuretbat I
WORKEWS 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 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 Labor Code,for the performance of work for which www.leginfo.ca.goy/calaw.html.
this permit is issued.
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,forthe performance of the work for which a By mysignature below I certify to each of the following:I am the property
this permit is issued.My worker's compensation Insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
Carrier e--o-,L with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy#W/, C175-VIV Expires &/,'Z1 7 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
pq certify that in the performance of the work for which this permit is issued,
Ishallnoterrini any persons in any manner so as to become subject tothe 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 forthwith comply with t�hpe pirmorons. Will the applicant or future building occupant handle hazardous material or a
121?-14 mixture containing a hazardous material equal to orgreater that the
amounts specified an the Hazardous Materials Information Guide?
W Ali' E TO SECURE WORKER'S COMPENSATION COVERAGE IS 0yes FiNo
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the build Ing 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 ATrORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY Dyes ar-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) 0 Yes E),10
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 mYes
Business and Professions Code).Any city or county that requires a permit to
construct,alter,improve,demolish or repair any structure,prior to its e�oo -!i:2 t,/-- Date /2
—. RR0iTERYYj0—WNER OR AUTHORIZED AGENT
issuance,also requires the applicant for the permit to file a signed statement W
that he or she is licensed pursuant to the provisions of the Contractor's State EPA.RENOVATION,REPAIR AND PAINTING(RRP)
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 distu rbs paint in a pre-1978
and the basis for the alleged exemption.Any Violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with
an Applicant for a permit subjects th a applicant to a civil penalty of not more required practices.This includes rental property owners and property
than($50D). managers who do the paint-disturbing work themselves or through their
ci 1,as owner of the property,or my employee with wages as their.sale employees.For more information about EPA!s Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure Is www.eria.gay/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 forthis 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 sa le. u 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 Contractor's State License Law dam not apply to an owner of a If your project dam not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE /:2/2- PERMIT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL 6�RESIDENTIAL OMULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRICAL OMECHANICAL
ONEW OPLUMBING Q RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK R4,~ve r ro� 0-1
Z4� tl, L"lw oo
PROJECTADDRESS .2- F-3e,0
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME c5�&oI5�, 73rawv-e�"
ADDRESS �93(00
PHONE f&q- ,223 - 2-01te EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACrOR'S NAME 0//-" OWNER BUILDER? 0 YES ONO
BUSINESSNAME
ADDRESS P. c. &,y -5z,5r( Apmd e,�4 9zsyl
PHONE f 571 - %7 9 -05-6*7 EMAIL
CONTRACTOR'S STATE LIC NUMBER 613L91 LICENSE CLASSIFICATION e� 3 ,9
VALUATIONs 3,2- 75 SO FT f,00 L SQ FT
APPLICANT'S SIGNATURE DATE 12 12//4'
J�,
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE � GREEN Smip
INVOICE � PAID AMOUNT
AMOUNT 1 0 CASH 0 CHECK# O-CREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT OCASH OCHECK# OCREDITCARD VISA/MC-
FOWNER BUILDER VERIFIED 0 YES 0 No DL NUMBER NOTARIZED LETTER 0- YES 0- NO
City of Menifee Building& Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
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