PMT17-01747 City of Menifee Permit No.: PMT17-01747
29714 HAUN RD. Type: Residential Re-Roof
<A_CCEL/_> MENIFEE, CA 92586
MENIFEE Date Issued:
06/OS/2017
PERMIT
Site Address: 28171 ENCINO DR, MENIFEE,CA 92586 Parcel Number: 336-233-003
Construction Cost $8,500.00
Existing Use: Proposed Use:
Description of TEAR OFF EXISTING ROOF,APPLY DIMENSIONAL COOL ROOF IN SILVER BIRCH BY
Work: CERTAINTEED
Owner Contractor
LINDA EDGMOM-TRUSTEE HOUSETOP ROOFING
28171 ENCINO DR 31760 BRIGGS ROAD
MENIFEE,CA 92586 MENIFEE, CA 92584
Applicant Phone:9516798369
RICH CARROLL License Number.371783
HOUSETOP ROOFING
31760 BRIGGS ROAD
MENIFEE,CA 92584
Fee Description Qtt( Amount ISI
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_3ldg_Pennit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or Improves thereon,and who contracts forthe projects
I hereby affirm under penalty of perjury that l am underprovisfons of with a licensed contractor(s)pursuant to the ContadouState License law).
Chapter9(commencing with section 7000)ofDidsian 3 of the Business and o l am exempt from licensure under the ContractoesSbte License Lawfor
Profes00115Code and my license is in full farce and effecL 2 the following reason:
License Class C°`,39 License No. 7,C J By mysignature below l acknowledge that,except formypersonal residence
Expires Signature in which l must have resided for at least one year prior to completion of
Improvements covered bythis permit)cannot legalftsen a structure that l
WORKER'S COMPENSATION DECLARAT109
have built as an owner-builder if it has not been constructed in its entirety by
o 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 cement ofself-insure forworker'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 fallowing webn'tc
by Section 3700 of the labor Code,for the performance ofwork for which .r.leeinfo.ca.aav/calaw.lstml.
this permit is issued.
Policy11 Date
Wave and will maintain worker's compensation inwrance,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 l certify to each ofthe followin&l am the property
this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act an the property ovmers behalf.l have read this
number are: application and the information 1 have provided is correct I agree to comply
Carder �o with all applicable city and county ordinances and state laws relating to
building construction.)authorize representatives of this city orcountyto
Policy 7//,e" Expires IZ 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
-0-�erfify that In the performance of the work for which this permit Is issued, �/�{{t,,�f
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE11 �`r✓ f I
workerscompensation lases ofCalifornia,and agree that if l should became HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,lshall forthwith comply with those prova S. A Will the applicant or future building occupant handle hazardous material ora
Applicant i� �t�fi� Date Zd amoure nts specified
iedong a hazardous materiousMalerals to Ivor ration uide?hat e
amounts specified on the Hazardous Materials Information Guide?
WARNING: LURE TO SECURE WORKER'S COMPENSATION COVERAGE IS oyes
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use ofahe building by the appllcantcr future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modiFation from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)7 See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguldeR
CONSTRURION LENDING AGENCY ayes ANG
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) oyes 9W.
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guideand the SCAQMD
I herebyaffirm under penalty of perjurythat l am exempt from the permitting checklist.I understand my requirements underline State of
California Health&Safety Code,Section 25505 and 25534 concerning
Contractor's Licensehave law fa nextr the reason(s)theapplicable
Rentaled s)(Section
hazardous material reporting.
cfierkmark(s)Ihave placed next to the applicable item(s)(Section 7031.5 Oes _ti
Business and Professions Code).Any city orcounty that requires a permit to Y 0 n 6 . f/� Date z�
construct,alter,Improve,demolish or repair any structure,prior.to its PROPEI) WNERORAUTHORIZEDAGENT
Issuance,also requires the applicant for the permitto file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors State EPARE OVATION.REPAIR AND PAINTING IRRP)
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting
Business and Professions Code)or that he or she is exempt from llcerssare P that
disturbs
requires contactors
and the bask for the alleged exemption.Any violation of Section 7031.S by receiving compensatfonfory to be Rost Pt rt fscl firm andcompt In a ly with
e-0978
residencera childcare facilityIncludes
es be rental
prop any firmszadd property
an Applicant fora permit subjects the applicant too civil penalryof not more required practices.This includes rentalpropertyawnersand properly
than($500). managers who do the paint-disturbing work themselvesor through their
ol,as owner of the property,or my employee with wages as thefrsole employees.For more Information about EPA's Renovation Program s4sit-
compensation,will doI)all ofor()portion of the work,and the structure is www.eoa.eov/lead orcontact the National lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800424-LEAD(5323).
Code,The Contractor's State License Law does not apply to an owner of aAn EPA Lead-SafeCertiged Renovator will be responsible for thIs project
property who,through employees'or personal effort,builds or improves the
properly provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that It was
not built or improved for the purpose ofno[a. O No EPA lead-Safe Certified Firm is required for this project because:
D I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Cade:The Contractars State License taw does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement
APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK
Menifee
DATE PERMIT/PLAN CHECK NUMBER '
0177
TYPE: O COMMERCIAL WRESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION Q DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING k<-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK /
PROJECT ADDRESS / 2�� p1
ASSESSOR'S PARCEL NUMBER ✓-��lD ASS " LOT TRACE
OWNERNAMEC(, (,� YYZD�A
ADDRESS /
PHONE ,r��p— S�/,�{ EMAIL
APPLICANT NAME C /t
ADDRESS
PHONE "Y—/ u& EMAIL ( /
i
CONTRACTOR'S NAME �C/ C OWNER BUILDER? O YES ONO
BUSINESS NAME
ADDRESS / ;lo OD ,
PHONE �G,$" /7// EMAIL 00, If
CONTRACTOR'S STATE LIC NUMBER 3 ]/ 7�3 LICENSE CLASSIFICATION
/)�VALUATION$ 5-oly SO FT L SO FT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN 'MP
INVOICE O pAIDAMOU NT O
AMOUNT • OCASH OCHECKA CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH :%CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building& Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-6 72-677 7
WWW.City0finenifee.u5Inspection Request Line 951-246-6213
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