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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. 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