PMT17-03135 City of Menifee Permit No.: PMT17-03135
29714 HAUN RD. Type: Residential Re-Roof
ACCELA? MENIFEE,CA 92586
MENIFEE Date Issued: 09/06/2017
PERMIT
Site Address: 23593 LUCAS DR, MENIFEE,CA 92587 Parcel Number: 350-113-010
Construction Cost: $1,500.00
Existing Use: Proposed Use:
Description of REROOF 50 PERCENT-400 SO FT
Work: "CRRC#0668-0004•• ...CODE CASE CE-17-1947•••
Owner Contractor
JOHN BIONDI
23593 LUCAS DRIVE
MENIFEE,CA 92587
Applicant License Number:
JOHN BIONDI
23593 LUCAS DRIVE
MENIFEE, CA 92587
Phone:9512442089
Fee Description ON Amountf$
Building Permit Issuance 1 27.00
Inspections not specified 98 98.00
Administrative Fee 131 130.90
GREEN FEE 1 1.00
General Plan Maintenance Fee-Building 1 4.90
$261.80
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_,Pernil_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 1 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 ptiam exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. (the following reason:
License Class. License No. 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 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
❑1 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 Busi s and Professions Code,is available upon re st when
compensation,issued by the Director of Industrial Relations as provided for thi Iicatio Is ubmitted or at the following website:
by Section 3700 of the Labor Code,for the performance of work for which
this permit is issued: www.l inf c . o c la I tml.
PolicyIf Date 'f J%
ER OW NER OR AUTHORIZED AGENT TI have and will maintain worker's compensatlon Insurance,as required by
section 3700 of the Labor Code,for the performance of the work for which y my signature below I certify to each of the following:I am the property
this permit is issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this
number are: applicZco
information I have provided is correct.I agree to comply
with allity and county ordinances and state laws rela ing to
Carrier in.I authorize representatives of this city or ounPolicy If Expires ente ntif p operty for i 11 ction purpo(This section need not to be completed is the permit is for one-hundred ^Dadollars($100)or less ORIZEDAGENT
o I certify that in the performance of the work for which this permit is Issued,
I shall nat emolov any persons In any manner so as to become subject to the CITY BUSINESS LICENSE If
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
Code,I shall forthwith comply 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 greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO 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($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 farguidelines
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) o Yes ❑No
OWNER BUILDER DECLARATIONS 1 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
California Health al 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 placod next to the applicable item(s)(Section 7031.5
oyes o 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
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)orthat he orshe 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($500). managers who do the paint-disturbing work themselves or through their
a 1,as owner of the property,or my employee with wages as their sole employees.For more Information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure Is www.eoa.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-BOD-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or Improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
❑I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
16 .
Menifee
,111111111.5
DATE ()Cj DGJI20 PERMIT/PLAN CHECK NUMBER- I"I
TYPE: O COMMERCIAL ESIDENTIAL O MULTI-FAMILY O MOBILE HOME O.POOL/SPA OSIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING IR RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK •r CO I 4--j*-
City Of Menifee
u Ing a t.
PROJECTADDRESS rrq [-�,
ASSESSOR'S PARCEL MBER V/U - I 13- O 1] LOT C) TRACT I
OWNER NAME nzngyp'
ADDRESS
PHONE EMAIL
APPLICANT NAME
ADDRESS
PHONE �lJ/`���J EMAIL
CONTRACTOR'S NAME OWNER BUILDER? YES O NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUUry BE LICENSE CLASSIFICATION
VALUATION$ V SO L SQ FFTTT
APPLICANT'S SIGNATURE i DATE-C;;!FffAFUSE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE 1'' _�� PAIDAMOUNT O
AMOUNT - � OCASH CHECK# 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH 0CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO OIL NUMBER NOTARIZED LETTER O YES O NO
City of Mq6tfAjMenifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586951-672-6777
Building & Safety Dept. I, ww.cityofinenifee.usInspection Request Line 951-246-6213
SEP 0 5 2017
Received
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