PMT17-03581 City of Menifee Permit No.: PMT17-03581
29714 HAUN RD.
C/1,CCEL/> MENIFEE,CA 92586 Type: Residential Re-Roof
MENIFEE Date Issued: 10/06/2017
PERMIT
Site Address: 28478 PEBBLE BEACH DR, MENIFEE, Parcel Number: 337-193-010
CA 92586 Construction Cost: $9,500.00
Existing Use: Proposed Use:
Description of TEAR OFF EXISTING GRAVEL ROOF, REROOF W/GAF TIMBERLINE COOL ROOF IN BIRCHWOOD
Work:
Owner Contractor
PATRICIA DAHL LEVEL 1 ROOFING INC
28478 PEBBLE BEACH DR 69 LINCOLN BLVD STE A SUITE
MENIFEE,CA 92586 133
Applicant Phone:9165736933
VERONICA ARANA License Number: 1019789
LEVEL 1 ROOFING INC
69 LINCOLN BLVD STE A SUITE
133
LINCOLN,CA 95648
Fee Description OQt Amount ISI
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_Templatespt 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).
Chapter9(commencing with section 70001 of Division 3 of the Business and ❑I am exempt from Ilcensure under the Contractor's State License Law for
Professions Code and m�yfl i
lcense is In full force and effect. C the following reason:
License Class C 3 / License No. I 0 1 q a X'_Iam, By my signature below I acknowledge that,except for my personal residence
Expires 01,31 /V SignaturegMAXAW 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
D 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 Industdal 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.leginfo.ca.gov/mlaw.html.
-0e9eyN- I AID26_ Date
❑I have 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 worker's compensation insurance carrier and policy owner or authorized to act an the property owner's behalf.I have read this
"nbe ar�e`.:-j.�,p.,, /� J application and the Information I have provided is correct.I agree to comply
4YI wT'C��-tl/t r f LY� with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Expires �Q/�3//7 enter the above Identified property for inspection purposes.
(This section need not to be completed Is the permit is for one-hundred Date 1014,117
dollars($100)or less
PROPERTY OWNER ORA AUTHORIZED AGENT
❑I certify 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 CITY BUSINESS LICENSE#
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 provisions. Will the applicant or future building occupant handle hazardous material or a
pplicant � Date V / 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 o Yes l0
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES WIII 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 use
permit far the construction applicant
modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SC lion or See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES fo Coast
Air
es
CONSTRUCTION LENDING AGENCY D Yes 7o
1 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�la
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
Contractors 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 haGasr�dopusNmaterianlreporting. /Business and Professions Code).Any city or county that requires a permit to yl/ryA VjA 1/� Dater
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER 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 Contractor's 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 apre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to beRAP-certifiedwork
thatdisturbs
firms and comply 978
with
than
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
o I,as owner of the property,or my employee with wages as their sale 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 1-800-424-LEAD(5323).
Code;The Contractor's 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:
❑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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
4- �enifee
DATE: 10/04/2017 PERMIT/PLAN CHECK NUMBER �JJp I
TYPE: O COMMERCIAL X RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA ")SIGN
SUBTYPE: O ADDITION ,O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING 'XRE-ROOF NUMBER OF SQUARES 20
DESCRIPTION OF WORK Removal of existing gravel roof, installing new GAF Timberline HD
Reflector Series shingles Color: Birchwood CRRC ID#0676-0096
PROJECTADDRESS 28478 Pebble Beach Dr � ZIP 92586
�y,?Q/�
ASSESSOR'S PARCEL NUMBER _ � I-1� (�ID LOT \ j TRACT
OWNER NAME Patricia Dahl
ADDRESS 28478 Pebble Beach Dr, Menifee, CA 92586
PHONE 951-237-7617 EMAIL bbydahl@att.net
APPLICANT NAME
ADDRESS
PHONE �pE,M,,AAIL� bbydahl@att.net
CONTRACTOR'S NAME Cesa V uL.a� NER BUILDER? O YES °XNO
BUSINESS NAME Level 1 Roofing, Inc.
ADDRESS 41571 Corning PI#108, Murrieta, CA 92562
PHONE 951-365-5155 EMAIL info@levellroofing.com
CONTRACTOR'S STATE LIC NUMBER 1019789 LICENSE CLASSIFICATION C39
VALUATION $ 9,500.00 SQ FT 2,000 L SQ FT
APPLICANT'S SIGNATURE DATE
10/04/2017
DEPARTMENT DISTRIBUTION �,,_ / CITY OF MENIFEE BUSINESS LICENSE NUMBER
BURRING PLANNING ENGINEERING FIRE ACCEPTED BY: >1
PERMIT FEE l� ,�Q SMIP GREEN
PLAN CHECK FEE INVOICE TOTAL 1 - .9 !—
OWNER BUILDER VERIFIED O YES 0 NO DRIVERS LICENSE# NOTARIZED LETTER +O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifeE,.us
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