PMT17-02932 City of Menifee Permit No.: PMT17-02932
29714 HAUN RD. T Residential P.o-Roof
�ACCELA-? MENIFEE, CA 92586 Type:
MENIFEE Date Issued: 08/18/2017
PERMIT
Site Address: 29861 KRATKA RIDGE LN, MENIFEE, CA Parcel Number: 338-271-014
92586 Construction Cost: $13,000.00
Existing Use: Proposed Use:
Description of TEAR OFF EXISTING ROOF,APPLY NEW COOL ROOF CERTAINTEED LANDMARK IN HEATHER
Work: BLEND CRRC 0668-0117
Owner Contractor
CHARLINE WILLS J W ROOFING COMPANY
29861 KRATKA RIDGE LN P 0 BOX 268
MENIFEE,CA 92586 CRESTLINE, CA 92325
Applicant Phone:9093385730
JAMES WILSON License Number:491289
J W ROOFING COMPANY
P 0 BOX 268
CRESTLINE, CA 92325
Fee Description ply 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 conslmction 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 perjury that I am under provisions of with a licensed contractor(s)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 ' ense is in full force and eLff(�t�yJ the following reason:
License Class C- 3-1 Lice o. ! r��
By my signature below I acknowledge that,except for my personal residence
Expire�3/'Z g Signature yt-- r 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
WOR ER'S COMPENSATION DEC TION 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 website:
by Section 3700 of the Labor Code,for the performance of work for which
this permit is issued. www.leainfo.ca,gov/calaw,html.
Policy# Date
r(; PROPERTY OWNER OR AUTHORIZED AGENT
�'have and will maintain worker's compensation insurance,as required by
section 3700 of the Labor Code,for the performance of the work for which n By my signature.below l certify to each of the following:1 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: ��' application and the information I have provided is correct.I agree to comply
Carrier �74re lee AJZ 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 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($100)or less
PROPERTY OWNER OR AUTHORIZED AGENT
❑I terrify that in the performance of the work for which this permit is issued.,
I shall not emolov any persons in any manner so as to become subject to the /�BU51NESS LICENSE#
workers compensate n laws of California,and agree that if I should become / HAZARDOUS MATERIAL DECLARATION
II subject to the wor s compensation prowisions of Section 3700 of the Labor f
,Code Ishall fort comp($I Wiithththosse provisions. / /% Will the applicant or future building occupant handle hazardous material or
¢ant � /�'� V' Dale { mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WAR :FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 ❑Yes t`[plo
UN FUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES
A CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN Will the intended use of the building by the applicant or future building
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permitfor the construction or modification from South
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)?See permitting checklist
forgui li es
CONSTRUCTION LENDING AGENCY ❑Yes TNO
I hereby affirm that underthe 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 i outer b u dary of a school?
(Section 3097 Civil Code) &VATION.
o
OWNER BUILDER DECLARATIONS the Hazardous Material Information Guide and the SCAQMD
1 hereby affirm under penalty of perjury that I am exempt from the checklist.I understand my requirements under the State of
Contractors License Law for the reason(s)indicated below by the ealth&S Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 azer' r rung.��j� r� Q
Business and Professions Code).Any city or county that requires a permit to0 ! — Date U r �17 17
construct,alter,Improve,demolish or repair any structure,prior to its NER OR AUTHORIZED AGENT
issuance,also requires the applicant for the permitto file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors State ATION REPAIRAND PAINTING RRP
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Th PA 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.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..e a. 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
property who,through employees'or personal effort,builds or improves the D An EPA Lead-Safe Certified Renovator will be responsible for this project
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 pu rpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this 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 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.
a •
`_kMenifee
DATE S - / ./ �PERMIT/PLAN CHECK NUMBER l
TYPE: r' COMMERCIAL yy'RESIDENTIAL 0 MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: C'ADDITION C'.ALTERATION CS DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING )CRE-ROOF-NUMBER OF SQUARES •_ 1
DESCRIPTION OF WORK 44� 0�� .4NbAgplV N F, t/
PROJECTADDRESS L 9 ; f/Q n-t-h J 1.�N)
ASSESSOR'S PARCEL NUMBER /blbg- -0 LOT TRACT d�Ov 1
OWNER NAME �t / {
ADDRESS
0 �1iry / l - 7/\-Ro4 z/�
PHONE `v I (i0'Q" ({77 TJ / EMAIL
APPLICANT NAME tA) BLS O OJ
ADDRESS
PHONE EMAIL /
CONTRACTOR'S NAME OWNER BUILDER? O YES Y110
BUSINESS NAME &O!Cr/w
ADDRESS
PHONE 9J ' EMAIL
CONTRACTOR'S STATE LIC NUMBER y / Q 9 LICENSE CLASSIFICATION
VALUATION$ 13 000 SO FT co L SO FT �dy
APPLICANT'S SIGNATURE DATE b O
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I� SMIP
INVOICE w/�y,�� PAIDAMOUNT
AMOUNT VV• OCASH O'CHECK# <i CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT CASH CCECCK# 0CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES O NO DL NUMBER NOTARIZED LETTER 0 YES0 NO
of ft!e;;�;'_> Building&SajFty Deportment 25714 H'cun Rd. fvlenifee, ''. . :`;E
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