PMT17-02555 City of Menifee Permit No.: PMT17-02555
29714 HAUN RD. T Residential Re-Roof
� E /?CCL MENIFEE,CA 92586 yam'
MENIFEE Date Issued: 0 7/2 412 01 7
PERMIT
Site Address: 27100 HOWARD ST, MENIFEE, CA 92586 Parcel Number: 335-302-028
Construction Cost: $9,200.00
Existing Use: Proposed Use:
Description of TEAR OFF 2 LAYERS, REROOF W/CERTAINTEED COOL ROOF IN BIRCHWOOD
Work:
Owner Contractor
CHARLES STAUDER HOUSETOP ROOFING
27100 HOWARD ST 31760 BRIGGS ROAD
MENIFEE,CA 92586 MENIFEE, CA 92584
Applicant Phone:9516798369
RICH CARROLL License Number:371783
HOUSETOP ROOFING
31760 BRIGGS ROAD
MENIFEE, CA 92584
Fee Description gyt Amount($)
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 propertywho builds or Improves thereon,and who mabacts forthe projects
I hereby affirm under penalty of perjury that l am under provisions of with a licensed rontractor(s)pursuant to the Conladas late License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and a l am exempt from licensure underthe Contractors5tue License Lawfor
Professions Code and my license is in full farce and effect the following reason:
License Class (2' -�License No. �7��70 C Bymysignature below l acknowledge that except farmypelsonal residence
Expires �2-- Signature in which l most haveresided for at least one year pdorlo completion of
WORKER'S CDMPENSATIDN OECUIRATID J Improvements covered bythis permit.)cannot legall0l a structure that I
have builtas an owner-builderif ithas not been compweted In its entirety by
o I hereby affirm underpenalty of perjury one of the following declara0om:I licensed contractors.)understand that a copy of theappliable law,Section
have and will maintain a certificate ofounsent ofself-Insure far workers 7044 oFthe business and Professions Code,is availableupon requestwhen
compensation,issued by the Director of Industrial Relations as provided for this appliation is submitted or at the following webstc
by Section 3700 of the Labor Cade,for the performance of work forwhfch
vrww.leefnfa.a.¢ov/alaswlr[ml.
this Permit is issued.
Policy ff Date
Weave and will maintain workers compensation Insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Lobar Code,for the performance of the work forwhich o By mysignature below l certify to each of the following:I am the property
this permit is Issued.My workers compensation insuance arderand policy owner or authorized to act on the propertyovmees belolf.I have read this
number are: application and the information 1 have provided is arrot.I agree to comply
Carder with all applicable city and county ordinances and statelaws relating to
building construction. authorize representatives oftAbdty or county to
Policyg 7//�? Expires /yZZ 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
-:%A`8erfify that in the performance of the work for which this permit is Issued,
Ishallnatemolov any persons in any mannersoastobecomesubjectto the CRY BUSINESS LICENSE 0 sY✓
workers compensation laws ofCalifrmia,and agree that if l should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the labor
Code,I shall forthwith comply with thosepmisfo s. �1 Will the applicant or future building occupant handle hrnrdous materialora
Applicant Date
Date 26 mixturespecifiedo the azardous
rial Materials
Inonation thatGuid the
amounts containing
on the Hazardous Materials to ormallon Guide?
WARNING (LURE TO SECURE WORKERS COMPENSATION COVERAGE IS Oyes rsne
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use ofthe 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 moddxation tram South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR CoostAir Quality Management District(SCAQMD)7 Seepennihing checklist
IN SECTION 37060FTHE LABOR C0DE,INTEREST,AND ATTORNEYS FEES ferguide11
CONSTRUCTION LENDING AGENCY oYes No
hereby affirm that underthe penalty afperjury there is a construction Will the proposed building or modified facility be withq[000 feet of the
lending agency far the performance of the work which this permit is issued aulerbo �daryofasrhool7
(Section 3097 Civil Code) D Yes D-
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guideand the STAQMO
permitting checkilst.l understand my requirements underthe State of
r hereby affirm under penalty of perjury that l am exempt from the California Health&Safety Code,Section 25505 and 25534 concerning
Contactors License Law for the reason(s)initiated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable flem(s)(Sectlon 703L5 oYes R
Business and Professions Code).Any city or county that requires a permit to >'jP//� Date 2�
construct,alter,Improve,demolish or repair any structure,priorto iLs PROPEL} INNER OR AUTHORIZED AGENT
issuance,also requires the applicant for the permitto file a signed statement
that he or she is licensed pursuant to the provisions of the Contactors State SPARE OVATION,REPAIR AND PAINTING(RRP)
License Law(Chapter9(cummencingw(1h5ect(on 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requiies contactors
Business and Profess(onsCode)or that he or she is exempt from licensure receiving compensation for most work that disturbs paintln a pre-1878
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 Appiiant for a permit subjects the applicant to a civil penalty of not more required practices.This Includes rental property ownersand property
than($50D). managers who do the paint4isturbing work themselvesorthrough their
O1,as owner ofthe property,or my employee With wages as theirsole employees.For more Information aboutEPXs Renovation Program visit
compenatlon,wlldo( )allofor()portion ofthework,and the structure is www•eoa.eov/lead or contact the National Lad Information Centerat
not intended or offered forsale.(Section 7044,Business and Professions 1-8 0 0 4 24-LFAD(5323).
Code;The Contactors State License Law does not apply to an owner of a oAn EPA Lead-Safe Certified Renovatorwill be responsible forthis project
property who,through employees'or personal effort,builds orimprovas the
property provided that the improvements are not intended or offered for Cediffed Firm Name:
sale,If,however,the building or Improvement is sold within one year of Firm CerhTation 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 Cert(Oed Firm is required for this project because;
01,as owner of the property am exclusively contacting with licensed
contactors to construct the project(Section 7044,Business and Professions
Code:The Contactors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rate please fib out the RRP
Acknowledgement
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION r"
Menifee
DATE PERMIT/PLAN CHECK NUMBER T
TYPE: O COMMERCIAL X-KrSIDENTIAL 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 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
PROJECTADDRESS 2. Q-� /,4ze,-AUvQ
� .y
ASSESSOR'S PARCEL NUMBER 0 - {/0 LOT 07 TRACT '
OWNER NAME '/
ADDRESS 7` llv-
PHONE /,-72 EMAIL
APPLICANT NAME et
ADDRESS 7— ,
PHONE ����� EMAIL e:,.
CONTRACTOR'S NAME OWNER BUILDER? O YES ONO
BUSINESS NAME 2�djFJ
ADDRESS iQO
PHONE ��4' EMAIL /�!. '�/�• C4
CONTRACTOR'S STATE LIC NUMBER ?j ���� LICENSE CLASSIFICATION e
VALUATION $ %,LBO SO FT L SO FT
APPLICANT'S SIGNATURE DATE
i
DEPARTMENT DISTRIBUTION ' CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT • O CASH O CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building& Sofety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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