PMT17-00671 City of Menifee Permit No.: PMT17-00671
_ 29714 HAUN RD.
!; CCEL/_> MENIFEE, CA 92586 Type: Residential Re-Roof
MENIFEE Date Issued: 03/06/2017
PERMIT
Site Address: 29412 CARMEL RD, MENIFEE, CA 92586 Parcel Number: 338-071-012
Construction Cost: $10,980.00
Existing Use: Proposed Use:
Description of TEAR OFF EXISTING LAYERS, INSTALL NEW COOL ROOF SHINGLES
Work: "' CRRC#0668-0078"
Owner Contractor
BELVA RICHARDS HOUSETOP ROOFING
29412 CARMEL ROAD 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 ON Amount I$1
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_Bldg_Permit_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 perjurythat 1 am under provisions of with a licensed contractor(s)pursuant to the Contractors State License taw).
Chapter!)(commencing with section 7000)of Division 3 of the Business and O I am exempt from Iicensure under the ContractoesState License Law for
Professions Code and my license is in full force and effect. �/ the following reason:
License Class � `3/ License No. 371174F. S By my signature below l acknowledge that,except for my personal residence
Expires Signature in which I must have resided for at least one year pdarto completion of
WORKER'S COMPENSATION DE[LARAT improvements covered by this permit.I cannot legallysell 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 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 www.Ieeinfo.ca.Aov/calaw.htmL permit is issued.
Polity it Date
W,5'.ve 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 behalf.I have read this
number are: 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# 77107 Expires /e-7 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
,V'ceri ify 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 370D of the Labor
Code,I shall forthwith comply with those provisfo s. Will the applicant or future building occupant handle hazardous material or
Applicant Date Z Z� mixture containing a hazardous material equal to or greater that the
amounts Rsp�ecified on the Hazardous Materials Information Guide?
WARNING: LURE TO SECURE WORKER'S COMPENSATION COVERAGE IS 0 Yes '_
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 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(SCAQMD)7 See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguide11
CONSTRUCTION LENDING AGENCY oYes No
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modifted 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) 0 Yes lido
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjurythat 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 Reni(Section 7031.5 hazardous material reporting.
Business and Professions Code).Any city or county that requires a permit to oYes /
construct,alter,improve,demolish or repair any structure,priorto its Date 2r�
issuance,also requires the applicant for the permit to file a signed statement PROPEQ WNER OR AUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RE OVATION.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 Iicensure 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 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 orthrough their
o I,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.eov/lead 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 OAn 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. - O No EPA Lead-Safe Certified Firm is required for this project bemuse:
O I,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 -
& SAFETY PERMIT/PLAN CHECK APPLICATION2
y�•
,MenifeE
DATE 3 PERMIT/PLAN CHECK NUMBER 't
TYPE: O COMMERCIAL KESIDENTIAL O MULTI-FAMILY " MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: ��ADDITION C ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
i% NEW C PLUMBING fi RE-ROOF-NUMBER OF SQUARES 3
DESCRIPTION OF WORK
PROJECT ADDRESS 2 9 �Z �'J�iC/%�L Ifee
.�Q � Building & Salty Dept.
ASSESSOR'S PARCEL NUMBER �C�1- /d���� LOT TRACT
OWNER NAME ��11`-c�y�'`��� `�lG�y�/tD S �f MAR 0 6 2017
ADDRESS is ! T�Z cq'*L/49� c,4 ed
PHONE lv7Z• d 7'7�1� �+��E�MAIIL 0.J
APPLICANT NAME /c-!V� c.�y�rlcr I/ e
ADDRESS �317G D RIC44 �•S fe0 - /
PHONE O y ��/� EMAIL /L/ O
- CO
CONTRACTOR'S NAME 4Gle7z r7 � lj L O OWNER BUILDER? 0 YES ON
BUSINESS NAME
/(
ADDRESS 3I--7GO
PHONE �iEMAIL
CONTRACTOR'S STATE LIC NUMBER �' / p� LICENSE CLASSIFICATION e^3
VALUATION$ /Q 0 jJ SO FT 33 L SQ FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP 'K
INVOICE ` PAID AMOUNT
AMOUNT 1 ,Q o OCASH "CHECK OCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES ONO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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