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PMT16-04361 City of Menifee Permit No.: PMT16-04361 29714 HAUN RD. Type: Residential Re-Roof <A-CCEU� MENIFEE, CA 92586 MENIFEE Date Issued: 12/2712016 P E R M I T SiteAddress: 28234 CHULA VISTA DR, MENIFEE, CA Parcel Number: 336-213-008 92586 Construction Cost: $6,475.00 Existing Use: Proposed Use: Description of TEAR OFF EXISTING LAYERS, INSTALL NEW COOL ROOF SHINGLES Work: CRRC 9 0850-0027 Owner Contractor THERESATHURMAN RANDYS CLASSIC ROOFING 28234 CHULA VISTA DRIVE 32960 DAILY DR MENIFEE, CA 92586 MENIFEE, CA 92584 Applicant Phone:9516729411 SUZANNE BALL License Number:726425 RANDY'S CLASSIC ROOFING 32960 DAILY DR MENIFEE, CA 92584 Fee Description P!Y 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 enrors in the plans and specifications or from preventing bulliding 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_Pennit-Template.rpt Page 1 of 1 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 ficensum underthe Contractor's State License Law for Professions Code and my license is in full force and effect. the following reason: By my signature below I acknowledge that,except for my persona I residence License Class 3 License No 7 �_.) Expires Signature 9,r�73K in which I must have resided for at least oneyear priarto completion of WORKER'S COMPENSATION DECLARATION Cl/ improvements covered bythis permit.I cannot legallysell a structurethat I have built as an owner-builder if it has not been constructed in Its entirety by ci I herebyaffirm under penaltyof 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 7044 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. "w.IeRinfo.ca.Rov/caIaw.htmI. Policy# q1)J (06b .9 Date ci 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 forwhich 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 behalf.I have read this numbe7� application and the Information I have provided Is correct.I agree to comply Carrier with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy# !i/2 4)�fp 5�1 Expires enter the above identified property for Inspection purposes. (This section need not to be completed is the permit is for 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, Ishallnotemplo 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 3700 of the Labol Code,I shall�fort)wltb comply with those provisions. Will the applicant or future building occupant handle hazardous material or a Applicant, Z2:�4� Da42-2,7 -1,6 mixture containing a hazardous material equal to or greater that the amounts specified on the Hazardous Materials Information Guide? WARNING:FAILUWTO SECURE WORKER'S COMPENSATION COVERAGE IS a Yes a No UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building AND CIVIL FINES UP TO ONE HUNDRED 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 At.r Quality Management District(SCAQM D)?See perm Itting checklist for guidelines CONSTRUCTION LENDING AGENCY a Yes a No 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) a 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 ciYes a 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 orshe is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING IRRPI 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 and the basis for the alleged exemption.Any violation of Section 7031.5 by receiving compensation for most work that disturbs paint in a pre-1978 an Applicant for a permit subjects the applicant to a civil penalty of not more residence or childcare facility to be RRP-certlfiecl 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 a 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 I I all of or I I portion of the work,and the structure is www.epa-goyllead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-8GO-424-LEAD(5323). Code;The Contractor's State License Law does not apply to an owner of a property who,through employees'or personal effort,builds or improves the o An EPA Lead-Safe Certified Renovator will be responsible for this project 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-BuRder will have the burden of proving that it was not built or improved for the purpose of sale. ci No EPA Lead-safe Certified Firm is required for this project because: ci 1,as owner of the property a m 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 comp IV with EPA RRIP rule please fill out the RRP Acknowledgement. BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION "Menifee DATE PERMIT/PLAN CHECK NLIMEIER9!�M�o -nL4 ate) TYPE: OCOMMERCIAL ?(RESIDENTIAL OMULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRICAL OMECHANICAL ONEW OPLUMBING KRE-ROOF-NUMBEROFSCLUARES / 7 DESCRIPTION OF WORK cAA1z1x-& -,of� 4�e�� riAcl Oseo-0baol PROJECTADDRESS w cot LIQM cl ASSESSOR'S PARCEL NUMBER LOT TRACT OWNERNAME JL4-a-dA- ADDRESS �/ 66,& 7//11-4 Bull 9� Ot= PHONOSJ) �11F -7 EMA'IL I --p DEC 2 ? 20!6 APPLICANT NAME ADDRESS '5 -4 /�j Roc()ived PHONE(9SI)-6-24 �Z&YC�4 EMAIL CONTRACTOR'S NAME OWNERBUILDER? OYES�(NO u /ad, BUSINESS NAME /- 0 ADDRESS 3':�9&� All) PHONE(1�-d EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION$ k7 5- 4 0 . SO,FT LSQFT APPLICANVSSIGNATURF—Li�4L--,g-;7--A.011-.r-kz--/341 DATE - :7-7- CITYSTAFFUSEONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BU51NE55 LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE � GREEN SMIP I X INVOICE PAIDAMOUNT AMOUNT 1 eo' 0 CASH OCHECK# OCREDITCARD VISAIMC— PLAN CHECK FEES PAIDAMOUNT 1 0 CASH 0 CHECK It 0 CREDIT CARD VISIVIVIC OWNER BUILDER VERIFIED OYES 0 NO DLNUMBER NOTARIZEDLETTER 0 YES 0 NO City of Menifee Building& Safety Department 29714 Houn Rd. 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