PMT17-01838 City of Menifee Permit No.: PMT17-01838
29714 HAUN RD. Type: Residential Re-Roof
<A-CCELI - MENIFEE,CA 92586
MENIFEE Date Issued: 06/12/2017
PERMIT
Site Address: 25915 WARWICK RD, MENIFEE, CA Parcel Number: 339-063-010
92586 Construction Cost: $10,000.00
Existing Use: Proposed Use:
Description of REMOVE EXISTING 2 LAYERS, REROOF W/CERTAINTEED SOLARIX COOL ROOF
Work:
Owner Contractor
JAMES KOLB AL'S ROOFING
25915 WARKWICK RD 20690 OLD ELSINORE ROAD
MENIFEE,CA 92586 PERRIS, CA 92570
Applicant Phone:9512295783
AL GRAY License Number. 716337
AILS ROOFING
20690 OLD ELSINORE ROAD
PERRIS, CA 92570
Fee Description Oty, Amount($1
Building Permit Issuance 1 27.00
Inspections not specified 96 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 t
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 contactor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and o 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 �'3 /License No. -7 i C 1 -7 By my signature below I acknowledge that,except for my personal residence
Expires a 7 Signature in which l 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
RKER'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 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:
6y Section 3700 of the Labor Cade,for the performance of work for which ,,y,m,,.leeinfo.ca.eav/calaw.html.
this permit Is issued. 127 7� - �^
PnlicyIt GIJ ( I Date
❑I have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,far 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: /) application and the information I have provided is correct.I agree to comply
Carrier ! A with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy If a.,c 79 70 Expires 7 /7t-9 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
�Q
o I certify that in the performance of the work for which this permit is issued, -7 0 1 LJ
I shall not emalov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE If
workers compensation laws of California,and agree that if I should become AZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 370D of eLabor
de,I shall Forthwith cam w'th those provisions. Will the applicant or future building occupant handle hazardous material or
i ��- 3 mixture containing a hazardous material equal to or greater that the
plicant Date amounts spefJfied on the Hazardous Materials Information Guide?
WARNING:FAILURE O SECURE WORKER'S COMPENSATION OVERAGE IS oyes oL .
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 modifrcation from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District See permitting checklist
IN SECTION 37OG OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY 0Yes 66
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 b Issued outer boun of a school?
(Section 3097 Civil Code) a Yes o
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjurythatlam exempt from the permitting checklist.I understand my requirements under the State of
California Health&Safety Code,Section 25505 and 2SS34 concerning
Contractors License Law for the reason(s)Indicated below by the hazardous ma AI reporting.
checkmark(s)I have placed next to the applicable Item(s)(Section 7031.5 Yes a N"
Business and Professions Code).Any city or county that requires a permit to �G� Date
construct,alter,improve,demolish or repair any structure,prior to its ROPERTY OWNERS, AUTHORIZED AGENT
issuance,also requires the applicant for the permit to file a signed statement IQ/
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVA710 REPAIR AND PAINTING IRRPI
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 701.5 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
al,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.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).
Code,The Contractors State License Law does not apply to an owner of a oAn 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. a No EPA Lead-Safe Certified Firm is required for this project because:
o I,as owner of the property am exclusively contacting with licensed
contactors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not applyto an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement
SAFETYBUILDING & • a APPLICATION
Menifee
DATE (d ( PERMIT/PLAN CHECK NUMBER COI ✓
TYPE: O COMMERCIAL cc'RESIDENTIAL O MULTI-FAMILY O MOBILE HOME 0 POOL/SPA O SIGN
SUBTYPE: 0 ADDITION O ALTERATION 0 DEMOLITION O ELECTRICAL O MECHANICAL
ONEW " PLUMBING PROOF-NUMBER OF SQUARES_>
DESCRIPTION OF WORK oo*'• - e ftn
R rwfw l kov AeAc( axi
PROJECTADDRESS ZSS S G✓Af w,%L-(c— /? 0
ASSESSOR'S PARCEL NUMBER ►p�p�✓ �� LOT A!57), TRACT
/f
OWNERNAME />.ti ey1 I 13
ADDRESS 2 ,} S /.r �/Gi c i,C L
PHONE / EMAIL
APPLICANT NAME G is
ADDRESS e o 4� dt _ r'C Ylri f Cot '9GIT J/
PHONE �-r/— -22 - J"78? EMAIL
CONTRACTOR'S NAME ., 5 At 6> OWNER BUILDER? ES
BUSINESS NAME l7lf
ADDRESS 106 a C ( 70
PHONE ¢Pl— EMAIL C
CONTRACTOR'S STATE LIC NUMBER -7K( T —7 LICENSE CLASSIFICATION
VALUATION $ 1& 0, SO.FT O L SQ FT
APPLICANT'S SIGNATURE DATE 7
a
DEPARTMENT DISTRIBUTION 00 CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN v_ SMIP
INVOICE PAID AMOUNT
AMOUNT 0 CASH O{HECK q O CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Deportment 29714 Noun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.LIS Inspection Request Line 951-246-6213
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