PMT17-02795 City of Menifee Permit No.: PMT17-02795
29714 HAUN RD.
c.^ Type: Residential Re-Root
CCELAh� MENIFEE, CA 92586
MENIFEE Date Issued: 08/07/2017
PERMIT
Site Address: 29603 SQUAW VALLEY DR, MENIFEE, Parcel Number: 338-252-019
CA 92586 Construction Cost: $12,500.00
Existing Use: Proposed Use:
Description of TEAR OFF EXISTING ROOF, REROOF HOUSE AND ATTACHED GARAGE W/OWENS CORNING
Work: COOL ROOF IN OAKRIDGE
Owner Contractor
ASTRID JIMENEZ ARCADE CURVES ROOFING
29603 SQUAW VALLEY DR P O BOX 9442
MENIFEE,CA 92586 ALTA LOMA, CA 91701
Applicant Phone:9493382869
DOMINIC VASQUEZ License Number: 797664
ARCADE CURVES ROOFING
P O BOX 9442
ALTA LOMA, CA 91701
Fee Description O—t Amount($)
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_8ldg_Permit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
with a licensed contractor(s)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 ❑I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force a ct. the following reason:
License Class Ae se No. By my signature below I acknowledge that,except for my personal residence
Expires ignature 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.leeinfo.ca.gov/calaw.html,
this permit is issued. —
Policy p Date
//,,
shave and will maintain worker's compensation 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 owner's behalf.I have read this
Carri.�� application and the Information I have provided d correct. agree to comply
Carri with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy q 2 Expires 2 /- 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
❑I certify that in the performance of the work for which this permit is issued, O �I
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS UCENSE ft
workers compens�f California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subjectto t prker's co�tion provisions of Section 3700 of the Labor
Code,I sit orthwIt com with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date mixture containing a hazardous material equal to or greaterthatthe
amounts swill on the Hazardous Materials Information Guide?
WARNING: LURE RE WORKER'S COMPENSATION COVERAGE IS ❑Yes ❑No
UNLAWFUL,AND HALL 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($300,000),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 guldt6rres
CONSTRUCTION LENDING AGENCY ❑Yes O No
I 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 boilli of a school?
(Section 3097 Civil Code) ❑Yes r}tI.
OWNER BUILDER DECLARATIONS I have read the us Material Information Guide and the SCAQMD
hereby affirm under penalty of perjury that I am exempt from the permittin ecklist. y requirements under the State of
Californi H It Safety C d ction 25505 and 25534 concerning
Contractors License Law far the reason(s)indicated below by the hazard at I repo in 7 �q
checkmark(s)I have placed next to the applicable items)(Section 7031.5 oyes n _ //J
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 O 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(RRP)
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
in 1,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.eo_—P 6a.g-ov 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. ❑No EPA Lead-Safe Certified Firm is required forthis project because:
❑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.
& SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE �'jI PERMIT/PLAN CHECK NUMBER -0339 57
TYPE: ,S COMMERCIAL ESIDENTIAL C MULTI-FAMILY O MOBILE HOME O POOL/SPA C,SIGN
SUBTYPE: t ADDITION {j ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O BING E-ROO - UM SQUA ES
DESCRIPTION OF WORK 709f «Z-7p. GLl,5�S.4
PROJECTADDRESS 2 LEy
ASSESSOR'S PARCEL NUMBER ,/ S�/�a�y�� LOT lb TRACT
OWNER NAME
ADDRESS S '"wt€
PHONE ? EMAIL
APPLICANT NAAM
ADDRESS "l SY -
PHONE � �3'�Zo 6�J EMAIL
CONTRACTOR'S NAME 1Q'�LRd OWNER BUILDER? OYES '. O
BUSINESS NAME
ADDRESS
PHONE EMAIL
t� /� p
CONTRACTOR'S STATE LIC NUMBER ` ! (4VW LICENSE CLASSIFICATION
VALUATION $ SO L SQ FT
APPLICANT'S SIGNATURE DATE ?�
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN r SMIP
INVOICE PAID AMOUNT AMOUNT I O. O O CASH .-CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 11 w CASH O CHECK# O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES C NO
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