PMT16-04239 City of Menifee Permit No. PMT16-04239
29714 HAUN RD. Type: Residential Re-Roof
<A-CCELA-? MENIFEE, CA 92586
MENIFEE Date Issued 12119/2016
P E R M I T
Site Address: 28937 SNEAD DR, MENIFEE, CA 92586 Parcel Number 337-385-013
Construction Cost: $9.000.00
Existing Use: Proposed Use:
Description of TEAR OFF EXISTING LAYERS, INSTALL NEW COOL ROOF SHINGLES
Work: CRRC#0089-0013
Owner Contractor
GERALD FULTON J D F CONSTRUCTION INC
28937 SNEAD DRIVE 1114 E TRUSLOW AVE
MENIFEE, CA 92586 FULLERTON, CA 92831
Applicant Phone:71452611120
JAY WEBER License Number. 956749
J D F CONSTRUCTION INC
1114 E TRUSLOW AVE
FULLERTON, CA 92831
Fee Description PIK 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
forfeited.
AA Bldg_Permit Template.rpt Page 1 of I
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 a I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class License No. 01 .6-6 -7 Cf-T 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
improvements covered by this permit.I cannot legally sell a structure that I
WORKEWS COMPENSATION DECLARAT60/ have built as an owner-builder If it has not been constructed in its entirety by
ci 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 7944 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.m.gov/calaw.html.
Policy# —Date
A 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 beha If.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 building construction.I authorize representatives of this city or county to
Policy#&' A 0C.0 Expires enter the above identified property for Inspection purposes.
(Thissection need not to be completed Is the permit is/or one'-hundred Date
dollars($100)or less PROPERTY OWNER 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#
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 37GO of the Labor
ode,I s a art wit camp y wit t use provisions. Will the applicant or future building occupant handle hazardous material or a
' 'w
C P h� 17-114114
Applicant Date mixture containing a hazardous material equal to or greater that the
amounts specified an the Hazardous Materials Information Guide?
WARNIN AILURE To SEC
4GE IS o Yes ci No
WARNIN AILURE TO SECURE WORKER'S COMPENSATION 1?DVE
UNLAWF AND SHALL SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIAnL FINES UP TOONE HUNDRED THOUSAND DOLLARS($100,DOO),IN
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)?See permitting checklist
for guidelines
CONSTRUCTION LENDING AGENCY oYes oNo
I 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 boundary of a school?
(Section 3097 Civil Code) ci Yes ci No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractor's License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material reporting.
Business and Professions Code).Any city or county that requires a permit to oYes n No
construct,alter,improve,demolish or repair any structure,prior to its —Date
issuance,also requires the applicant for the permit to file a signed statement PROPERTY OWNER OR AUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING IRRP)
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
an Applicant for a permit subjects the applicant to a civil penalty of not more residence or childcare facility to be RRP-certified firms and comply with
than($500). required practices.This includes rental property owners and property
managers who do the paint-disturbing work themselves or through their
ci 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.goy/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions I-BUG-424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner Of a ci 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 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. a No EPA Lead-Safe Certified Firm is required for this project bemuse:
a 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
...'Menifee
DATE 4 PERMIT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL "ESIDENTIAL OMULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION 0DEMOUTION OELECTRICAL OMECHANICAL
ONEW OPLUMBING Q�RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK ---raaA
tA)
PROJECT ADDRESS 7 6.�J
City Oj MenifeO
ASSESSOR'S PARCEL NUMBER LOT TRACT Dep -
OWNER NAME J�w/+,9 n
Mt i 9 20is
ADDRESS a,?'jq -7 e-UJ D4
PHONE -7 2— 'If EMAIL Ftecejved
r
APPLICANTNAME L004 vje,&�r To
ADDRESS I't tt)
PHONE 71�V
EMAIL hPx--e,5e4-,11i c �a�oa
CONTRA�OR'S NAME OWNERBUILDER? OYES"O
BUSINESS NAME
ADDRESS /(/
PHONE EMAIL
CONTRACTOWS STATE LIC NUMBER q52� 7 6� LICENSE CLASSIFICATION
VALUATION$ eOPO SQ FT LSQFT
APPLICANT'S SIGNATU RE DATE
CITYSTAFF USE ONLY
DEPARTMEW DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAIDAMOUNT 11-6b
AMOUNT�J':�(),CkO CASH CHECK 9 0 CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DL NUMBER NOTARIZED LE17ER 0 YES 0 NO
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City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofimenifee.us Inspection Request Line 951-246-6213
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