PMT17-04072 City of Menifee Permit No.: PMT17-04072
29714 HAUN RD. Type: Residential Re-Roof
<A_CCEL/_> MENIFEE,CA 92586
MENIFEE Date Issued:
11114120117
PERMIT
Site Address: 27182 RIO VISTA DR, MENIFEE,CA Parcel Number: 336-290-002
92586 Construction Cost: $11,600.00
Existing Use: Proposed Use:
Description of TILE ROOF PREVIOUSLY REMOVED BY OTHERS, REROOF WITILE#2605 AND NEW FELT PAPER
Work:
Owner Contractor
ELIZABETH JONES BLAKE ROOFING INC
27182 RIO VISTA DR 180 VANDER STREET UNIT C
MENIFEE, CA 92586 CORONA,CA 92880
Applicant Phone:9513402600
BLAKE HARRISON License Number. 972683
BLAKE ROOFING INC
180 VANDER STREET UNIT C
CORONA,CA 92880
Fee Description OQt rr Amount(SI
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 carded 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_B1dg_Perm1l_Temp1ate.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 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 ❑I am exempt from Rcensure under the Contractors State License Law for
Professions Cade and my license is In full force and effect.. / the following reason:
License Class 3 9 License No.
C/ 7 Z b C id 3 By my signature below l acknowledge that,except for my personal residence
Expires Signature AtA! ( JCL,, 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
p 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 wvvw.leKInfo.ca.goy/caIaw.html.
html.
this permit is issued.
Policy# Date
O I have and will maintain workers compensaton 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 1 certify to each of the following:I am the property
this permit is issued.My workers compensation Insurance carder and policy owner or authorized to act on the property owners behalf.I have read this
number are: T 1 1 application and the information I have provided is correct.I agree to comply
Carrier J+4 t'-- rr�^ with all applicable city and county ordinances and state laws relating to
- / building construction.I authorize representatives of this city or county to
Policy# r 2-G 9 2 'o Expires �/ Z 3 j 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
D 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 11
workers compensation laws of California,and agree that If 1 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
Applicant �l JcLr1 Date �� �Lj 7 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 15 D Yes IpNo
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 mpolfication from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES
T, A AND ATT D ATT ORNE PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
YS FEES forguidelines
IN SECTION 37060E THE LABOR CODE,INTEREST,
CONSTRUCTION LENDING AGENCY o Yes JTlo
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 r}rNo
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 reasons)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 hazardous material reporting.
Business and Professions Code).Any city or county that requires a permit to oYes 4t n p® 7 J� Date r
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)
Ucense 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 Ilcensure 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
O 1,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.epa.gov/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:
01,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.
I
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE: // /`I /7 PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL VRESIDENTIAL 0 MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEEW O PLUMBING 0 RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK R c roo F
PROJECTADDRESS Z, 1 B�y� Clio V+S/I}-��+ Qo'- 1,4 G1 ZIP
ASSESSOR'S PARCEL NUMBER /\� ��� 'o`�O'er LOT _ TRACTD J
OWNER NAMEJi SS Totncs 'ZLc-
ADDRESS 5a Qs 4�io.1�
PHONE O11rj EMAIL
APPLICANT NAME
ADDRESS
PHONE rrEMAIL
CONTRACTOR'S NAME C q k'c coorl� i'L/ C-
: ' OWNER BUILDER? O YES 'ENO
1
BUSINESS NAME !q Are- koc/ /n 'L Yv C 1
ADDRESS AVE crcc)
PHONE q T 1- 526- �1 `133 EMAIL
CONTRACTOR'S STATE LIIC NUMBER c 0 Z 60 LICENSE CLASSIFICATION C 3 7
VALUATION$ l I, G Gha SQJ FT Z Y GU L SQ FT ^/
APPLICANT'S SIGNATURE DATE /I /y / 1
CITYSTAFF.USEONL_Y in
DEPARTMENT DISTRIBUTION CITY CmiIN, $IBC{ SE NUMBER
ACCEPTED BY: f(CV/// II L1{-
BUILDING PLANNING ENGINEERING FIRE
PERMIT FEE I , 9 • SMIP GREEN I
PLAN CHECK FEE I INVOICE TOTAL I;�7V ."')O
OWNER BUILDER VERIFIED J YES 0 NO DRIVERS LICENSE# NOTARIZED LETTER 0 YES O NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityo finenifee.us
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