PMT16-04039 City of Menifee Permit No.: PMT16-04039
29714 HAUN RD. Type: Residential Re-Roof
<A_CCF_LA_> MENIFEE, CA92586
MENIFEE Date Issued: 1211212016
P E R M I T
Site Address: 29238 PEBBLE BEACH DR, MENIFEE, Parcel Number., 338-083-004
CA 92586 Construction Cost: $8.500.00
Existing Use: Proposed Use:
Description of TEAR OFF EXISTING, RE-ROOF WITH COOL ROOF OWENS CORNING IN SHASTA WHITE
Work:
Owner Contractor
STEVE NELSON HOUSETOP ROOFING
2923B PEBBLE BEACH DR 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 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 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.Bidg_Permit Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION propertywho builds or improves thereon,and who contracts for the projects
with a licensed ccartractor(s)pursuant to the Contractors State License Lawl.
I hereby affirm under penalty of perjury that I am under provisions of
Chapterg(commencing with section 70001 of Division 3 of the Business and 0 1 am exempt from licensure under the Contractoes State License Law for
Professions Code and my license is in full fame and affect. the following reasom
License Class. C— 5 i; LicenseNo. 3,y&Z(-9- By my signature below I acknowledge that,except for my personal residence
Expires —7— /7 Signature In which I must have resided for at least one year prior to completion of
Improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-bulkler if it has not been constructed in its entirety by
cl 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 7D44 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 webafte;
by Section 3700 of the Labor Code,for the performs nce of work for which www.le-info.m.gay/calaw.111mil
this permit is issued.
Policy d PROPERTY OWNER OR AUTHORIZED AGENT Date
n I have and will maintain worker's compensation insurance,as required by
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 workees compensation insurance carrier and policy owner or authorized to act on the property ownees behalE I have read this
num her are: application and the information I have provided is correct.I agree to comply
Carrier XL—.e with all applicable city amf county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
policy N '1Xy"i;0 13 rr—)i 1Y Expires I jr— I enter the above identified property for inspection purpose.
(This section need not to be completed Is the permit is for one-hundred Date—
dollars($100)or less PROPERTY OWN Ell OR AUTHORIZED AGENT
ci 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 0 7,gv-541
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workees compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS a Yes PO
U NLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applimunt or future build Ing
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,00(f),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(SCAOM D)?See permitting checklist
IN SECTION 3706 OF TH E LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidellnes
CONSTRUCTION LENDING AGENCY a Yes "0
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 10DO 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) uYes Oo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMO
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
Contractoes License Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(5)I have placed next to the applicable item(s)(Section 7031.5 oYes
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 of the contractoes state EPA RENOVATI N REPAIR AND PAINTING JR�Pl
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting RRP)Ru le 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 703LS 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
a 1,as owner of the property,or my employee with wages as their sole em ployees.For more in formation about EPA!s Renovation Program visit:
compensation,will do( )all ofor( )portion of the work,and the structure is www.epa.govilead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions I-BOG424-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 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 build Ing 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 sate. Is No EPA Lead-Safe Certified Firm is required far this project bemuse:
a 1,as owner of the property am exclusively contracting With licensed
contractors to construct the project(Section 7044,Business a nd 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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
"0,
Wenifee
DATE PERMIT/PLAN CHECK NUMBER wTl(0 ,-v46=M-
TYPE: 0 COMMERCIAL �rRESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA 0 SIGN
SUBTYPE: OADDITION 0ALTERATION ODEMOLITION OELECTRICAL OMECHANICAL
ONEW OPLUMBING P-R'E-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK VZLX, j�q�� 4;:Fy(5 1 d;:%� A117,71
6cpe & 4�11111174_ e"01"141,11"
PROJECT ADDRESS AWe%4�r 2?ZZ46 X/
ASSESSOR'S PARCEL NUMBER :�ft--0f5-0DqLOT ILO?% TRACT A04
OWNER NAME -57&219
ADDRESS
o� z,69
PHONE 49-�07 EMAIL
APPLICANT NAME Re,c X4 Z1fxoe_0Z
ADDRESS 31-1&o oeiO ,
PHONE S6� EMAIL a
CONTRACTOR'S NAME OWNER BUILDER? 0 YES C NO
BUSINESS NAME 1&5g-1na
ADDRESS :?./7210 L02 9/—/4��_5
PHONE 62�5_ — 1-711 EMAIL 042"If,�
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ SO FT L SQ FT
APPLICANT'S SIGNATURE 151Z-Z�X DATE
241 il- IN 81014, . _,!sffr�
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE -01 PA
AMOUNT r,�Oel IDAMOLINT 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0 CASH OCHECK# 0 CREDIT CARD VISA/MC
LOWNER BUILDER VERIFIED OYES 0 No DLNUMBER NOTARIZED LETTER =_
City of Menifee Building& Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
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