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PMT17-02582 City of Menifee Permit No.: PMT17-02582
29714 HAUN RD. Type: Residential Re-Roof
�A_CCEL A_> MENIFEE, CA 92586
MENIFEE Date Issued:
07/2512017
PERMIT
Site Address: 26399 CHERRY HILLS BLVD, MENIFEE, Parcel Number: 337-182-004
CA 92586 Construction Cost: $5,000.00
Existing Use: Proposed Use:
Description of REROOF OVER EXISTING 1 LAYER COMP SHINGLES WITH COMP COOL ROOF
Work:
CRRC:00890-0002
OWENS CORNING SHASTA WHITE
Owner Contractor
BARBARA HESS PREMIER CONSTRUCTION
26399 CHERRY HILLS BLVD 6185 MAGNOLIA AVENUE#216
MENIFEE, CA 92586 RIVERSIDE,CA 92504
Applicant Phone:9515451957
TRAVIS HAYWARD License Number.949376
PREMIER CONSTRUCTION
6185 MAGNOLIA AVENUE#216
RIVERSIDE, CA 92504
Fee Description Qtr Amount ISI
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_Pennit_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 I am under provisions of with a licensed contractors)pursuant to the Contractors State License Law).
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 my license is in full force and effect. the following reason:
License Class Licens o. By my signature below I acknowledge that,except for my personal residence
Expires �D���/x 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
❑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:
by Section 3700 of the Labor Code,for the performance of work for which www.legido.ca.zov/calaw.html.
this permit is issued.
Polity If Date
❑I have and will maintain workers compensaton 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 workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this
number are: City Of MGOteeapplication and the information I have 000tall applicable city a d county ordinances nd state laws relating to
Iciumply
Carrier jt&k. A $any building construction.I authorize representatives of this city or county to
Policy If Expires ,,11 5 IV
Vter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundrealit 11'1 Date
/ars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
I certify that in the performance of the work for which this permit i ytJF�d��+ o,p d
1 shall not emolav any persons in any manner so as to become subjec�Veve1 v CITY BUSINESS UCENSE q
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the work rs compensation pro '4qns of Section 3700 of the Labor
Code,I shall fort ith comply'w h those r 4isions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date �--25 mixture containing a hazardous material equal to or greater that the
amounts so fled on the Hazardous Materials Information Guide?
WARNING:FAILURE Tl�.fE URE WORKER'S COMPENSATION COVERAGE IS ❑Yes o
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
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South
_ IN SECTION 3706.OFTHE LABOR CODE,INTEREST,AND ATTORNEYS FLF Coast Air Quality Management District(SCAQMD)?See permitting checklist
for gui a n----
CONSTRUCTION LENDING AGENCY ❑Yes 7-
I 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 boun ry of a school?
(Section 3097 Civil Code) ❑Ye No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements underthe State of
hereby affirm under penalty of perjury that I am exempt from the
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
ha Poous ma[eria eporting.
Checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 �s ❑No ��//J
Business and Professions Code).Any city or county that requires a permit to !ji Date
construct,alter,improve,demolish or repair any structure,prior to Its PROPERTY Oif4WER OR AUT ORIZED 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 Contractors State EPA RENOVATION,REPAIR AND PAINTING(FIRM
License Law(Chapter9(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 exemptfrom licensure receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Anyvlolation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with
an Applicantfora 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 orthrough their
❑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.epa.aov/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 ❑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 EPA Lead-Safe Certified Firm is required for this project because:
in 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
Menifee
DATE 7 -(7 PERMIT/PLAN CHECK NUMBER-}V n `1 -D2r'1 T2
TYPE: O COMMERCIAL O RESIDENTIAL 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 11 I11 '1
ASSESSOR'S PARCEL NUMBER 331 - 18 2.00q LOT TRACT y 1p
OWNER NAME &
ADDRESS
PHONE zY J-aT- 7/%61 EMAIL
APPLICANT NAME
ADDRESS
PHONE 9,s/ '1�>= /y'� EMAIL
CONTRACTOR'S NAME OWNER BUILDER? O YES O NO
BUSINESS NAME ,E
ADDRESS
PHONE f�,f/ .TW-- /5r1"7 EMAIL
CONTRACTOR'S STATE LIC NUMBER 9y9376 LICENSE CLASSIFICATION
VALUATION$ o S L SO FT
APPLICANT'S SIGNATURE DATE 7 z_i—,
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE GAD PAID AMOUNT
AMOUNT O CASH JCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City Of M0131100
City of Menifee Building& Safety Department 29714 Haun Rd. Menifeej3Alld 998%S0PWR9?t177
www.cityofinenifee.cis Inspection Request Line 951-246-62j�L 2 5 'LUl!
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