PMT16-03960 City of Menifee Permit No.: PMT16-03960
29714 HAUN RD. Type: Residential Re-Roof
<A-CCELA? MENIFEE, CA 92586
MENIFEE Date Issued: 12105/2016
P E R M I T
Site Address: 29661 CARMEL RD, MENIFEE, CA 92586 Parcel Number: 338-063-016
Construction Cost: $3,960.00
Existing Use: Proposed Use:
Description of TEAR OFF EXISTING, RE-ROOF WICOOL ROOF OWENS CORNING IN WHITE
Work:
Owner Contractor
JAMES BOLES HOUSETOP ROOFING
29661 CARMEL RD 31760 BRIGGS ROAD
MENIFEE,CA 92586 MENIFEE,CA 92584
Applicant Phone: 9516798369
RICH CARROLL License Number: 371783
HOUSETOP ROOFING
31760 BRIGGS ROAD
MENIFEE, CA 92584
Fee Description ON Amount($1
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.Bldg_Pe"lt_Template.rpt Page 1 of 1
C[TY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who cintnicts for the projects
I hereby affirm u nder pena Ity of perjury that I am under provisions of with a licensed contractoqs)pursuant to the Contractors State License Law).
Chapter!)(commencing with section 7000)of Division 3 of the Business and cz I am exempt from licensure under the Contractor's State License Law for
Profinsions Code a nd my license is in full force and effect. the following reason:
License Class C— 3'149 license No. '��:71?i6� By my signature below I acknowledge that except for my personal residence
Expires IZl
,4�� Signature in which I must have rukled for at least one year pflorto completion of
r improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATIOd 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 Profusions 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 370D of the La bor Code,for the performance of work for which �w.leginfo.ca.eov/calaw.lit!!Lll.
this permit is issued.
Policy H PROPERTY OWNER OR AUTHORIZED AGENT Date—
V�Ih;ime and will maintain worker's compensation insurance,as required by
section 3700 of the Labor code,for the performance of the work for which a 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
Carrier with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives ofthis City or county to
Policy 0 Expirn—I.?-1-14 enter the above identified property forinspecrion purposes.
7
(This section need not to be completed is the permit is for one-hundred Date—
dollars($100)or[us PROPERTY OWNER OR AUTHORIZED AG ENT
rz 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 9
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 ithcomplywith hoseprovi.si n . e applicant or future building occupant handle hazardous materialore
1�7 mixture containing a hazardous material equal to orgreater that the
Applicant Date lellIAl- will 0,
amounts specified on the Hazardous Materials Information Guide?
WARNING:(
FURE TO SECURE WORKER'S COMPENSATION COVERAGE IS oYes oNo
- L
UNLAWFU ND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use ofthe building by the appitcantor future building
AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modilicatilon from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAULMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTERES17,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY Oyu UND
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified fa cility be within 100D feet of the
lending agency for the performance of the work which this permit is issued outer bounda ry of a school?
(Section 3097 Civil Code) nYes ciNo
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 Hea Ith&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 0yes 0 No
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,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 ofthe Contractor's State EPA RENOVATION,REPAIR AND PAINTING IRRP)
License Law(Chapter 9(commencing With Section 70UD)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 7032.5 by ressidence or childcare facility to be RRP-certiried firms and comply with
an Applicant for a permit subjects the applicant to a civil penalty of not more required practicu.This includes rental property owners and is roperty
than($500). martagerswho do the paint-disturbing work themselvesor through their
a 1,as ownerofthe propeft ormy employee with wages astheirsole employcess.For more Information about EPA�s Renowarion Program visit:
compensation,will do( )allofor( )portion ofthe work,and the staticture is www.epa.amy/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5373).
Code;The Contractor's State License Law don not apply to an owner of a a An EPA Lead-Safe Certified Renov;ttor Will be ruposuble for this project
property who,through employees'or personal effort,builds or Improves the
property provided that the Improvements are not intended or offered for Certified Firm Name:
sale.if,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that It was
not built or improved for the purpose ofsale. cz No EPA Lead-Safe Certified Firm is required for this project because:
0 1,as owner ofthe property am exclusively contracting with licensed
contractors;to construct the project(Section 7044,Business and Professions
Code:The Contraictor's State License Law don not apply to an owner of a Ifyour project don not comply with EPA RRP acule please fill out the RRP
Acknowledgement
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
.."Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL 2VIRESIDENTIAL CMULTI-FAMILY OMOBILEHOME 0 POOL/SPA 0,SIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRICAL 0 MECHANICAL
ONEW OPLUMBING (XfiE-ROOF-NUMBER OF SQUARES-_22,
DESCRIPTION OF WORK
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER LOT TRACT
-r -5
OWNER NAME xlo-,;g
ADDRESS a c4ye,42oz
PHONE ;70�0 EMAIL
APPLICANT NAME a
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILDER? 0 YES Cl NO
BUSINESS NAME
ADDRESS
PHONE SP-5- -Z 7// EMAIL
CONTRACTOR'S STATE LIC NUMBER ;7 r3 LICENSE CLASSIFICATION
VALUATION$ F�- 3&2,,;, — sQ FT LSQFT
APPLICANT'S SIGNATURE DATE 12 Z2;2�//
DEPARTMENT DISTRIBUTION SMIP CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN
INVOICE I PAIDAMOUNT
AMOUNT 0 CASH OCHECK# �.,CREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0 CASH 0 CHECK# OCREDITCARD VISAIMC
OWNER BUILDER VERIFIED OYES 0 No DL NUMBER NOTARIZED LE17ER 0 YES 0 NO
City of Menifee Building& Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
z P a w n L! > rl) 'o ;a!3
9 C. g - m M qm �
0 m ff
4S� 0' 9 0 ' G) m
F 2L m
2 3 m 0
0 M Z 0
n x
:6 m
o, �o n q >
M Z!:
3 n> -4 m
m m 0
0 n m n
m
0
0 A
9 z
m m z
z r) >
V M m
3 0 0
m m a 0
Z
m m
0 0
E� >
Z
>
0 X
0 m m
& ; =;;
M= M,
0 M
n z m
m > MR w 11 , S m
m 3 1 0 o
0
m
m
mm ;- a
3 0
a m
;p 0 03� 0 , = :;- ,
G 0 0
W m
- 0
o 3
m M.
Om VM m a w
0, ar D "0
m M 0 u - M M M
o m 0 3 C 12
V x m 2m
m
4 0
01 8
0 2. n
C)
o 2 o 3
0,
bo R.
m FL
M >
rl: m
c 2.
-3, 0 , Q� �=
c w m m ED
m EL
n x
>
m "o Mw
m
m 9:
M 00 0 % I
M m , a A� --- — T r I
No 8 MM a 0 c
m C3 3 1�1 V� 01 3 w QO
m m
n OS CD
m m m w SD 0
3 m m M M 0 X
0 m X
z m
0
0 CD CD
M n
m CD
w w 0 0 CD
c 0 n
m 0 M 3
1 03�
0 M M M
W
x
m
w >
cm
>
0
in
Z
M m
m
M z
0 x
G)
0
0 0
w Ln
0 6 La W Z o
0 FL u z
F3 m
n z M
0 a 0 CD ;a
3 3 -0 IZO _4
m 2-:
W 0
0
Z
9 K 0 a 0 C
m
m m o
o
0
0
0 Er 0 E5
0 0
Z
9L 2. 5 0 0 m
m 2. mm 0 m z m w
R 3 x o o o 0
n 0 n
. , 0 0 0 a
0
g C, 1 3
m
0
Z
0 0 X,
0
0
0 o w
0 = - w 9 ,
0 o q
D
0 <
0 M
M u M 0 a o -
0 0 0
0
n Z3 b
0
no P' c3
0 C) 0
0
0 o m 0
0 0 - , 2, M m
3 0 0 m
m i> m
C , D 0 2 - 1 0
iD, M M -, 5' 3 - - M
0 G) m 0 m n N
0
o 0
0 0 m 0 M 0 m
m 3
0
0 ET o 0 m n 0 0
0
0
m 0 o
n 81 w 0 m
m
0
0 z
0 M
I
m > m 0 T. 0
0� p 9
n EL
m 0 0 m
0
rb
3. 0 Q. 00
M M 0
x n
0
0 n 7; 0. 5 m 0
0
FL
0
o
0
0
0
0
n
< 0
0 m
w 3
c 0 w
n
0
0
Lk) 3 0
+ F,
0
p
m
z Al
>
3
m
3
0
0
0
0
3
Z
G)
0