PMT17-01837 City of Menefee Permit No.: PMT17-01837
29714 HAUN RD. Type: Residential Re-Roof
<__ACCELA" MENIFEE, CA 92586
MENIFEE Date Issued: 06/12/2017
PERMIT
Site Address: 29502 CATANO RD, MENIFEE, CA 92584 Parcel Number: 339-222-003
Construction Cost: $3,200.00
Existing Use: Proposed Use:
Description of TEAR OFF EXISTING ROOF, REPAIR DAMAGED WOOD, REROOF W/CERTAINTEED RESAWN
Work: SHAKE COOL ROOF
Owner Contractor
LYNETTE CAROLE YOUNG
29502 CATANO RD
MENIFEE,CA 92584
Applicant License Number:
AUTHORIZED AGENT
,CA
Phone: 9518335977
Fee Description QtV Amount($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_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 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 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
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 consent of self-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 following website:
by Section 3700 of the Labor Code,for the performance of work for which
this permit is issued. www.IeRinfo-capov&aIaw.html.
Policy# Date
❑I have and will maintain worker's compensation insurance;as required by PROPERTY&NER OR AUTHORIZED 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 worker's compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
number are: 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
building construction.I authorize representatives of this city or county to
Policy# Expires enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred iW Date —�2'_ /7
dollars($100)or less PROPERTY bWNER 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 laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply 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
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes cLAo
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES WIII the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR _Coast Air Quality Management District(SCAQMD)?$eepermitting checklist
IN SECTION 37060E THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY ❑Yes a.lb
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) ❑Yes Ifo
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
Contractor's License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
hazardous material reporting.
checkmaBusiness and
I have placed next to the applicable item(s)(Section 7031.Spermit mYes _„�� _
Business and Professions Code).Any city or county that requires a permit to �lef� /i/` `� � Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNE RAUTHORIZEO 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 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 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
S owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
ompensatlon,will do(L-('all of or( )portion of the work,and the structure is www.eoa.eoy/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 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 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:
❑I,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 RRP rule please fill out the RRP
Acknowledgement.
APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK
Menifee
Admolok-
DATE PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING kE-ROOF-NUMBER OFSQUARES2g_ /
DESCRIPTION OF WORK oF`l+ ` '
o I - rUU 2 u� eLoA Aw i �1
WLxJd "4 re- w� \ t,%k (sty L (n� 'IeS,
PROJECTADDRESS 5_0Z,? p -7 7 • (/ e-a� Ife l q7-5-gq
ASSESSOR'S PARCEL NUMBER 3J q 2 L Z 0Q J - 1 LOT 1_ TRACT a2 331 y—
OWNERNAME 1. Y D
ADDRESS Z SOZ C fe 0
PHONE S �i.��,'�IL�(p,`�i7�� EMAIL C \
APPLICANT NAME '�' �•2` M
ADDRESS Zq.t Fyti d( 'I,�se? Z S—S Y
PHONE qS( Ss33 j 7�7 EMAIL 12 O�'} l,,i.� �' 4�w•�
CONTRACTOR'S NAME 410== OWNER BUILDER? $-IES O NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ 31,Z00,0 � SOFT LSO FT
APPLICANT'S SIGNATURE 0 DATE G' - /Z - / 7
ALL
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAIDAMOUNT AMOUNT I I O CASH OCHECKB 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHELK# 0CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Deportment 29714 Houn Rd. Menifee, CA 92585 951-672-6 77 7
www.cityofinenifee.us Inspection Request Line 951-246-6213
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amity of Mende
Building & Safety Dept.
JUN 12 2017
Received
atF& (�ll� f CI LI �0
Ow , Qa�_
A notary public or other officer completing this certificate
verifies only the Identity of the Individual who signed the
document to which this certificate is attached,and not
the truthfulness,accuracy,or val city of that document.
Slate of California,County of_-wpr5(d2 ARBELLA VELASQUEZ
Subscribed and sworn to(or affirmed)before me - _- COMM.#2181910 0
2 rv� t-'� g NOTARY PUBLIC•CALIFORNIA >
on this dayof 7;s � ,20_ \I tF - ,r RIVERSIDE COUNTY
by tc1cm e -sOe olr_ t 1C oAj m te* Cu l 2 7 Vt q £ y�'`y My Comm.Expires:JAN 30,2021
proved to me on the basis of satisfactory evidence
to be the persori'KIS>ho a ared before me.
i
Signature: i