PMT16-03959 City of Menifee Permit No.: PMT1 6-03959
29714 HAUN RD. Type: Residential Re-Roof
47�C�L:A�? MENIFEE, CA 92586
MENIFEE Date Issued 12105/2016
P E R M I T
Site Address: 28108 GOETZ RD, MENIFEE, CA 92587 Parcel Number: 341-020-025
Construction Cost: $16,310.00
Existing Use: Proposed Use:
Description of TEAR OFF 1 LAYER REROOF W/OWENS CORNING COOL ROOF IN SHASTA WHITE
Work:
Omer Contractor
SHEHAN FAMILY TRUST THE ROOF EXPERTS
28108 GOETZ RD 520 N QUINCE STREET 6
MENIFEE, CA 92587 ESCONDIDO, CA 92025
Applicant, Phone:7606704391
JANE RECKTENWALD License Number.,740020
THE ROOF EXPERTS
520 IN QUINCE STREET 6
ESCONDIDO, CA 92025
Fee Description Qty 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 emors 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
forreited.
AA BidgPemnit—Ternplate.rpt Page I 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 o I am exempt from licensure underthe ContmctoeS State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class_C77) License No._1cAC6_,)-0 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 prior to completion of
�ZY�' improvements covered by this permit.I cannot legally sell 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 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
this permit is issued. www.leginfo.ca.goy/calaw.litmi.
Policy# Date
o I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which o By my signature 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
with all applicable city and county ordinances and state laws relating to
Carrier 15��-C- GY-P -TiAJ:. I�w%d building construction.I authorize representatives of this city or county to
Policy# tCA-1 qO�q _Expires Lcr7JA_1 enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date k-AC�A(�
dollars($100)or less R__;Z —
PROPERTY—OWr"ORIZED AGENT
o I 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 CITY BUSINESS LICENSE#
workees compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subjectto the worker's compensation provisions of Section 3700 of the Labor
Code,I shall forth those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Data?'GAU mixture containing a hazardous material equal to or greaterthat the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECUU-WORKER'S COMPENSATION COVERAGE IS a Yes
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENA
LTIES 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 SECnON 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCrION LENDING AGENCY 0 Yes *r 0
1 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 b dary of a school?
(Section 3097 Civil Code) ci Yes �;o
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements underthe 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 'terial reporting. 15�7
checkmark(s)I have placed next to the applica ble Itern(s)(Section 703 1.5 nYes W.
Businessand Professions Code).Any city or county that requires a permitto <"__�_Date g,-(5_44�
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTl!QBL2ED 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[IRRPI
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 childcare facility to be RRP-certified firms and comply with
an Applicant for a permit subjects the 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
n 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( )all of or( )portion of the work,and the structure is www.epa.gayllead 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 o An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,th rough em ployees'or personal effort,builds or!in proves 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. ci 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 71344,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 out the RRP
Acknowledgement.
"A e n 1 f e e
DATE 12-5-16 PERMIT/PLAN CHECK NUMBER Ftj-_T1(p-
TYPE: , COMMERCIAL VRESIDENTIAL — MULTI-FAMILY - MOBILE HOME POOL/SPA -;SIGN
SUBTYPE; ADDITION ,�,ALTERATION � DEMOLITION �� ELECTRICAL MECHANICAL
NEW � PLUMBING VRE-ROOF-NUMBER OF SQUARES 28
DESCRIPTION OF WORK 28 Squares, tear off, layers - 1, roof pitch - 2/12, class A
Owen's Corning, brand/model - Oakridge-Shasta White, IMUL Listing 0890-0002
PROJECTADDREss 28108 Goetz, Rd Quail Valley, CA 92587
ASSESSOR'S PARCEL NUMBER 341-020-025 LOT TRACT
OWNER NAME Shehan Famil�T_rust
ADDRESS 28108 Goetz, Rd Quail Valley, CA 92587
PHONE 951-490-1480 EMAIL
APPLICANT NAME Jane Recktenwald
ADDRESS
PHONE 714-336-6159 EMAIL -janereckQatnet
CONTRACTOR'S NAME OWNER BUILDER? '.) YES VNO
BUSINESS NAME The Roof Experts
ADDRESS 520 N Wnce St #6 Escondido, CA 92025
PHONE 760-670-4391 EMAIL
CONTRACTOR'S STATE LIC NUMBER 740020 LIC NSE CLASSIFICATION
VALUATION$ 16,310.00 So FT L So FT
APPLICANT'S SIGNATURE 74��7DATE 12-5-16
DEPARTMENT DISTRIBUTION IVO SMIP CITYOFP4NIFEE NESS LICENSE NUMBER
GR
G FIRE
BUILDING PLANNING ENGINEERIN Ll:,;EEN
INVOICE PAIDAMOUNT
AMOUNT CASH CHECK N CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUN CHECK 9 _�CREDITCARD VISA/MC
OWNER BUILDER VERIFIED , YES , NO DL NUMBER NOTARIZED LETTER __ YES � NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.drvofmet7iIcee.us Inspection Request Line 951-246 6213
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