PMT17-01301 City of Menifee Permit No.: PMT17-01301
29714 HAUN RD. Type: Residential Re-Roof
�A_CCEL/> MENIFEE, CA 92586
MENIFEE Date Issued: 0412 612 01 7
PERMIT
Site Address: 28250 WESTOVER WAY, MENIFEE,CA Parcel Number: 337-183-028
92586 Construction Cost: $10,100.00
Existing Use: Proposed Use:
Description of TEAR OFF EXISTING COMPOSITION ROOF AND INSTALL NEW GAF COOL ROOF SHINGLES IN
Work: CHARCOAL
Owner Contractor
MARSHA LITTEL CIRCLE CITY ROOFING INC
28250 WESTOVER WAY 454 SIXTH ST
MENIFEE, CA 92586 NORCO,CA 92860
Applicant Phone:9517365252
MICKEY DALFIOR License Number:674814
CIRCLE CITY ROOFING INC
454 SIXTH ST
NORCO, CA 92860
Fee Description QtV Amount I51
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 builli ing 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 propertywho 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 D I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class - License No. z By my signature below I acknowledge that,except for my personal residence
Expires 2VSlh7Signature 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
in 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. www.leginfo.ca.goy/calaw.him1.
Polity# Date
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 1 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
number are: application and the information I have provided is correct.I agree to comply
Cartier 'yfrt with all applicable city and county ordinances and state laws relating to
//'� building construction.I authorize representatives of this city or countyto
l Policy#e -Op, d'/lcm - -d FExpires Z 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 I certify that in the performance of the work for which this permit is issued,
1 shall not employ 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 of the Labor
Code,I shall forthwith co p ith tho provisions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to orgreater that the
Applicant Date � amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILUI ETO SECU WORKER'S COMPENSATION COVERAGE IS D Yes On
UNLAWFUL,AND SHALL SUBIECTAN 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)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY aYes j34g0
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 ylfb
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the California Health&Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable items)(Section 7031.5
Business and Professions Code).Any city or county that requires a permit to o No
construct,alter,improve,demolish or repair any structure,prior to its — /"��Eyi�. Date 7
Issuance,also requires the applicant for the permitto file a signed statement ,PRdPERTY NER OR AUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING MRPI
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 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($500). managers who do the paint-disturbing work themselves or through their
❑1,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.ena.Rov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Cade,The Contractors State License Law does not apply to an owner of a An EPA Lead-Safe Certified Renovator vAll be respomi a for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. o No EPA Lead-Safe Certified Firm is required for this project bemuse:
D I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
Menifee
DATE `f�Z6 PERMIT PLAN CHECK NUMBER 3t I
TYPE: COMMERCIAL XRESIDENTIAL 0- MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION C ALTERATION O DEMOLITION C ELECTRICAL C MECHANICAL
O NEW O PLUMBING RE-ROOF-NUMBER OF SQUARES
TC 30
DESCRIPTION OF WORK kv c i fia .v� /2w0- TA.rla-t /v
PROJECTADDRESS �0 V 2 Yp��, Ay c rr- C. TX
ASSESSOR'S PARCEL NUMBER 3�'J7�'�$�� O� O LOT TRACT �jGJ Z
OWNER NAME Ior.94aT�6 ✓
ADDRESS � J'q'ne
PHONE C/,+O 2( J Z Z S) - 6 $77�� EMAIL
APPLICANT NAME /e f{�. 11JG1 }J-'6 t- 2
ADDRESS pp 7 �7 ��� S�/; rVaYCO CAA, Z/6 lI
PHONE EMAIL /O61 q � (O11 CP
CONTRACTOR'S NAME (,,1 YG P l n A 1 /Jo f i ot. • OWNER BUILDER? O YES Vl0
BUSINESS NAME /'
ADDRESS ST 6 x(
PHONE /' EMAIL
CONTRACTOR'S STATE LIC NUMBER U 7 9y-1 V LICENSE CLASSIFICATION
VALUATION$ /F),/OO SO FT o L SQ FT
APPLICANT'S SIGNATURE DATE 2
DEPARTMENT DISTRIBUTION / CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I ' SMIP / Lo
INVOICE `�O-G PAID AMOUNT
AMOUNT 1 0CASH 0 CHECK!! OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA&Aq-%t-"6njfea677t7
www.cityofinenifee.us Inspection Request Line 951-24"01139 & Safety 080
APR 2 6 20V
Received
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