PMT17-01931 City of Menifee Permit No.: PMT17-01931
29714 HAUN RD.
�f\OCELA� MENIFEE,CA 92586 Type: Residential Re-Roof
MENIFEE Date Issued: 0 611 612 01 7
PERMIT
Site Address: 26179 LAZY CREEK RD,MENIFEE, CA Parcel Number: 338-272-011
92586 Construction Cost: $10.920.00
Existing Use: Proposed Use:
Description of TEAR OFF EXISTING CMP SHINGLES(1 LAYER)AND INSTALL NEW COMP SHINGLES
Work:
Owner Contractor
JOHN&LINDSY DIETZ SEMPER SOLARIS CONSTRUCTION INC
26179 LAZY CREEK RD 1805 JOHN TOWERS AVE
MENIFEE, CA 92586 EL CAJON,CA 92020
Applicant Phone:6197154054
ALICIA ANDREWS License Number.978152
SEMPER SOLARIS CONSTRUCTION INC
1805 JOHN TOWERS AVE
EL CAJON, CA 92020
Fee Description QQtt( Amount ISl
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 1 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 Ilcensure under the Contractor's State License Law for
Professions Co�de and my license Is iujjforce and effect. the following reason:
License Class J37 ,o O GLice 1 Lm ec
en No. IX% By my signature below I acknowledge that,except for my personal residence
Expires )ri• .31. 261 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 for worker'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 Cade,for the performance of work for which
this permit is issued. www.leginfo.ca.gov/calaw.htmi.
Policy If Date
Ahave and will maintain workers compensation insurance,as required by PROPERTY OWNER 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 areeQ:+ /p application and the information I have provided is correct.I agree to comply
Carrier ✓" \ MAp, with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# —20 Expires IO. Ia- 2-rN 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 emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's compe tion laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to th or er's compensation provisions of Section 3700 of the tabor
Code,I shall f h ith 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 a Yes >RNo
UNLAWFUL,AND SHALLSUBJECT 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 modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OFTHE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes #(_No
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) o Yes Alo
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 Heal afety Code,Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)Indicated below by the hazardous m erfal eporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 j(�Yes ❑No
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,Improve,demolish or repair any structure,priorto its PROPERTY O RAUTHORIZED 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 fRRPI
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
❑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.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 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. o No EPA Lead-Safe Certified Firm Is required for this project because:
a 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 till out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
v�
'Menifee
DATE 0 6/1 6120 1 7 PERMIT/PLAN CHECK NUMBER
TYPE: ❑COMMERCIAL ❑✓ RESIDENTIAL E MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION []ALTERATION [-]DEMOLITION ❑ELECTRICAL []MECHANICAL
[-]NEW ❑PLUMBING ✓❑RE-ROOF-NUMBER OF SQUARES 22
DESCRIPTION OF WORK TEAR OFF EXISTING COMP SHINGLES(1 LAYER)AND INSTALL NEW COMP SHINGLES
PROJECTADDRESS 26179 LAZY CREEK RD.SUN CITY 0I2.%CO
ASSESSOR'S PARCEL NUMBER '5'5b' 7,7 2^ U 1 LOT I TRACT ?-2r20 41
PROPERTY OWNER'S NAME JOHN AND LINDSY DIETZ
ADDRESS 26179 LAZY CREEK RD.SUN CITY
PHONE EMAIL
APPLICANTNAME ALICIAANDREWS
ADDRESS 1218 SPRING ST.RIVERSIDE,CA 92507
PHONE (619)357-0383 EMAIL alicia.andrews@sempersolads.com
CONTRACTOR'S NAME SEMPER SOLARIS OWNER BUILDER? ❑YES❑✓ NO
BUSINESS NAME
ADDRESS 1805 JOHN TOWERS AVE. EL CAJON, CA 92020
PHONE (619)357-4142 EMAIL
CONTRACTOR'S STATE LIC NUMBER 978152 LICENSE CLASSIFICATION B, C10,C46,C36
VALUATION$ $ 10,920.00 SO FT L SQ FT
APPLICANT'S SIGNATURE DATE 06/16/2017
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN '' SMIP _ QJ
INVOICE /��� Q PAID AMOUNT
AMOUNT -a/ m O CASH O CHECK# O CREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH UCHECK# OCREDITCARD VISA/Mc
OWNER BUILDER VERIFIED OYES 0 NO DLNUMBER NOTARIZEDLEFrER O YES O NO
City of Menifee Building&Safety Deportment 29714 koun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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f15/2017 Mail-benny.mitchell@sempersolaris.com
permit info dietz # 9037
Benny Mitchell
Thu 6/15/2017 1:48 PM
To Alicia Andrews <Alicia.Andrews@sempersolaris.com>;
ccKimberly Saavedra <Kimberly.Saavedra@sempersolaris.com>;
PERMIT INFO
JOHN AND LINDSY DIETZ-26179 LAZY CREEK RD SUN CITY 92586
PHONE# 760-521 -8977
• SCOPE : tear off existing composition shingles ( 1 layer ) and install new composition shingles we will be
roofing whole home .
• SHEATHING : roof is already sheathed we will not be sheathing
• SIZE ; 22 SQ
• PITCH : 3/12-4.5 SQ, 4/12-15.5 SQ, 6.5/12 2 SQ
• MATERIAL : OWENS CORNING DURATION STANDARD COOL-SUMMERWOOD
o CRRC# : 0899-0015, SOLAR REFLECTANCE : 0.20,THERMAL EMITTANCE : 0.90, SRI : 19
• VALUTATION : $ 10,920
Benny Mitchell
Roofing Manager
909-499-4089
Semper Solaris
httpsJ/outlook.office.com/awa/?realm=sempersolaris.combexsvurl=I&II-cc=l033&moduri=D&path=/mail/sermtems 1/1