PMT17-02853 City of Menifee Permit No.: PMT17-02863
29714 HAUN RD.
t-ACCELA? MENIFEE,CA 92586 Type: Residential Re-Roof
" MENIFEE Date Issued: 0 811 412 01 7
PERMIT
Site Address: 26790 ST ANDREWS DR, MENIFEE, CA Parcel Number: 337-381-001
92586 Construction Cost: $9,000.00
Existing Use: Proposed Use:
Description of TEAR OFF EXISTING SHINGLE LAYERS, INSTALL NEW COOL ROOF SHINGLES
Work: CRRC#0668-0118
Owner Contractor
DENNIS FAHEY HOUSETOP ROOFING
26790 ST ANDREWS DRIVE 31760 BRIGGS ROAD
MENIFEE, CA 92586 MENIFEE, CA 92584
Applicant Phone: 9516798369
RICH CARROLL License Number:371783
HOUSETOP ROOFING
31760 BRIGGS ROAD
MENIFEE,CA 92584
Fee Description
City. Amount lEl
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_Permit_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 perjurythat I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter!)(commencing with section 7000)of Division 3 of the Business and 0I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. / C the following reason:
License Class C ` License No. 37I/O
, By my signature below 1 acknowledge that,except for my persona)residence
Expires 2.— 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 DECLARATI d
have built as an owner-builder if it has not been constructed in its entirety by
01 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 website:
by Section 3700 of the Labor Code,for the performance of work for which
this permit is issued. www.leeinfo.ca.eav/calaw.lrtmL
Policy N Date
Wave 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 0 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
number are: application and the information I have provided Is correct.I agree to comply
Carrier �� with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or rounty to
Policy It ze"? Expires 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
,ASertify that in the performance of the work for which this permit is issued,
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE N
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those provisio s. �I Will the applicant or future building occupant handle hazardous material or
Applicant Date 9Ad mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING. .URE TO SECURE WORKER'S COMPENSATION COVERAGE IS 0 YesKo
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($300,000),IN occupant require a permit for the construction or modification from South
IN SECTIODITION N
3 THE OF COST OF
CODE,INTERDAMADATTOGES AS ROVIDEDS Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 37060E THE LABOR[ODE,INTEREST,AND ATTORNEYS FEES for guidelin
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 bound ryofa school?
(Section 3097 Civil Code) ❑Yes
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist I understand my requirements under the State of
Contractor's License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material reporting.
Business and Professions Code).Any city or county that requires a permit to /
construct,alter,improve,demolish or repair any structure,prior to its "'Yes �U Date 2�f
issuance,also requires the applicant for the permit to file a signed statement PROPEg WNER OR AUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractors State EPA RE OVATION.REPAIR AND PAINTING(RRP)
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 exempt from licensure receiving compensation far most work that disturbs paint in a pre-1978
and the basis far 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 ownersand property
than($500). managers who do the paint-disturbing work themselves or through their
a 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.epa.eov/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 Contractor's State License Law does not apply to an owner of a 0 An EPA Lead-Safe Certified Renovator will he 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. ❑No EPA Lead-Safe Certified Firm is required for this project because:
a 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's 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.
APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK
-Menfee
DATE �// /7 PERMIT/PLAN CHECK NUMBER �JI ' ��✓
TYPE: OCOMMERCIAL '!4t lDENTIAL O MULTI-FAMILY O MOBILE HOME C- POOL/SPA SIGN
SUBTYPE: O ADDITION "ALTERATION O DEMOLITION 0 ELECTRICAL <`, MECHANICAL
O NEW�JO PLUMBING ;W ROtOF-NUMBEROFSQUAARES Z.
DESCRIPTION OF WORK /� ®Y/� ri f ,T�i�/lj /L✓5 - �'�f ��T '
PROJECTADDRESS D qgmj
ASSESSOR'S PARCEL NUMBER LOT TRACT
City of Menifee
OWNER NAME N/f�!'f �� Building $ Safety De
ADDRESS -5i41w;w� o, f/W4$ki S
PHONE FJOI� 2-50— fJ'740 EMAIL
APPLICANT NAME a14A4 "w/LOL L Received
ADDRESS 740 ,efI445' ;@O .
PHONE -711 EMAIL •rrF'� 147,41*4 d
CONTRACTOR'S NAME ✓! /d/1 Irw f f ex OWNER BUILDER? ()YES t:) NO
BUSINESS NAME
ADDRESS 17b /BLS X p
PHONE Os -/•7X EMAIL *4,MiSIF' <F ,y,¢sc • ��'
CONTRACTOR'S STATE LIC NUMBER ?j 7) LICENSE CLASSIFICATION C•-,3
VALUATION$ 9� apQ SQFT G LSQFT
APPLICANT'S SIGNATURE DATE /
arysTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE //�� PAID AMOUNT w [] v,
AMOUNT ,� :I� 1'A 1� C>CASH CHECK# OCREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH 0 CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES O NO DL NUMBER NOTARIZED LETTER 01 YES C NO
City of Menifee Building-0 njeiy Department 9714 Houn Rd. Menifee, CA 925Eb 95:±-F72-6??:
�vi,vw.cityofinenir-ee.us!nspectiun Request One 95i-.[4b-b2s3
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