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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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