PMT17-02432 City of Menifee Permit No.: PMT17-02432
29714 HAUN RD. Type: Residential Re-Roof
'ACCELAI MENIFEE, CA 92586
""11_111%M - MENIFEE Date Issued: 07/1212017
PERMIT
Site Address: 29225 AVENIDA DE LAS FLORES, Parcel Number: 341-133-042
MENIFEE, CA 92587 Construction Cost: $14,405.00
Existing Use: Proposed Use:
Description of TEAR OFF COMP ROOFING, REPLACE DECKING AS NEEDED AND INSTALL(N)OC DURATION
Work: MOUNTAINSIDE COMP-INCLUDING PATIO.
CRRC 0890-0016
OWENS-CORNING
GRAY
Owner Contractor
KEVIN STEWART PETERSEN-DEAN INC
29225AVENIDA DE LAS FLORES 39300 CIVIC CENTER DRIVE
MENIFEE,CA 92587 FREMONT,CA 94538
Applicant Phone:5103716500
DALLAS PEREZ License Number:468117
PETERSEN-DEAN INC
39300 CIVIC CENTER DRIVE
FREMONT, CA 94538
Fee Description QQtt( Amount lSt
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 enors 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 far 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 o I am exempt from Iicensure under the Contractors State License Law for
Professions Code and my,license Is in full force and effect. 7 the fallowing reason:
License Class G By my signature below l acknowledge that,except for my personal residence
Expires 1—%- • �1 Signatureicense "I 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 workers 7D44 of the Business and Professions Code,is available upon request when
compensation,Issued by the Director of Industrial Relations as provided for th, licatfon is submitted or at the following website:
by Section 3700 of the Labor Code,for the performance of work for which ty info. oZHORIZCDA
this permit is issued.Policy R DatePROPERTYOWNER NT
have and will maintain worker's compensation Insurance,as required by
section 3700 of the Labor Code,for the performance of the work for which D By my signature below I certify to each of the foilowing:l am the property
this permit is Issued.My workers compensation insurance carrier and policy owner or authorized to act on the prop owners behalf.I have read this
number are�:y �., 1 } application and the information I have provided Is correct.I agree to comply
Carrier Y1fL St?2Cl�� IC/I 1�7J with all applicable city and county ordinances and state laws relating to
Policy r' `� 4 O"�Y( ru . uthadze representatives of this city or county to
ftU Exp res __ enter the identifie property for inspection purpose
(This section need not to be completed is the permit is for one-hundred Date 2D 1 rY
dollars($100)or less PROPERTYO RORAIITHORRED GENT
o I certify that in the performance of the work for which this permit is issued,
shall not employ any persons In any manner so as to become subject to the CITY BUSINESS LICENSE 9 n SPA
workers c=-
AND laws of orma, d agree that if l should become HAZARDOUS MATERIAL DECLARATION
subject toworker's ensation provlsi ns of Section 3700 of the Labor
Code,I shc ly with those pro istons. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
ApplicantDate amounts sp nfied on the Hazardous Materials Information Guide?
WARNING S CURE W K S COMP SATION C VERAGE IS o Yes 10
UNLAWFL 5 ERA E PLOYERTO IMINALPENALTIES
AND CIVI 0NE�UN RED THOUSAND DOLLARS($100,000),IN Will the intended use of the building by the applicant or future building
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a Permit for the construction or See permitionting
from South
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Airide Quality Management District(SCAQMD)?See permitting checklist
for guidelines
CONSTRUCTION LENDING AGENCY D Yes "o
1 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 bodary of a school?
(Section 3997 Civil Code) o Yes No
OWNER BUILDER DECLARATIONS a Hazardous Material Information Guide and the SCAOMD
I hereby affirm under penalty of perjury that i am exempt from the permitting che,c .I un a nd my requirements under the State of
Contractors License Law for the reason(s)indicated below by the Cal ornia Neal h afety Code, ection 25505 and 25534 concerning
haz 5r to porting.
checkmark(s)I have placed next to the applicable item(s)(Section 703L5 oY s vMa 'n
Business and Professions Code).Any city or county that requires a permit to Date 23 W
construct,after,improve,demolish or repair any structure,prior to its PR P TY OWNER OR A*OR1ZED NT
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 IRRPI
License Law(Chapter9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRPj 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
a I,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.eua.gav/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 o 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 orimprovement issold within one yearof 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 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 RAP
Acknowledgement.
LI enifee
DATE PERMIT/PLAN CHECK NUMBER MT-1-1-ti"LyZZ
TYPE: []COMMERCIAL ❑RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ❑SIGN
SUBTYPE: []ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑MECHANICAL
❑NEW ❑PLUMBING N RE-ROOF-NUMBER OF SQUARES--25j-a
DESCRIPTION OF WORK
PROTECT ADDRESS N
ASSESSOR'S PARCEL NUMBER 3L41 .133 .OL-42 LOT 2 TRACT
PROPERTY OWNER'S NAME �Dr
ADDRESS IE tJ e �
PHONE r1S.���Z�l�'�l�'7 EMAIL
APPLICANT NAME p� --
ADDRESS jf62 Q C W
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILDER? OYES NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION L�
VALUATION S1 O S L SO FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE I�O
AMOUNT C{'O PAIDAMOUNT
O CASH O CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT OCASH 0CHECK# QCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER 0 YES O NO
City of Menifee Building&Safety Department29714 Houn Rd. Menifee, CA 925869516ifJ {7"nlfee
www.cityofinenifee.us Inspection Request Line 951-246-6213 Building &Safety Dept.
JUL 12 2017
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CRRCpR00.10 MPNUFACRUREMBRPND PROOUCTTYDE COLOR SOIMPEMCANCF n1EBMALEMITTANCE 591 MWE
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WNW 3Year InlVal 3Yor Inkul 3Yov
o89"ot6 Owens Coming Roofingand Asphalt, Steep Slope:Asphalt Grey oao D.n&., 0.90 pendeg 19 pmang +
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