PMT17-04021 City of Menifee Permit No.: PMT17-04021
29714 HAUN RD. Type: Residential Re-Roof
-1 CCEL/t7i. MENIFEE, CA 92586
G°",$A.' MENIFEE Date Issued: 11/08/2017
PERMIT
Site Address: 26843 RANCHO SERENA ST,MENIFEE, Parcel Number: 360-512-008
CA 92584 Construction Cost: $4,500.00
Existing Use: Proposed Use:
Description of REPAIRS TO ROOF DECK, REPLACE PAER AND REPLACE WITH EXISTING TILES.
Work:
Owner Contractor
MARTHA VILLARRUEL
26843 RANCHO SERENA ST
MENIFEE, CA 92584
Applicant License Number:
MARTHA VILLARRUEL
26843 RANCHO SERENA ST •
MENIFEE,CA 92584
Phone:9516236481
Fee Description Qty Amount 1$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_Bldg_Pennit_Terrplate.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 am 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 seff-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 fall wing website:
by Section 3700 of the Labor Code,for the performance of work for which
this permit Is Issued. �www.ieginfo.ca.gov//calaw.html.
Policy ff JA Date
o 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 ❑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 correct.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 If Expires enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred
dollars($100)or less Date
PROPERTY OWNER OR AUTHORIZED AGENT
o I certify that in the performance of the work for which this permit is Issued,
shall not 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 became HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,1 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 VVes ❑No
UNLAWFUL,AND SHALLSUBIECTAN EMPLOYERTO CRIMINAL PENALTIES Will the intended use ofthe building bythe applicant orfuture 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)7 See permitting checklist
IN SECTION.3706 OF THE LABOR COBE,JNTEREST,AND ATTORNEYS FEES forguidel�in�ens r - - ---- -
CONSTRUCTION LENDING AGENCY ❑Yes 1
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 boun ary of a school?
(Section 3097 Civil Code) ❑Yes o _
46 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 reason(s)indicated below by the hazardous material reparti g.
checkmark(s)I have placed next to the applicable items)(Section 7031.5 s ❑N o _
Business and Professions Code).Any city or county that requires a permit to
construct,alter,improve,demolish or repair any structure,prior to its PROPEPbWNER 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 IRRP1
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.S 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 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.goy/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 ❑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: I • K PERMIT/PLAN CHECK NUMBER I
TYPE: O COMMERCIAL ESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW
, {-0 PLUMBING E-ROOF NUMBER
�OF„SQUARES a �-� O
ry\
DESCRIPTION OF WORK " C1 e I I v {�C�� D e�k
ahri o a ozl lw o� ?, � 5 ` � cs
(0PROJECTADDRESS oZ b`'� ' a nCA(llo Se('e 0CLZIP q D� Sp 171
ASSESSOR'S PARCEL NUMBER 3(Qb •ba•C)`�' VLOT 01e} TRACT
OWNER NAME K ( Gl VJ( q ( V e
ADDRESS -:� (0 6 -L 3 0 S e 2( 0 ct
1,,
PHONE GS I- 6� 3- EMAIL lj Cj K { I G V Q Y 1O+r-na I k C76
APPLICANT NAME V + I la r Y ute-/ - 1
ADDRESS a b W 3 (/p jG ftLh� e Ie rl a` r ,_ 5�r (�} jC,, ) a 9 S/y
PHONE q s 1- b 23 Z O ( EMAIL
CONTRACTOR'S NAME OWNER BUILDER? - ES ONO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER �7 LICENSE CLASSIFICATION
VALUATION$ SO FT L SO FT
APPLICANT'S SIGNATUREL.1DATE -(
CITY.STAFF USE ONLY 1
DEPARTMENT DISTRIBUTION CITY OF M TEE BUSINESS LICENSE NUMBER
BUILDING PLANNING NGINEERING FIRE ACCEPTED BY:
PERMIT FEE 3-0, CtD I SMIP GREEN
PLAN CHECK FEE INVOICE TOTAL
OWNER BUILDER VERIFIED C YES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
City of Menifee Building& Safety Deportment 29714 Houn Rd, Menifee, CA 92585 Ayllo g Dept.
www.cityofinenifee.us NOV 0 8 201/
Received
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