PMT16-04261 City of Menifee Permit No.: PMT1 6-04261
29714 HAUN RD. Type: Residential Re-Roof
't�kCCFLA> MENIFEE, CA 92586
MENIFEE Date Issued: 1212012016
P E R M I T
Site Address: 29536 AVIDA DR, MENIFEE, CA 92584 Parcel Number: 339-223-006
Construction Cost: $13,160.00
Existing Use: Proposed Use:
Description of TEAR OFF EXISTING COMP, INSTALL NEW 1 LAYER OF 30LB FELT&NEW COOL ROOF OC
Work: DURATION SHINGLES IN FORREST BROWN
Owner Contractor
JOELFLECK PETERSEN-DEAN ING
29536 AV]DA DR 39300 CIVIC CENTER DRIVE
MENIFEE, CA 92584 FREMONT, CA 94538
Applicant Phone:51037116500
JENNY ENCISO License Number:468117
PETERSEN-DEAN INC
39300 CIVIC CENTER DRIVE
FREMONT, CA 94538
Fee Description QtV Amount f$)
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 BidgPermit—Terriplate.rpt Page 1 of I
CITY OF MENIFEE
LICENSED DECLARATION propertywho builds or improves thereon,and who contracts forthe 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).
Chapterg(commencing with section 7000)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 force and effect. the following reason:
Liceri (c3n Ucense No. By my signature below I acknowledge that,except for my personal residence
Expiresl—aL-lj Signature_ In which I must have resided for at least one year prior to completion of
WORKEWS COMPENSATION DECLARATION improvements covered bythis permit.I cannot legally sell a structure that I
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 th--G Ing eclaratons:I licensed contractors.I understand that a copy of the applicable law,Section
have and will maintain a certificate of conse 121 re\f.r wNre�s 7044 of the Business and Professions Code,is available upon request when
compensation,issued by the Director of lndustriaTR�elatlons is 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.ca.gov/calaw.htmi.
Policy# Date
,NO have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
Zlion 3700 of the Labor Code,for the performance of the work for which ci By my signature below I certify to each of the following:I a m the property
this perm it is Issued.My worker's com pensation insura nce ca nrier 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 cityand county ordinances and state laws relatingto
buildingcon ;ructIon). AkQorbe representatives of this city or county to
Policy 6,4040 4Ti-) _EA�rm ' 'o-3c) enterthea oveide fied Ilroperty for inspection purposes -
(This section need not to be completed is the permit is for one-hundred r Date
dollars J$100)or less PIR�WERTY DIM-
14ER OR&THORIZED AGENT
o 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 BIKINFS I-CENSE III
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 La bar
Code,I shall forthwith co IV witli&a-se provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date mixture containing a hazardous material equal to orgreater thatthe
amounts sped ad on the Hazardous Materials Information Guide?
&ametts COMPENSATIOU COVERAGE 15 0
WARNING:FAILU E`/T10,SE&Ftt'r: Yes ZVO
UNLAWFUL,ANnSHALL UB)ECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
SUB
AND CIVIL F114ES UP TO ONkHUNDRED THOUSAND DOLLARS($100,000),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 A. Quality Management District(SCAQMD)?Sea permitting checklist
it
forguldelines
CONSTRUCTION LENDING AGENCY o Yes Oo
I hereby affirrin that under the penalty of perjury there is a construction Will the prop�sed building or modified facility be Within 1000 feet of the
lending agency for the performance of the work which this permit is Issued outer ho,qnary of a school?
a
(Section 3097 Civil Code) u Yes a a
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 under d my requirements under the State of
Contractor's License Law for the reason(s)indicated below by the California 021drf"
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous materiali,repo,;(Ing. Section 25505 and 25534 concerning
Business and Professions Code).Any city or county that requires a permit to aYes o3ju
\ �.-- *1 ) Date
construct,alter,Improve,demolish or repair any structure,prior to its PROPERTY OWNER"TH60RUVAGENT
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 Contractor's S.tate EPA RZIVATION.REPAIR AND PAINTING(RRPI
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt from licensure The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
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 residence or childcare facility to he RRP-certified firms and comply with
an Applicant for a permit subjects the applicant to a civil penalty of not more
than($500). required practices.This includes rental property owners and property
managers who do the paint-disturbing work themselves or through their
a 1,as owner of the property,or my employee with wages as theirsole employees.For more information about EPA!s Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is WINW.epa.govIlead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-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 persona I effort,builds or im proves 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 because:
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 Ucense Law dam not apply to an owner of a If your project dam not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
SA
MITIPLAN C46(APPLIC ION
DATE PERMIT/PLAN CHECK NUMBER
TYPE! COMMERCIAL ORESIDENTIAL [-]MULTI-FAMILY [:]MOBILEHOME [-]POOL/SPA []SIGN
SUBTYPE: F]ADDITIONE]ALTERATISIW []DEMOLITION DELEcTRICAL F]MECHANICAL
[3NEWE]PLUMBING ERE-ROOF-NUMBER OF SQUARES 21 12
DESCRIPTION OF WORK
ml,Ul AUS Q,IfAm sbiydn �hyfef
PROJECTADDRESS Ziv�L5U ,Av)d,:Q Dr. CWN VID- DI
ASSESSOR'S PARCEL NUMBER LOT TRACT
�77A -410L -DL -;k"4-3
PROPERTY OWNER'S NAME ( �r,-)rA �� � t-CK
ADDRESS 5?) L�2 A \j I Ida t2'-, mfhl�ee-
PHONE( Lo.-75- ) �]A — EMAIL
APPLICAN7-NAME
ADDRESS Lj2b Dr.
PHONE 22-11 vp EMAIL jfXCj �rTPrS
mc- I
CONTRACTOR'S NAME 9WNERBUILDER? DYESE�NNO
BUSINESS NAME
ADDRESS �12b
PHONE �dOJT2�U ' All D EMAIL
CONTRACTOR'S STATE LIC NUMBER 40M LICENSE CLASSIFICATION C - 5
VALUATION $ 1 ?) ) I LSQFT —, I
APPLICANT'S SIGNATURE DATE i,)
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP
INVOICE PAID AMOUNT OCASH OCHECK# G CREDIT CARD VISA/MC
AMOUNT 10;�Dilll I I
PLAN CHECK FEES PAID AMOUNT 0 CASH 0 CHECK# OCREDITCARD ViSA/MC
[OWNER BUILDER VERIFIED OYES 0 No DLNUMBER NOTARIZEDLETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
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