PMT16-03976 City of Menifee Permit No.: PMT16-03976
29714 HAUN RD. Type: Residential Re-Roof
<A_CCIEG�.' MENIFEE, CA 92586
MENIFEE Date Issued: 12/0612016
P E R M I T
Site Address: 27650 CHARLESTOWN DR, MENIFEE, Parcel Number: 335-255-010
CA 92586 Construction Cost: $9,000.00
Existing Use: Proposed Use:
Description of TEAR OFF EXISTING LAYERS, INSTALL NEW COOL ROOF SHINGLES
Work: **CRRC#0668-0084
Owner Contractor
LARRYISRAEL BAKER ROOFING CORPORATION
27650 CHARLESTOWN DRIVE 29515 DUNKIRK STREET
M ENIFEE, CA 92586 MENIFEE,CA 92586
Applicant Phone:9512557237
LARRY BAKER License Number. 884731
BAKER ROOFING CORPORATION
29515 DUNKIRK STREET
MENIFEE, CA 92586
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 firom 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 oommenred 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_PerrnRTemp1ate.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION 0 1 am exempt from ficensure under the Contractors'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 an my ficense is in Full force and effect. which I must have melded for at least one year prior to completion of
License Class —7q UcenseNo._R F ti r7(3 1 improvements covered by this permit, I cannot legally sell a structure that I have
Expires Signature built as an owner-building it 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 DECLARATION Business and Professions Code,is available upon request whaff-thig application is
submitted or at the following Web site:
0 1 hereby affirm under penalty of pedury one of the following declaratkins: htti3,//www.leginfo.ca.ciovlcalaw.htmI
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 orAuthodzed Agent
Policy# El By my Signature below. I certify to each of the following: I am the property
r_Q�' 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
permit Is issued.My workers'com nsationinsurancecam.er 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 S�_'P ZJ7 identified Rroperty for the inspection purposes.
Policy#& Expires
_4F,�77 int E [9--�t Date
- I Property Owner orAuthorized Agent
(This section need not be completed if the permit is for City Business License#
one-hundred dolIws_(_$1 00)or less)
HAZARDOUS MATERIAL DECLARATION
0 1 certify that in the performance of the work for which this permit is Issued,1
shall not empla 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 mixture containing a hazardous material equal to or greater that the
subject to the workers'compensation provisions of Section 3700 of the Labor amount pecified on the Hazardous Materials Information Guide?
Code,I shall forthwith comply With those provisions. DYES F
Applicant,-2- Date; Will the Intended use of the building by the applicant or future building
occupant require a permit for the construction or modification 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 (63b
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 TH� boundary of a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES NO
CONSTRUCTION LENDING AGENCY r.
I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm that under the penalty of pedury 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) hazardougaterfal reporting.
I
El YES 01
OWNER BUILDER DECLARATIONS W, Date
I hereby affirm under penalty of peijury that I am exempt from the Contractor's L,
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 permit to construct, alter, improve, demolish, EPA RENOVATION.REPAIR AND PAINTING(RRP)
or repair any structure,prior to its issuance,also requires the applicant for the
permit to rile a signed statement (hat 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 a 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 fins and comply With
she is exempt fircim 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 to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than($500).) employees.For mom information about EPXs Renovation Program visit:
www.epa.govilead or contact the National Lead Information Center at
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 Law 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 contmct!Ag 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
licensed contractor(s)pursuant to the Contractors State License Law). If your project does not comply with EPA RRP rule please fill out the RRP
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