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PMT17-03966 City of Menifee Permit No.: PMT17-03966 29714 HAUN RD. T Residential Re-Roof �A_CCELAk�. MENIFEE, CA 92586 Type: MENIFEE Date Issued: 1 110 312 01 7 PERMIT Site Address: 25284 BARNES LN, MENIFEE, CA 92584 Parcel Number: 362-430-005 Construction Cost: $2,500.00 Existing Use: Proposed Use: Description of REMOVE AND REPLACE EXISTING ROOF WITH COOL ROOF SHINGLES. Work: OWENS CORNING CRRC:0890-0005 COLOR:COOL SHINGLES FROSTED OAK-TAN Owner Contractor DONALD WOHLT 20450 VIA BURGOS Applicant License Number: CA Fee Description Qtv Amountfs) 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 I hereby affirm under penalty of perjurythat I am under provisions of with a licensed contractors)pursuant to the Contractors State License Law). Chapter9(Commencing with section 7000)of Division 3 of the Business and o I am exempt from licensu_rre under Contractors State License Law for Professions Code and my license is in full force and effect. the following reason: (i ( > ^ /7 License Class License No. By my signature below 1 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 bythis 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 o 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 workers 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.Ieeinfo.ca.gGv/caIaw.htmI. Policyq UY Date —vL ❑I have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT section 3700 of the Labor Code,for the performance of the work for which o 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 an the property owners behalf.I have read this number are: application and the information I have provided is comecL 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 county to Policy p 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 certify that in the performance of the work forwhich this permit is Issued, I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE p 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 haneerthatthe ous material or a mixture containing a hazardous material equa a Applicant Dale amounts specified on the Hazardous Matea(q n C�p�e7 WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes f�No G� �� UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN Will the intended use of the building st th ppllca t Mature bull di ADDITION TOTHE COST OF COMPENSATION,DAMAGESAS PROVIDED FOR occupant requlreapermit for the construction ifica[ion IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQM See permitUX cklist -- - - for guidelines- CONSTRUCTION LENDING AGENCY o Yes %,No A�J I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be 00 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) XYes ❑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 Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning hazardous material reporting. checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 �es ❑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 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 Business and Professions Code)or that he or she is exempt from licensure The EPA Renovation,Repair and Painting(RRP)Rule requires contractors and the basis for the alleged exemption.Any violation of Section 7031.5 by receiving compensation for most work that disturbs paint in a ply w78 an Applicant for a perm it subjects the applicant to a civil penalty of not more residence ra childcare facility a be RRP-certified firms and comply with than($500). required practices.This includes rental property owners and property managers who do the paint-disturbing work themselves or through their ❑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.eopa.eov/lead/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 o 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. DATE: PERMIT/PLAN CHECK NUMBERPIM_1_ 301 V/ ( TYPE: O COMMERCIAL RESIDENTIAL C MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW OO PLUMBING A RE-ROOF NUMBER OF SQUARES DESCRIPTION OF WORK � 8S Gqyq �58 PROJECTADDRESS >^� 1 , lrs L ZIP pe- ASSESSOR'S PARCEL NUMBER 3�a DO OT I TRACT OWNERNAME .r/�JGf�p�ALlj ADDRESS a.17 f d b PHONE `J�pZt(� "�y5 Zl �,�) EMAIL q%iJo2 c.'�/ �'�/ APPLICANT NAME �� ES F/" �°'//D�// _: t�A`L•No MGI'I'mo ADDRESS s/ ,Jv (�//'�2 �G(9� j sG'//f�f�T u/T�A1• CA- PHONE !� 7 QC��I�"� /Cy� rJGEMAIL1� /�. ��m y`1'• lIri/�l'G • y CONTRACTOR'S NAME `i(`O`G�(V1 UrK \ _ t un C E"�t\ t O NER BU DER? 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PRINT EXPORT ALL PRODUCTS CRRCPROD.ID MANUFACTURE"UND eRODUCTTYPE COLOR SOLAR REFLECTANCE TNERMALEMTTTANCE 5111 MORE MODEL INFO Initial 3Year Weal 3Yaar Initial 3year 0890-0005 Owens Coming Roofing and Asphalt, Steep Slope:Asphalt Tan 0.28 0-28 0.89 0.93 29 30 + LLO Duration(l)Premium Shingles Cool Shingles Frosted Oak as COOL ROOF RATING COUNCIL 449 i5th Street,Suite 40o TEL(866)465-2523 EMAIL:[nfo@coolroofs.org Wn Oakland,CA 94612 FAK(Slo)g8xgqx3 CeYl0are 3Mfi.alICY fte Bu tr�/�IY�1er1�NO- Nov 0 3 2017 Received http://coolroofs.org/products/results/search&keywords=oakridge/ 11/3/2017 Mail -pwinters@cityofinenifeems Page 1 of 2 Authorization Donald Wohlt <djwohlt@hotmail.com> Fri 11/3/2017 1:57 PM To:Paradise Winters <pwinters@cityofinenifee.us>; This will verify that I am the owner of the property located at 25285 Barnes Ln., Menifee Ignacio Montano is my agent and is applying for necessary permits from the City of Menifee, for remodeling at my property. If you have any further questions, please feel free to contact me James A Wohlt 20450 Via Burgos Yorba Linda, Ca 92887 714 264-8253 City of Menifee Building Dept. NOV U 3 20417 Received https://outlook.office.com/owa/?realm=cityofinenifee.us&exsvurl=l&ll-cc=1033&modurl=0&pat... 11/3/2017 Mail-pwinters@cityofinenifee.us Page 2 of 2 CALIFORNIA DRIVER LICENSE nL N33417.60 r f:LAJS C F-rp 05/20/2022 ENE) NONE r L`I WOHLT JAMES ALLEN r 20460 VIA BURGOS YORBA LINDA, CA 92887 ooB 05120/1957 RSTR NONE f 006+ 201957 SEX M HAIR BRN' EYES GRN HGT 6--W WGT 340 lb _. .ISs i ' E)E)05AW01764231MCF0122 0lj116l201T Sent from my Whone City of Menifee Building Dept NUV U 3 2017 (Received https:Houtlook.office.com/owa/?realm=cityofinenifee.us&exsvurl=l&ll-cc=1033&modurl=0&pat... 11/3/2017