PMT17-02621 City of Menifee Permit No.: PMT17-02621
29714 HAUN RD. Type: Residential Re-Roof
ACCEL-A? MENIFEE, CA 92586
MENIFEE Date Issued: 08/03/2017
PERMIT
Site Address: 26482 CHERRY HILLS BLVD, MENIFEE, Parcel Number: 337-181-020
CA 92586 Construction Cost: $5,000.00
Existing Use: Proposed Use:
Description of RE-ROOF OVER EXISTING 1 LAYER COMP SHINGLES WITH COMP COOL ROOF
Work:
CRRC:00890-0002
OWENS CORNING-SHASTA WHITE
Owner Contractor
LYDIA SMITH PREMIER CONSTRUCTION
26482 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 gyt Amount t8l
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 forthe projects
with a licensed contractors)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑1 am exempt from licensure under the Contractors State License Law for
Professions Cade and my license is in full force and effect. the following reason:
License Class N Ucens o. c' _ By my signature below I acknowledge that,except for my personal residence
Expires Signature / in which i must have resided for at least one year prior to completion of
/ improvements covered by this permit.I cannot legallysell 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 w,ww.leginfo.ca.gov/calaw.htmi.
this permit is issued.
Policy k Date
❑I have 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 D 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: eTl-19eapplication and the information I have provided is correct.I agree to comply
Of Clt a meni D®Atall applicable city and county ordinances and state laws relating to
Carrier Safety— -0A building construction.I authorize representatives of this city or county to
Policy If Expires 2 5 zV7ter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundreAU lFF Date
dollars($100)or less PR ERN OWNER OR AUTHORIZED AGENT
I certify that in the performance of the work for which this permit it¢'�}}y�J&P�dn�+n `I e u
I shall not emolov any persons in any manner so as to become subjecl(t UL;v'tl CITY BUSINESS LICENSE tl
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the work is compensation provisions of Section 3700 of the Labor
Code,I shall fort th compl w'h those r isions. Will the applicant or future building occupant handle hazardous material or a
Applicant .-wr Date —25 mixture containing a hazardous material equal to or greater that the
amounts sp ified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes 10
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 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 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelln s
CONSTRUCTION LENDING AGENCY in Yes r,
1 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 bouVgry of a school?
(Section 3097 Civil Code) ❑Yes plNo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the California Health&Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the h jardous matena porting.-n
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 /dyes ❑Nc ////
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OYONER OR AUTAORFZED AGENT
issuance,also requires the applicant for the permit to file a signed statement i
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRP1
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
❑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.goy/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 forthis 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. hMo EPA Lead-Safe Certified Firm is required for this project because:
D I,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.
C
UILDING & SAFETY PERMIT/PLAN CHECK APPLICATION POO
Menifee
DATE 7�S/7 PERMIT/PLAN CHECK NUMBERTV I M-
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 O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK ovF F
fU/TN t/o�
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME
ADDRESS
PHONE �ffQ- YMY /� EMAIL
APPLICANT NAME /,eqQ
ADDRESS ro, Zr
PHONE -j SSrr--/5s� EMAIL
CONTRACTOR'S NAME OWNER BUILDER? O YES ONO
BUSINESS NAME
ADDRESS 37x su.
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER f`y 37G LICENSE CLASSIFICATION
VALUATION$ S 7 L SO FT
APPLICANT'S SIGNATURE DATE / Zs--- 17
DEPARTMENT DISTRIBUTION , CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I SMIP
INVOICE ap PAIDAMOUNT
AMOUNT I-6c)'_--. 0CASH 0CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES.O NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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