PMT17-01487 City of Menifee Permit No.: PMT17-01487
29714 HAUN RD.
�CCEGJ MENIFEE, CA 92586 Type: Residential Re-Roof
MENIFEE
Date Issued: 0 5/1 112 01 7
PERMIT
Site Address: 28183 W WORCESTER RD, MENIFEE,
CA 92586 Parcel Number: 339-092-006
Construction Cost: $5,000.00
Existing Use:
Proposed Use:
Description of TEAR EXISTING LAYERS, INSTALL NEW COOL ROOF SHINGLES
Work: `*CRRC#0850-0028"
Owner
DAVID LAYTON Contractor
28183 W WORCESTER ROAD ENVISION ROOFING INC
MENIFEE,CA 92 24370 CANYON LAKE DR INSTE 11
CANYON LAKE, CA 92587
Applicant
DAVID LAYTON Phone: 9512448200
28183 W WORCESTER ROAD License Number.993434
MENIFEE, CA 92586
Phone: 9512333834
Fee Description
Building Permit Issuance 9Y Amount isl1
Inspections not specified 27.00
GREEN FEE 98 98.00
General Plan Maintenance Fee-Building 1 1.
4.90
0
$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 carded 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 property who builds or improves thereon,and who contracts for the projects
I hereby affirm under penalty of perjury that 1 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 ❑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. By my signature below I acknowledge that,except for my personal residence
Expires 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 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 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 3700 of the Labor Code,for the performance of work for which
this permit is issued. ��]
www.le info.ca. ov calaw.html.
Policy 11 1 a"'� ^ Date 1 f
°I have and will maintain workers compensation Insurance,as required by PROPERTY OWNER OR AU HORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which ❑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
number are: application and the information I have provided is correct.I agree to comply
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 JJ Expires enter the above identified property for inspection purposes.
(This section need not to be the is completed permit is for one-hundred t—
dollars($100)or less p , �"" Date
PR PERTY OWNER 04 AUTHORIZED AGENT
❑I 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 became subject to the CITY BUSINESS LICENSE p
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 comply with those provisions. WIII the applicant or future building occupant handle hazardous material or a
Applicant Date 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 ❑Yes ❑No
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($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 370fi OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY D Yes D No
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the
lending agencyfor the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) ❑Yes o No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item hazardous material reporting.$)(Section 7031.5 °yam ❑No
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repairany structure,priorto 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 Contractors State EPA RENOVATION,REPAIR AND PAINTING fRRPI
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 that
receiving compensation for most work at 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 beork thertifled firms and comply with
than
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
❑I,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.epa.eov/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).
A e,'The Contractors State License Law does not apply to an owner of a
e?My who,through employees'or personal effort,builds or improves the °An EPA Lead-Safe Certified Renovator will be responsible for this project
,provided that the improvements are not intended or offered for Certified Firm Name:
wever,the building or improvement is sold within one year of
o tfie Owner-Builder will have the burden of proving that it was Firm Certification No.:
Pled for the purpose of sale. ❑No EPA Lead-Safe Certified Firm Is required for this project because:
e➢'Perty am exclusively contracting with licensed
It the project(Section 7044,Business and Professions
d 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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE Q/]// 7 PERMIT/PLAN CHECK NUMBER QvM, -dl 1
TYPE: ❑COMMERCIAL tRESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN
SUBTYPE: [-]ADDITION []ALTERATION [-]DEMOLITION []ELECTRICAL [-]MECHANICAL
❑NEW ❑PLUMBING RE-ROOF-NUMBER OF SQUARES I b
DESCRIPTION OF WORK Tea.0 (3 t)n TdaF
hl, a c-�l ado
PROJECTADDRESS 'Z p 183 W WafGeS +av� U Q f mb
ASSESSOR'S PARCEL NUMBER -3 3 9 O p` Z O 6✓�-1j,L LOT /�I l �TtACT '2,
PROPERTY OWNER'S NAME rj n1,.,t,k IPA
ADDRESS 2 3 y L,/ �ot - L i �'pl �`�`j Oildtng & Safety apt.
PHONE Q5/ ' Z33 -Jgyl/ EMAIL - ''p d/ .c- MAY 1 1 201
APPLICANT NAME nould "Yip
ADDRESS SA19i hc
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILDER? ❑YESX 0
BUSINESS NAME / ss^�
ADDRESS 2 v C n D L 9 -11 4+1 . t " G J 8
PHONE (�ZOld p /EMAIL 2
CONTRACTOR'S STATE LIC NUMBER �/ 9,J//,�/ LICENSE CLASSIFICATION C,3
VALUATION$ SQ FT 1�0 D L SQ Ff
APPLICANT'S SIGNATURE _ DATE /I /
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE �y PAID AMOUNT
AMOUNT I ,�I ,q O CASH O CHECK# O CREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZEDLETTER 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
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