PMT17-00854 City of Menifee Permit No.: PMT17-00854
29714 HAUN RD. Type: Residential Re-Roof
<A-CCr=LA> MENIFEE, CA 92586
MENIFEE Date Issued: 0 8/2 012 01 7
PERMIT
Site Address: 28791 PORTSMOUTH DR, MENIFEE, CA Parcel Number: 339-161-005
92586 Construction Cost: $10,000.00
Existing Use: Proposed Use:
Description of TEAR OFF EXISTING SHINGLES, INSTALL NEW COOL ROOF
Work: "CRRC#0890-0002
Owner Contractor
RICK BOONE HOUSETOP ROOFING
28791 PORTSMOUTH DRIVE 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 gyt Amount f51
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_Sidg_Permit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds cur improves thereon,and who contracts for the projects
I hereby affirm under penalty of perjurythat 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 o I am exempt from[[censure under the Contractor's State License Law for
Professions Code
and my license is in full force and effect. the following reason:
License Class ` `3�_License No. /I/O g m signature below I acknowledge that,except for m
y y g g p y persona)residence
ExpiresZ,9 Signature in which l must have resided for at least one year priorto completion of
improvements covered by this permit.I cannot Iegallysell a structure that I
WORKER'S COMPENSATION DE[LARATI 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 workers 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. n.yvw.leeinfo.ca.eav/calaw.html.
Policy# Date
Wave OWNER OR AUTHORIZED AGENT
and will maintain workers compensation insurance,as required by -
section 3700 of the Labor Code,for the performance ofthe work for which o By my signature below I certify to each of the following:I am the property
this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this
numberare: application and the information I have provided is correct I agree to comply
Carrier ytlj with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# 7�fo7 Expires /Z enter the above identified property for inspection purposes.
(This section need not to be completed Is the permit is for one-hundred
dollars($100)or less Date
PROPERTY OWNER OR AUTHORIZED AGENT
�erbify that in the performance of the work for which this permit is issued,
Ishallnotemolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 ofthe Labor
Code,I shall forthwith comply with those provisio s. �1 Will the applicant or future building occupant handle hazardous material or
Applicant C! Date ZtT mixture containing a hazardous material equal to or greater that the
amounts�sp�ecified on the Hazardous Materials Information Guide?
WARNING: LURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes �.V
UNLAWFUL,AND SHALLSUBIECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use ofthe building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,00D),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant Quality Management District the
or See modification
mitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Corguid ast Airlin
CONSTRUCTION LENDING AGENCY o Yes No
I hereby affirm that under the penalty ofpedury there is a construction Will the proposed building or modified facility be within 1000 feet ofthe
lending agency for the performance ofthe work which this permit is issued outer boundary ofa school?
(Section 3097 Civil Code) ❑Yes PVO
OWNER BUILDER DECLARATIONS 1 have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that l am exempt from the permitting checklist.I understand my requirements under the State of
Contractors 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 DYes q,1r1' l
construct,alter,improve,demolish or repair any structure,prior-to its Date 0E
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 ofthe Contractors State EPA RE OVATION.REPAIR AND PAINTING IRRPI
License Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)orthat 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
thanApplicant fora permit subjects the applicant toacivil penalty of not more required practices.This includes rentalproperty
than($500). q P ownersand property
managers who do the paint-disturbing work themselves or through their
o I,as owner ofthe property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion ofthe work and the structure Is www.eoa.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1.80D-424-LEAD(5323).
Code,The Contractors State Uceme Law does not apply to an owner of a DAn EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not Intended or offered for Certified Firm Name:
sale,If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. o No EPA Lead-Safe Certified Firm is required for this project because:
D I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK
Menifee
DATE 3AoI17 PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL m7 RESIDENTIAL O MULTI-FAMILY 0 MOBILE HOME O POOL/SPA 0 SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING I�?AE-ROOF-NUMBER OF SQUARES .Z
DESCRIPTION OF WORK QF� I$T/�(/� ��fiST.�l� ('S . C
TJ/ S COOL ,C��
PROJECTADDRESS .Ze Building& Safety C 9pt.
ASSESSOR'S PARCEL NUMBER '�jalq• LOT TRACT MAR P O 201
OWNER NAME f(f tG
ADDRESS 2
/'
PHONE (71 V q/5/-.37xl EMAIL
APPLICANT NAME LG C
ADDRESS
PHONE X-6-5--/7�� ' EMAIL A'JE
CONTRACTOR'S NAME !G/ "fle! C OWNER BUILDER? O YES O NO
BUSINESS NAME
ADDRESS
PHONE f?6,15- •—/7// EMAIL //N, , / .v/if.�•ClJlf-I
CONTRACTOR'S STATE
r�LICNUMBER • 2 7/763 LICENSE CLASSIFICATION C'-3
VALUATION$ 14 OOO SO FT o`! fQQ L SQ FT
APPLICANT'S SIGNATURE DATE
FCffi��;FF USE
ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP J�
INVOICE nn pAID AMOUNT /j� �7,�
AMOUNT . �LQ ' o ICI O CASH O CHECK# 0 CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK u O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building& Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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