PMT17-01594 City of Menifee Permit No.: PMT17-01594
29714 HAUN RD.
�CCEL/_> MENIFEE, CA 92586 Type: Residential Re-Roof
MENIFEE Date Issued: 0 512 212 01 7
PERMIT
Site Address: 26509 SUN CITY BLVD,MENIFEE, CA Parcel Number: 337-222-001
92586 Construction Cost: $9,000.00
Existing Use: Proposed Use:
Description of REMOVE 2 EXISTING LAYERS OF ROOF AND INSTALL COMPOSITION SHINGLES -MALARKEY
Work: HIGHLANDER GOLDEN AMBER CRRC#0850-0024
Owner Contractor
RON CHANNELS ROOFTEK ROOFING&WATERPROOFING
26509 SUN CITY BLVD 23991 VISTAWAY
MENIFEE,CA 92586 MENIFEE,CA 92587
Applicant phone:9512448524
ROOFTEK ROOFING&WATERPROOFING License Number: 520957
23991 VISTAWAY
MENIFEE,CA 92587
Fee Descrlotion Oft Amount t$1
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_Pemnit_Templete.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 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 ❑I am exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class "� License No. J tJ
By my signature below I acknowledge that,except for my personal residence
Expires I I !�/ 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
❑I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.)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 Cade,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 WWW.Ieginfo.ca.gov/calaw.litml.
this permit is issued.
Policy# Date
`�Ihave and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
dection 3700 of the Labor Code,for the performance of the work for which '�]�yy 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 rner or authorized to act on the property owners behalf.I have read this
number are:,..' r (' application and the information I have provided Is correct.I agree to comply
Carrier with all applicable city and county ordinances and state laws relating to
Q building construction.I authorize representatives of this city or county to
Policy# Expires 40 enter the above identi ed-property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred
dollars($100)or less Date
PROPERTY OWN OR HORIZ GENT
❑1 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#
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation proyyisiOJls of Section 3700 of the Labor
Code,i shall forthw/itJT complywithhith -pr visions. Will the applicant or future building occupant handle hazardous material or
Applicant (♦/C 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 15 ❑Yes l0
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 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes Proposed
1 hereby affirm that under the penalty of perjury there is a construction Will th 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) ❑Yes 0lu
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 underthe State of
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
chetkmark(s)I have placed next to the applicable Rem(s)(Section 7031.5 hazardous aerial reporting.
Business and Professions Code).Any city or county that requires a permit to es
Date �� ao
construct,alter,improve,demolish or repair any structure,prior to its PRO RTY 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 IRRP)
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 6e RRP-certified 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 orthrough 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.eoa.gov/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 ❑An EPA Lead-Safe Certified Renovator will be responsible forthis 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. 'bAVo EPA Lead-Safe Certified Firm is required for this project because:
❑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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Wenifee
DATE e05— l7 PERMIT/PLAN CHECK NUMBERNI I-1-0I"5"i
TYPE []COMMERCIAL WRESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑MECHANICAL
NEW []PLUMBING RE-ROOF-NU BEROFSQUARES
�y2m�np
DESCRIPTION OF WORK p-
S
PROJECTADDRESS Amel. Sun
1 '
ASSESSOR'S PARCEL NUMBER '��•22 •OOI LOT 43 TRACT 23 Co
PROPERTY OWNER'S NAME S
ADDRESS o `.
PHONE 7/V 3/ l EMAIL h
APPLICANT NAME ' /
ADDRESS ROOFTEK ROOFING
23991 Vista Way
PHONE Menifee CA9�FA7 EMAIL
CONTRACTOR'S NAME OWNERBUILDER2 [:IYESSNO
ROOFTEK ROOFING
BUSINESS NAME
ADDRESS p Menifee,CA92587
PHONE 9, ., /s'T-7-E Q,SZ)-q Q EMAIL RCZ9 T f //�N�ii Ly`
CONTRACTOR'S STATE LIC NUMBER /S J LICENSE CLASSIFICATION -4;§0
VALUATION $ SO.FT LSQFT
APPLICANT'S SIGNATURE DATE - avL /
DEPARTMENT DISTRIBUTION CRY OF MENIFEE BUSINESS UCENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT OCASH OCHECK# OCREDTT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT OCASH O CHECK# O CREDRCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
Menfta
Taullding a "tfCTePt�
Oty of"Oenifee Building&Safety Department 29714 Noun Rd. A4enifee, CA 92586 951-672-6777
www.cityofinenifee.us inspection Request Line 951246-6213 MAAX 22 2017
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