PMT17-03717 City of Menifee Permit No.: PMT17-03717
29714 HAUN RD.
�/tCCEL/� MENIFEE, CA 92586 Type: Residential Re-Roof
MENIFEE Date Issued: 1 011 612 01 7
PERMIT
Site Address: 26070 PINE VALLEY RD, MENIFEE, CA Parcel Number: 337-021-029
92586 Construction Cost: $14,625.00
Existing Use: Proposed Use:
Description of REMOVE ALL EXISTING ROOFING LAYERS, INSTALL NEW COOL ROOF SHINGLES
Work: '•CRRC#0890-0009
Owner Contractor
ROBERT YOUNG T&R ROOFING CO INC
26070 PINE VALLEY ROAD P O BOX 747
MENIFEE, CA 92586 TEMECULA, CA 92593
Applicant Phone:9513959717
ROBERT PATTENBACK License Number. 939038
T&R ROOFING CO INC
P O BOX 747
TEMECULA, CA 92593
Fee Description 9-ty Amount($1
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_Bidg_Permit_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 contractors)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 Iicensure underthe Contractor's State License Law for
Professions Code and my license is in(full force and effect. �^ the following reason:
License Cla !)"� / License N 03/ By my signature below I acknowledge that,except for my personal residence
Expires D / 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
❑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 www leginfo_ca.xov/calaw.html.
this permit is issued. ---
Policy# Date
PROPERTY OWNER OR AUTHORIZED AGENT
❑I 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 ❑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 owners behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
Carrier UKF� J� ` S C..O with all applicable cityand county ordinances and state laws relatingto
building construction.I authorize representatives of this city or county to
Policy# C'l-7 xpires /_Z 6 4 / 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 certify 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#
worker's compensation laws of California,and agree that if I.should became HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code;I shallll f�h. r Dale sions. // Will the applicant or future building occupant handle hazardous material or a
Applicant `� /6 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($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 ❑No
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
California Health&Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reasons)indicated below by the hazardous material re orting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oyes u / -7
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 PRUPERTY 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 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)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($500). managers who do the paint-disturbing work themselves or through their
❑I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www_epagovflead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will he responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
❑1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
DATE: lo PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA ',;SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW 0- PLUMBING 0 RE-ROOF NUMBER OF SQUARES
DESCRIPTION OA�FF"WORK /af Pjc.(�n Q
PROJECT ADDRESS 11) ;Ple Vdit /G4l ZIP � ity of Menife
ASSESSOR'S PARCEL NUMBER 433'�'I . (�\_.�'� "lluin9 flty opt.LOT TRACT �yy
OWNER NAME dl/ XT 6 CQ
ADDRESS / �� f�/t C/ Cd ,�Zj�'$�'
PHONE tJ -02 _f 9 EMAIL •�
APPLICANT NAMES/��
ADDRESS,e2e , 46a/J, , 01. L ,'� f C^ V5-,,521
PHONE 9J/—,67��,J �I EMAIL
CONTRACTOR'S NAME OWNER BUILDER? 0)YES I NO
BUSINESS NAME 'e 'U-e
ADDRESS a
PHONE ���S y�n / / EMAIL
CONTRACTOR'S STATE LIC NUMBER 9. 6 3% LICENSE CLASSIFICATION B C
VALUATION $ I �� Q FT �.-t�C/ L SQ FT
APPLICANT'S SIGNATURE DATE 16A
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
p�
BUILDING PLANNING ENGINEERING FIRE ACCEPTED BY: l
PERMIT FEE SMIP )r GREEN
PLAN CHECK FEE I INVOICE TOTAL
OWNER BUILDER VERIFIED 0 YES 0 NO DRIVERS LICENSE## NOTARIZED LETTER 0 YES 0 NO
v r z
m' O n' o O? A 3 a? m C) umi A n m
2 3 ' °• v� c °, umi 3 r3o 00 m g C! n RI n 1 r Of) m
x o O C m .°e m N w n Y m j < o N A r v D
V O S O 3 8 < O y D W O N O V m A A .. D Q Z
m a n v < 5 r rm b .-1 m0
0 o o mZ 1p m
e
$3 x ° Vo ❑
°o 0 Onrn A`gy$mo.
r
N OO O mm
N � 159 ° � pm
�
x
D Z M
m.
o o m " N mm m Omm r'`YfJ
D-
m
dwdoA az � CO)
omi o r N o a 3 3 o ELn N o O c $ n Q O ��n
m T 3 m m ? n a ' 0
w o m 3 0 o N a g 00 0 » 7
�+ m NN m 1 T �' 0 m n m = a n m e < A G)
^. n v mx m m C 7 ry 0 O m .�
b- n mm j 0 w 0 N 9 3 a N W
O
o
0, o O o
w Sr o m f F w c 2 a b> 'm O
O- �+ 7 N S n 6 0 3 m A m N m
O m m °
.� o ao n m w D m m � m x y w m v
y N d v m 3 0 �• „ 3 -
d O O n O1 N m ° m
ry N O M ON m 3 + M
C1 n F+ W O O O O ,
O 3 A
m A m
N M F' D O S
N m n ° 0 0 0 Z x
P m w n m
_3• o' n < n m a F
N 09 3 m J P m m
'm �
°
m 3 _°o 'm p, p°p °
w O O C < ° 0 y y 0
m « n a N m "O" m noS,
m m 0 3 y m a s 'm
-a
F c m 3 m d w c m w w a m m
S O j O A
g � w », g , fie
? m n H w
o m ^ 5 f1
x o
p c m d n m A T
n 'm m `$L 'm o o mow r
c -
ry a N ~ D
H F n C O
n A
m n
P m N 10 m j M m
m x "' o ry W o 3 3 m
30
o � n
w
0 S C S
a, x 3 a Q
TO ;, __ : vm '» N °' � O Z o o "� m m o
0 m N N 2
`m a
U
LL O `a aeao w Y
c E
O b m Y N a
a s E
>' m t U>> w {
W Z Q 3 m E
ei a a y v a
4
Q a
Cc w V d O N \
V Ct
1~L V m n # N U O
U a m E A « a
N �
°
p iY c s
q U U O C
� ° u
J U p U U d
— j d v C C a
�
E W y 0 O O O « O E m m � o o v
0 'moo i s J a
0 015
� m m u m N
o N 3.
0
a o
g y o > a m m a
E �
J d y V
v
` 3 p 3 ai
3 o Y w c m E o a = « m o 0 m
n u a O
¢ o o u E u u w o. o
2 a"i ` o ri m n u w o m
u N
U m 0 u cca ti a m a
C N m "O N ¢ u ii O
° m a ¢ m o ° o
a w J ° w y ¢ 'u. a m ,'may u o0
d 6 VO = m O. w m V O q C .+
m
O �w„ 1O C v 0 m •� W N
. o o n vm
0V
a o
W c ° Em ; x v
N m a° 'i0 9 T a y p m o -oO p p C ro
U p U m mC
c Y Z v w a m w
v ¢o
u p n «
w o o N 5 c a « c a
w
a 3 ° m pN w m
o00 ° ° i0 .• a c
c
c c a a o 2' a c u o m Y, m t 'u c E c 0
u ° ° a a w 3 N Q 'a n a ° u w v ° ❑ v
it s w a m a 0 Y, ,n o « c - > v n 0 N c o
> L a n o N ° ¢ z o > wt a
c m h a i E c o o a o '� m a -o y m -° `� a w
co v E m ° m = n 'L" N 3 iv o « m ° w Jc f E in
m m y o N '° c o 'w m m °a `a rav c m v a E f o < m
m m o c }`a• o w 'd^ -3 u "-' « 'L" « Y� 1O w N m \/ w
m
N L t c c n m E um « a > E .� « a m c 'N « O w
O o ¢° z s x ° 4c-. m y c c v c o E A `m w a a y ¢ n { I m
W i Y a ° o o Y, Y, c N o a 0 g E E c g o v c
Z y v c• m i E ¢p .. a a c m e `m a E " S E
o y c m
J Q 0 z 'M o o ai ¢ Ym, a E w ¢ f ° : E N w
cO. A G « � = o m m m W o v v a m ` O
L C 't rj a N 'N N w u N d d w C = d C°
Ql L z rn
a [[Vyy�� J
W C Z +'• t+i w 0 w L u°i d d d > > > W O FF 4 (Y O
Q > d C 9 jp 6 d 6 C Y a n d C A C �VV C
w y N
•� m
F N o .4 ri m ~O t u E E v` m
W ` v ui �c n ro of .+ •+ •� •� Z C • Z U Q U u
U O.