PMT17-04286 City of Menifee Permit No.: PMT17-04286
29714 HAUN RD. Type: Residential Re-Roof
<ACCELA— MENIFEE, CA 92586
sxr...r MENIFEE Date Issued
12/0412017
PERMIT
Site Address: 25801 LANCASTER DR, MENIFEE, CA Parcel Number: 335-092-004
92584 Construction Cost: $8,000.00
Existing Use: Proposed Use:
Description of TEAR OFF EXISTING ROOF, RE-ROOF W/SOLARIS CERTAINTEED COOL ROOF IN RESAWN
Work: SHAKE
CRRC#0668-0118
Owner Contractor
DAN DAGOSTINO AUS ROOFING
25801 LANCASTER DR 20690 OLD ELSINORE ROAD
MENIFEE,CA 92586 PERRIS, CA 92570
Applicant Phone:9512295783
AL GRAY License Number:716337
AUS ROOFING
20690 OLD ELSINORE ROAD
PERRIS, CA 92570
Fee Description (t Amount fSl
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 othenAse slated,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_Permil 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 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 licensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. 7 the following reason:
License Class �� License No. /6 3 X -/
By my signature below I acknowledge that,except for my personal residence
ExpiresSignature in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I
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 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.leeinfo.ca.eov/calaw.html.
Policy# Date
rave 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 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 with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# Ilo 7 clf7 Expires enter the above identified property for Inspection purposes.
(This section need not to be completed is the permi( is far one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED A!G�E,�NT,,�y��
❑1 certify that in the performance of the work for which this permit is issued, yiJ K 75
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# y
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 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:FAIL ETO SECURE WORKER'S COMPENSATION COV RAGE IS ❑Yes oNo
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 Alt Quality Management District(SC tion or See permitting anonro checklist
IN SECTION 37060E THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidellnes�
CONSTRUCTION LENDING AGENCY o Yes `_f�,•,!
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 bounda of a school?
(Section 3097 Civil Code) O Yes
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that 1 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 reporting.
checkmark(s)I have placed next to the applicable Item(s)(Section 7031.5 oyes
Business and Professions Code).Any city or
repair
county that requires a permit to Date
construct,also
after,Improve,demolish of repair any structure,signets its PROPERTY OWNER 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 RENOVATI .REPAIR AND PAINTING fRRPI
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
o 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( I all of or( )portion of the work,and the structure is www.eoa.esv/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).
Cade;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 said 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:
D 1,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 dues not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
DATE: t<� (� PERMIT/PLAN CHECK NUMBER I
TYPE: O COMMERCIAL *"RESIDENTIAL 0 MULTI-FAMILY O MOBILE HOME C POOL/SPA CSIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL ECHANICAL
O NEWQ O PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK snlai E
2 �n�l-eed 3awn*s
PROJECTADDRESS _ aS�6/y'� LSsi! CS SG/•' �/- ZIP
,J ASSESSOR'S PARCEL NUMBER 55- a_0"ML� LOT TRACT
OWNER NAME q /
ADDRESS '2 o 1
PHONE 1-7(<(-24e - 7C-C EMAIL
APPLICANT NAME o4f G
ADDRESS Zd (�50 cwd e�rr-T� Cp P 7
PHONE 517- 2-0 2 S? P� EMAIL t �J OCa�fy of G <Co
CONTRACTOR'S NAME so < •-� C� i'T OWNER BUILDER? O YES ONO
BUSINESS NAME d L/f eo ( t
ADDRESS Zo(.. o ot.4 %fho -n 9zf 2 O
PHONE 95-1-2zS -s7? T EMAIL of dC�
CONTRACTOR'S STATE LIC NUMBER 716 337 LICENSE CLASSIFICATION C`
VALUATION$ Arco a SO FT 2r SP L SQ FT
APPLICANT'S SIGNATURE DATE 16 l
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION 'C/ CITY 06ENI_FEE BU��S LICENSE NUMBER
ACCEPTED 6 ��:bg
BUILDING PLANNING ENGINEERING FIRE
LV-
PERMIT FEE �' , 1 o SMIP GREEN I
PLAN CHECK FEE INVOICE TOTAL �® ,'1
OWNER BUILDER VERIFIED 0 YES 0 NO DRIVERS LICENSE# NOTARIZED LETTER C YES NO
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