PMT17-01930 City of Menifee Permit No.: PMT17-01930
29714 HAUN RD. Type: Residential Re-Roof
'5A_CCEL/k_>. MENIFEE, CA 92586
""'"""z P..A ' MENIFEE Date Issued:
06/16/2017
PERMIT
Site Address: 29589 PEBBLE BEACH DR,MENIFEE, Parcel Number: 338-064-001
CA 92586 Construction Cost: $9,490.00
Existing Use: Proposed Use:
Description of REMOVE EXISTING COMP ROOFING AND REPLACE WITH 30#FELT AND COOL ROOF SHINGLES
Work:
CRRC 0890-0009
OWENS CORNING-AMBER COLOR
Owner Contractor
JIM BASINGER GARDNER ROOFING COMPANY
29689 PEBBLE BEACH DR 594 WEST SEVENTH STREET
MENIFEE, CA 92586 SAN JACINTO, CA 92382
Applicant Phone:9516542794
LEE BLOOMER License Number: 528309
GARDNER ROOFING COMPANY
594 WEST SEVENTH STREET
SAN JACINTO, CA 92382
Fee Description QtV Amount t$)
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 building 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
with a licensed contractors)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 ❑I am exempt from licensure under the Contractors State.License Law for
Professions code
'and
7myy license is in full force and effect. the
p' q !,(� the following reason:
License Class C -_Tl License No. .) O O o By my signature below I acknowledge that,except for my personal residence -"
Expires I7 2o(7 SignaturP 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
a 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 www.lezlnfo.ca.zov/calaw.html.
this permit Is issued. -
Policy# qp[Z 3R7 Date
PROPERTY OWNER OR AUTHORIZED AGENT
❑I have and will maintain workers compensation insurance,as required by
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 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
clv�Uf 1, with all applicable city and county ordinances and state laws relating to _
Cartier building construction.I authorize representatives of this city or county to
Policy#'?f 1// Expires����� / 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
❑I 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 provisions of Section 3700 of the Labor _
Code,I shall fo h corn I provisions. Will the applicant or future building occupant handle hazardous material or a
�17 mixture containing a hazardous material equal to or greater that the
Applicant �� � Date amounts s ec'fled on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building f
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modifiation 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 guid"es
CONSTRUCTION LENDING AGENCY 0 Yes
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 bog of a school?
(Section 3097 Civil Code) 0 Yes o
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
California H alth&Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the u aterial re
checkmark(s)I have placed next to the applicable item(s)(Section 7031.E ciYes ❑ 1 _
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,prior to its PROP WNER OR AUTHORIZED AGENT I
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(RRPI
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt from licensure The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
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($500). managers who do the paint-disturbing work themselves or through their
❑1,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.eoa.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323). }'
Code;The Contractors State License Law does not apply to an owner of a
property who,through employees'or personal effort,builds or improves the ❑An EPA Lead-Safe Certified Renovator will be responsible for this project ,h
Property provided that the improvements are not intended or offered for . Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or Improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
O 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a
If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
w
Menifee
DATE �l�� ( PERMIT/PLAN CHECK NUMBE !J
TYPE: ❑COMMERCIAL Vf RESIDENTIAL MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATI N ❑DEMOLITION ❑ELECTRICAL [-]MECHANICAL
❑NEW ❑PLUMBING RE-ROOF-NUMBEROFSOUARES�
DESCRIPTION OF WORK v� lS jkkA C01,Akp ,
ah
PROJECT ADDRESS Z-1 l —12 rV$ILC
ASSESSOR'S PARCEL NUMBER 33 0 -0�04 00I LOT 4��L TRACT 0 -
PROPERTY OWNER'S/NAME
ADDRESS 2c(,1/Q 5 & Le
ZY
PHONE (95l) O- (?7Q2 EMAIL
APPLICANT NAME I 7 f �C/l
ADDRESS "{/ ft[ t lV�-�,p Ca- q 3
PHONE (f,5-6 (QV-Z7 `y EMAIL
CONTRACTOR'S NAME OWNER BUILDER? ❑YES NO
BUSINESSNAME // pp
ADDRESS 1 / .,I 'Lt� G{. RZS(�
PHONE �9S1 1 /j,s"1� 7qq EMAIL
CONTRACTOR'S STATE LIC NUMBER �5 S';nq LICENSE CLASSIFICATION
VALUATION $ O . O- SO FT Z7o O L SO FT
//
APPLICANT'S SIGNATURE DATE LO-IS'-1 7
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN ( 'OO SMIP
INVOICE ��//�� C�
� PAID AMOUNT �CASH '-'CHECK p �-'CREDIT CARD VISA/MC AMOUNT 1 50
PLAN CHECK FEES PAID AMOUNT CASH CHECK# CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED YES 0 NO DL NUMBER NOTARIZED LETTER YES C NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-67P,W9kMenitep
www.cityofinenifee.us Inspection Request Line 951-246-6213 Building & Safetyept.
JUN 16 2017
Received
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