PMT17-02818 City of Menifee Permit No.: PMT17-02818
29714 HAUN RD. T Residential Re-Roof
gf\CCEL/� MENIFEE, CA 92586 Type:
MENIFEE Date Issued: 08/09/2017
PERMIT
Site Address: 28860 HOPE DR, MENIFEE, CA 92586 Parcel Number: 337-366-010
Construction Cost: $10,870.00
Existing Use: Proposed Use:
Description of REMOVE ALL EXISTING LAYERS, INSTALL NEW COOL ROOF SHINGLES
Work: •'CRRC#0850-0027
Owner Contractor
GREGORIO 8 JOSEFA ESPINOZA WEATHERTIGHT ROOFING INC
28860 HOPE DRIVEP 0 BOX 5281
MENIFEE, CA 92586 HEMET, CA 92544
Applicant Phone: 9519290557
GUY SCHEMBRI License Number:643691
WEATHERTIGHT ROOFING INC
P 0 BOX 5281
HEMET, CA 92544
Fee Description ,city Amount 151
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
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 and effect.
l/Z 9 the following reason:
License Class C" U rise No. I ✓� By my signature below I acknowledge that,except for my personal residence
Expires 3� l Signature
/' '7 in which I must have resided for at least one year prior to completion of
improvements covered by this permit.)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 worker's 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 webske:
by Section 3700 of the Labor Code,for the performance of work for which www leeinfo ca.gov/calaw.html.
this permit is issued. Date
Policy If PROPERTY OWNER OR AUTHORIZED AGENT
❑I have and will maintain workers compensation Insurance,as required by B signature below I certify to each of the following:I am the property
section 3700 of the Labor Cade,for the performance of the work for which Y m Y g
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: application and the information I have provided Is correct.I agree to comply
with all applicable city and county ordinances and state laws relating to
Carrier �t7fC /L �y building construction.I authorize representatives of this city or county to
Policy fl CU ell Z- !q_2/ 4 Expires 61ll Ilk enter the above identified property for Inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($300)or less PROPERTY OWNER OR AUTHORIZED AGENT
,ptI certify that in the performance of the work for which this permit is issued, CITY BUSINESS LICENSE ri
I shall not employ any persons in any manner so as to become subject to the
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor Will the applicant or future building occupant handle hazardous material or a
Code,I shall forthwith comply with those rovisi
-� mixture containing r hazardous material equal to or hazardousthat the
Applicant Date amounts specified on the Hazardous Materials Information Guide?
WAR :-FA-ILURIGO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes ❑No
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 guidelines
CONSTRUCTION LENDING AGENCY ❑Yes ❑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 boundary of a school?
(Section 3097 Civil Code) ❑Yes o No
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 hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oYes ❑No
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 OWN ER OR AUTHORIZED AGENT
issuance,also requires the applicant for the permit to file a signed statement EPA RENOVATION REPAIR AND PAINTING(RRP)
that he or she is licensed pursuant to the provisions of the Contractors State
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,compensation,will ( )all ( )portion of the work,and the structure is www ep
not intended or offered for sale.
gov/lead or contact the National Lead Information Center at
ale.((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
properr, %ugh employees'or personal effort,builds or improves the Certified Firm Name:
'tat the improvements are not Intended or offered for
'building or improvement Is sold within one year of Firm Certification No.:
'-Builder will have the burden of proving that it was
❑No EPA Lead-Safe Certified Firm Is required for this project because:
r the purpose of sale.
o •rty am exclusively contracting with licensed
d
e project(Section 7044,Business and Professions
tolle License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please RII out the RRP
Acknowledgement.
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