PMT17-01627 City of Menifee Permit No.: PMT17-01627
29714 HAUN RD. T Residential Re-Roof
'5A_CCEL/_> MENIFEE,CA 92586 yam'
MENIFEE Date Issued: 05/23/2017
PERMIT
Site Address: 28770 ANDERSON CT, MENIFEE, CA Parcel Number: 337-372-001
92586 Construction Cost: $11,000.00
Existing Use: Proposed Use:
Description of TEAR OFF EXISTING LAYERS, INSTALL NEW COOL ROOF SHINGLES
Work: "CRRC 089D-0011 "
Owner Contractor
FLOYD HUGHES STUTZMAN SIDING
28770 ANDERSON COURT 23520 BRIGIN PLACE
MENIFEE,CA 92586 MURRIETA,CA 92562
Applicant Phone:8003887224
ADAM STUTZMAN License Number: 803876
STUTZMAN SIDING
23520 BRIGIN PLACE
MURRIETA, CA 92562
Fee Description ON Amount(SI
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_Permil_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
with a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure under the Contractors State License Law for
Professions Cod d my ice se is in full force nd effeq r_ the following reason:
Ucense Class e s No. UU IVY 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 DECLARATIO 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.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 perm is issued. // yn ''L !� www.leainfo.ca.ecv/calaw.html.
P/9.IIry# X a�t� V Date
i1 have and will maintain workers compensation Insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
ection 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 workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this
number are: t s I,!-I application and the Information 1 have provided is correct.I agree to comply
IaauNhiQ�i ry{VI with all applicable city and county ordinances and state laws relating to
I f Q,Carrier L, building construction.I authorize representatives of this city or county to
Policy# °�� 6_71 ( Aires 6 �$ enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($SOO)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#
workers compensation I ws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the rkers apensation provisions of Section 3700 of the Labor
Code,I shal f It it ply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Dates 7,3 1� mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE T CURE WORKER'S COMPENSATION COVERAGE IS ❑Yes ❑No
UNLAWFUL,AND SHAL SUBJECTAN 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 Districtconstruction
or modification
permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forCoast
Airlines
Qua
CONSTRUCTION LENDING AGENCY D Yes ❑No
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility he 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 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(s)(Section 7031.5 hazardous material reporting.
Business and Professions Code).Any city or county that requires a permit to oYes ❑No
construct,alter,improve,demolish or repair any structure,prior to its Date
issuance,also requires the applicant for the permit to file a signed statement
PROPERTY OWNER OR AUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractors 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 apre-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
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.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 D 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. ❑No EPA Lead-Safe Certified Firm is required for this project because:
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.
• • • wil k,ton 17,41'a-mal •
Menifee
DATE ' — PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATIIlON O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O,P *1LUMBING RE-RO`OFF-NUMBEROFSQUA`R 1L ES (O
DESCRIPTION OF WORK V p l �D I/l J
COO 0'1� y°l� o e
PROJECTADDRESS S 1AV A)WUA G"l _` CIS & Saietty Dept.
ASSESSOR'S PARCELLNUMBER LOT TRACT mAy 2 a '
OWNER NAME T
ADDRESS caive
PHONE O S EMAIL
APPLICANT NAME AftA
//�� Fl
ADDRESS �0 VVO(9 ^ \/ ✓` 2 l>o
PHONE r Z 3 L, EMAIL
CONTRACTOR'S NAME G l OWNER BUILDER? OYES 0
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LI/ICUMBER D LICENSE CLASSIFICATION
VALUATION$ k D SO FT �/� L SQ FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN S M I P X
INVOICE PAID AMOUNT //��
AMOUNT �• q0 leo. D OCASH OCHECK# 0CREDIT CARD VISA/MC
CHECK FEES PAIDAMOUNT 0CASH 0CHECK# OCREDITCARD VISA/MC
[OEWNERBILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building& Safety Deportment 29714 Houn Rd. Menifee, CA 92596 951-6 72-6 7 77
www.cityofinenifee.us Inspection Request Line 951-246-6213
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