PMT17-01134 City of Menifee Permit No.: PMT17-01134
29714 HAUN RD. Type: Residential Re-Roof
�A_CCELA? MENIFEE, CA 92586
MENIFEE Date Issued: 04/17/2017
PERMIT
Site Address: 29501 THORNHILL DR, MENIFEE, CA Parcel Number: 336-121-012
92586 Construction Cost: $9,000.00
Existing Use: Proposed Use:
Description of REMOVE EXISTING ROOF LAYERS, REROOF W/NEW COOL ROOF IN AMBER
Work:
Owner Contractor
WAYNE ELLISON HOUSETOP ROOFING
29501 THORNHILL DR 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 IS)
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_Pennit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who 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).
Chapter9(commencing with section 7000)of Division 3 of the Business and a I am exempt from Iicensure under the Contractofs5bte License Law for
Professions Code and my license is in full force and effect. 7C the following reason:
`License Class '3"? License No.. Bymyslgnature below l acknowledge that,except formy,personal residence
Expires ;gqb� Signature / in which l must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATI 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 is entirety by
a 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 websRe:
by Section 3700 of the labor Code,for the performance of work for which ,My,�,,leeinfa.a.eav/alaw.lstml.
this permit is issued.
Policy g Date
�ave and will maintain workers 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 l 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 an the property owners behalf.I have read this
numberare: application and the information I have provided is correct l agree to comply
Carder ��� with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy 7/612 Expires ly enter the above Identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($10D)or less PROPERTY OWNER OR AUTHORIZED AGENT
,%iSerfify that in the performance of the work for which this permit is issued, �/
Ishallnotemolov any persons in any mannerso asto becomesubjectto the CITY BUSINESS LICENSE R �`r✓�I
workers compensation laws of California,and agree that if l should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,l shall forthwith comply with those Provisions. Will the applicant or future building occupant handle hazardous material or
Applicant Date mixture containing a hazardous material equal to or greater that the
amounts Fsp�ecified an the Hazardous Materials Information Guide?
WARNING: LURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 Dyes K.
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 permit for the construction or modification from South
ADDITION SECTION
T3 06 OF
ELAB OF OR CODE,INTERTION, ST, ADATIOGES AS ROVIDED FOR Coast Air quality Management District(SCAQMD)7See permitting checklist
INSECRON 3706 OE THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguideltn
CONSTRUCTION LENDING AGENCY mYes 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 ofthe
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) O Yes S'r^°
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guideand the SCAQMD
permitting checklist.I understand my requirements under the State of
Hherebyaf0rmunseLaw for
a peson(s)atlam ex ed below by
California Health&Safety Code,Section 25505 and 75S34 concerning
Cantractars License Law for the to
ppnaca Itern(owby the hazardous material reporting.
cheiness and
I have plated next to the applicable items)(Section permit oyes
Business and Professions Code).Any city or county that requires permit to Date 2�
construct,alter,improve,demolish or repair any structure,prforto its pROPEi) WNER OR AUTHORIZED AGENT
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 Contactors 5tate EPA RE OVATION,REPAIR AND PAINTING(RRPI
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contactors
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
an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property ownersand property
than($SOD). managers who do the paint-disturbing work themselves orthrough their
al,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.eoa.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-8 0 0 424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a aAn 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:
o 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 RAP
Acknowledgement.
BUILDINGAAPPLICATION
— Menifee
DATE /'7 PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW C PLUMBING IeRIE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Ae
PROJECTADDRESS oz SO �iDY�.r/.�JLG
ASSESSOR'S PARCEL NUMBER • '��� � LOT ��✓ TRACT
OWNER NAME
ADDRESS
PHONE x*� Q'�// - EMAIL
APPLICANT NAME /G!l Cllf�ltf
ADDRESS ..Y 7lOr� / iG!/• 1/�-
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILDER? O YES ONO
BUSINESS NAME
ADDRESS
PHONE �EMAIL /� .'� T �SH%i�7�/�• �'
CONTRACTOR'S STATE LIC NUMBER 37���5 LICENSE CLASSIFICATION I
VALUATION$ 9, QUO SO FT L SO FT
APPLICANT'S SIGNATURE DATE
r
DEPARTMENT DISTRIBUTION CITY O M NIF U NESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN 60 SMIP
INVOICE O PAIDAMOUNT Q
AMOUNT • 'CASH OCHECK# 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT I 0CASH OCHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDERVERIFIED OYES O NO DLNUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building& Safety Department 29714 HDun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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