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PMT17-01164 City of Menifee Permit No.: PMT17-01164 29714 HAUN RD. �CCEU/ MENIFEE, CA 92586 Type: Residential Re-Roof MENIFEE Date Issued: 0411912017 PERMIT Site Address: 28211 ENCINO DR, MENIFEE,CA 92586 Parcel Number: 336-270-013 Construction Cost: $5,000.00 Existing Use: Proposed Use: Description of REMOVE EXISTING SHINGLES, REPLACE WITH COOL ROOF OWENS CORNING IN AMBER Work: Owner Contractor PAUL ROURMAN TRIANGLE ROOFING 28211 ENCINO DR 1392 ENCHANTED TRAILS MENIFEE,CA 92586 SAN JACINTO, CA 92582 Applicant Phone:8003606771 MAYNOR ALVAREZ License Number:790599 TRIANGLE ROOFING 1392 ENCHANTED TRAILS SAN JACINTO, CA 92582 Fee Description Qtt Amount ISI 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 staled,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_Pe"il_Template.rpl Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects with a licensed contractors)pursuant to the Contractors State License Law). 1 hereby affirm under penalty of perjury that 1 am under provisions of Chapter9(commencing with section 7000)of Division 3 of the Business and a I am exempt from lirensure under the Contractors State License Law for Professions Code and my license is in full force and effect. the following reason: License Class C3 '\ License No. -Y9'05`1 O p By my signature below tacknowledge that,except for my personal residence Expires 10130`11 Signature "/ mil in which I must have resided for at least one year prior to completion of improvements covered by this permit.I cannot legally sell a structure that I WORKER'S COMPENSATION DECLARATION 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 forworkers 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 followingwebsite: by Section 3700 of the Labor Code,for the performance of work for which www.Iegmfo.m,aov/caIavv.htmI. this permit is Issued. Policy g Date sI have 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 ofthe 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 number are: application and the information I have provided is correct.I agree to comply N n with all applicable city and county ordinances and state laws relating to Carrier building construction.I authorize representatives of this city or county to Policy g ��[ -q 23 Expires t o L'Ln 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 o l 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 BUSINESS LICENSE 9 O�/ /;515 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,I shall forth with ply wi hose provisions. Will the applicant or future building occupant handle hazardous material or Applicant C � Date S S MCP mixture containing a hazardous material equal to or greater that the amounts specified on the Hazardous Materials Information Guide? WARNING-FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS Dyes An UNLAWFUL,AND SHALL SUBJECT AN 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($100,000),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)?See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES fcrguldellnes CONSTRUCTION LENDING AGENCY a Yes "0 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) o Yes IMO OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm under penalty of perjury that 1 am exempt from the permitting checklist.I understand my requirements under the State of California Health&Safety Code,Section 255D5 and 25534 concerning Contractors License Law for the reason(s)Indicated below by the hazardous material rep in checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 ptrds o N Business and Professions Code).Any city or county that requires a permit to S Date construct,alter,-imp rove,demolish or repair any structure,prior to its PROPERTY DINER 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 Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRP) 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)or that he or she is exempt from licensure 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 or through 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.ecia.gay/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 Contractors State License Law does not apply to an owner of a o An 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: a 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 Ifyour project does not comply with EPA RRP rule please fill out the RRP Acknowledgement. BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION Menifee DATE IF 17 . PERMIT/PLAN CHECK NUMBER I V TYPE: O COMMERCIAL O RESIDENTIAL C MULTI-FAMILY O MOBILE HOME O<POOL/SPA O SIGN SUBTYPE: C ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW C PLUMBING O RE-ROOF-NUMBER OF SQUARES/- 15 DESCRIPTION OF WORK C r Ke A,- CW-� S PROIECTADDRESS 223ZI I 4E::ijck08 T->dy2 ASSESSOR'S PARCEL NUMBER !y�� '�Q'O�;,J LOT TRACT OWNER NAME GW K-oL}Rr✓�a ^� ADDRESS �ti✓"'� PHONE (_(0?A0) 590 4728 EMAIL APPLICANT NAME ADDRESS PHONE ��"" EMAIL CONTRACTOR'S NAME r� „tc ut �rw F•(' e OWNER BUILDER? O YES ANO BUSINESS NAME ADDRESS 12�q2 e-1U/IgN3-re.6 -rplrlI C�,u Jzcii-rro CA PHONE r960) 3 bo l 1077 / EMAIL CONTRACTOR'S STATE LIC NUMBER -7g6s9 c( LICENSE CLASSIFICATION VALUATION$ Q SQ FT L SO,FT APPLICANT'S SIGNATURE �" C-���' DATE CITYSTAFFUSEONLY DEPARTMENT DISTRIBUTION T CITV OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN ' Y_ SMIP INVOICE 9Q PAIDAMOUNT AMOUNT C7 CASH C CHECK A C CREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT I 0CASH 0CHECK# 0CREDIT CARD VISA/MC OWNER BUILDER VERIFIED C YES O ND DL NUMBER NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 N o �Eo . . Z n mm � v_� y v nm .'0w m 'o M— a o 9 o m 3 `-•2 m � m M omy ?. = = O m w H -0 3. F. 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