PMT17-01373 City of Menifee Permit No.: PMT17-01373
29714 HAUN RD. Type: Commercial Re-Roof
�ACCEL/_> MENIFEE,CA 92586
MENIFEE Date Issued: 0 510 212 01 7
PERMIT
She Address: 28971 GOETZ RD, MENIFEE, CA 92587 Parcel Number:
Construction Cost: $40,240.00
Existing Use: Proposed Use:
Description of TEAR OFF EXISTING LAYERS, INSTALL NEW COOL ROOF SHINGLES
Work: •'CRRC#0890-0002"
Owner Contractor
COUNTY OF RIVERSIDE R&R ROOFING&WATERPROOFING INC
2980 WASHINGTON STREET 26338 RIM CREEK PATH
RIVERSIDE, CA 92503 MENIFEE,CA 92584
Applicant Phone: 9512460695
RAUL JASSO License Number:934782
R&R ROOFING&WATERPROOFING INC
26338 RIM CREEK PATH
MENIFEE,CA 92584
Fee Description Oy Amount fE)
Building Permit Issuance 1 27.00
Inspections not specified 98 98.00
Administrative Fee 98. 98.00
GREEN FEE 1 2.00
General Plan Maintenance Fee-Building 1 4.90
$229.90
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 prevenfing 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.rpl Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
1 hereby affirm under penalty of perjurythat I am under provisions of with a licensed contractor(s)pursuantto the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and o 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 L_3L1 Licens �Io. `�I: " "Z. B m signature below I acknowledge that,except for m y y g g p y personal residence
Expires M Signature in which I must have resided for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell astructurethatl
WORKER'S COMPENSATION DECLA4TION
have built as an owner-builder if it has not been constructed in its entirety by
❑1 hereby affirm under penalty of perjury one f 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 3703 of the Labor Code,for the performance of work for which
this permit is issued. www.leginfa.ca.gov/calaw.html.
Policy# Date
❑I have 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: l-,n_ ,, .` application and the information I have provided is correct.I agree to comply
Carrier 2wr' YJI`SU- �I� "1Nwo with all applicable city and county ordinances and state laws relating to
G. ,�3�6 building construction.I authorize representatives of this city or county to
Policy# 11 .� Expires `c 2 enterthe 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
❑I certify that in the performance of the work for which this permit is issued,
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's compensation Aws of California,and agree that If I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers qm pensation provisions of Section 3700 of the Labor
Code,I shall forthwith fnply with those provisions. / Will the applicant or future building occupant handle hazardous material or a
Applicant Date /! mixture containing a hazardous material equal to or greater that the
II amounts specified on the Hazardous Materials Information Guide?
WARNING:FA LURE T�SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes ❑No
UNLAWFUL,AND SHA SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UPTQb NE HUNDRED THOUSAND DOLLARS($500,000),IN occupant require a permit forthe 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 ❑Yes ❑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 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 o No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
California Health&Safety Code,Section 25505 and 25534 concerning
Contractor's 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 ciYes D No
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER 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 Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRP)
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 forthe alleged exemption.Anyviolation 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
o I,as owner of the property,or my employee with wages as theirsole 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.gov/lead or contact the National Lead Information Center at
not Intended or offered for sale.(Section 7044,Business and Professions 1-BOG-424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds ar improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or Improvement is said 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. ❑No EPA Lead-Safe Certified Firm is required for this project because:
o 1,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 RAP rule please fill out the RRP
Acknowledgement.
4�
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
f.
Menifee
DATE S I f2- PERMIT/PLAN CHECK NUMBER -o�3 3
TYPE: IQ COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA 0 SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING A(RE-ROOF-NUMBER OF SQUARES 4�-55
DESCRIPTION OF WORK S # /P 5 Tew- -0If ' • 36ve RII&
,f1 � `� lyo eme
PROJECT ADDRESS ZM 7 r �, ly,Up�1 V q � Building 14 Safety )ePt.
ASSESSOR'S PARCEL NUMBER J� LOT TRACT
OWNER NAME Commof CcP,we-rs 7e ,,_-�,1 � s± N4 Qe4t46
ADDRESS q I-W W l rl uT• t`•vaiA° cA ��P•rV�
PHONE t51 3gg1 EMAIL vii. reed 9 &f.roa cA, c tJ
APPLICANT NAME ';9312
ADDRESS I /'•'-!� 66111tv e L LsIS
PHONE JJJ7- 21/J 'aZ4,b EMAIL
CONTRACTOR'S NAME -ie OWNER BUILDER? O YES U/ITO
BUSINESS NAME
ADDRESS //yy 17 9f 4111ir r LAr04 e '
PHONE 4W 2/6/S%0�P n7 EMAIL e , D C f� A/ • n�
CONTRACTOR'S STATE LIC NUMBER `7J 601 Z}� LICENSE CLASSIFICATION C'
211
VALUATION$ q10 Z U SO FT Li u D L SO FT
APPLICANT'S SIGNATURE DATE /
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP X
INVOICE I PAID AMOUNT
AMOUNT • 0CASH 0CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDERVERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES 0 NO
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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