PMT17-04374 City of Menifee Permit No.: PMT17-04374
29714 HAUN RD. Type: Residential Re-Roof
<ACCELA-�. MENIFEE, CA 92586
MENIFEE Date Issued: 12/11/2017
PERMIT
Site Address: 26230 BURLINGTON WAY,MENIFEE, CA Parcel Number: 337-112-020
92586 Construction Cost: $10,350.00
Existing Use: Proposed Use:
Description of TEAR OFF AND REPLACE WITH NEW COOL ROOF SHINGLES.
Work:
CRRC:0890-0009
OWENS CORNING-AMBER
Owner Contractor
MARK SLEEKER BAKER ROOFING CORPORATION
26230 BURLINGTON WAY 29515 DUNKIRK STREET
MENIFEE,CA 92586 MENIFEE,CA 92586
Applicant Phone:9512557237
BAKER ROOFING CORPORATION License Number:884731
29515 DUNKIRK STREET
MENIFEE, CA 92586
Phone:9512557237
Fee Description Qty Amount r81
Building Permit Issuance 1 27.00
Inspections not speed 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 Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ 1 am exempt from licensure under the Contractors State License Law for the
I hereby affirm under penalty or perjury that I am licensed under provisions of following reason:
Chapter 9(commencing With section 7000)of Division 3 of the Business and By my signature below I acknowledge that,except for my personal residence in
Professions Code and my license is in full force and effect. which I must have resided for at least one year prior to completion of
License Class Zq License o. '. kF!1 r7<31 improvements covered by this permit, I cannot legally sell a structure that 1 have
Expires Signature 4- built as an owner-building if it has not been constructed in its entirety by licensed
contractors. I understand that a copy of the applicable law,Section 7044 of the
WORKERS'COMPENSATION DECLARATION Business and Professions Cade,is available upon request when-this application is
submitted or at the following Web site:
❑ I hereby will under penalty of perjury one t the following for workers: htto•J/w .lecinfD.ca.cov/calaw html.
I have and will maintain a certificate of consent of self-insure for workers'
compensation,issued by the Director of Industrial Relations as provided for by Dale
Section 3700 of the Labor Code, for the performance of work for which this
permit is issued. Property Owner or Authorized Agent
^^^P...olliicy# ❑ By my Signature below, I certify to each of the following: I am the property
Ly I have and will maintain workers' compensation insurance, as required by owner or authorized to act an the property owner's behalf. I have read this
,section 3700 of the Labor Code, for the performance of the work for which this application and the information I have provided is correct. I agree to comply
permit Is issued.My workers'compensation insurance carder and policy number are: with all applicable city and county ordinances and scale laws relating to building
construction.I authorize representatives of this city of county to enter the above-
Carrier //�� "r��- •�a� t identified property for the inspection purposes. ..
Policy#(O TS�� l'[ Expires ` �" j Dale
Property Owner or Authorized Agent
(This section need not be completed if the permit is for City Business License#
one-hundred dollars(5100)or less) y
❑ I certify that In the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not emulov any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or a
workers'compensation laws of California, and agree that if I should become mixture containing a hazardous material equal to or greater that the
subject to the workers compensation provisions of Section 3700 of the Labor amounts specified on the Hazardous Materials Information Guide?
Code,I shall forthwith comply with those provisions. DYES )ONO
Applicant,.-2-6r—lpl Date; Will the Intended use of the building by the applicant or future building
occupant require a permit for the construction or modification from South
WARNING: FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES (eOb
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be vdlhin 1000 feet of the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES�I�NO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAQMD
-I hereby affirm that under the penally of perjury there is a construction lending permitting checklist.I understand my requirements under the State of
agency for the performance of the work which this permit is issued (Section California Health R Safety Cade,Section 25505 and 25534 concerning
3097 Civil Code) hazard0usinaterial reporting.
OWNER BUILDER DECLARATIONS ❑YESO'�
I hereby affirm under penalty of perjury that I am exempt from the Contractor's o Date
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OWNER OR AUTHORIZED AGENT
next to the applicable item(s)(Section 7031.5.Business and Professions Code:
Any city or county that requires a permit to construct, alter, improve,demolish, EPA RENOVATION,REPAIR AND PAINTING fRRP1
or repair any structure,prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
provisions of the Contractor's State License Law(Chapter 9(commencing%vilh receiving compensation for most work that disturbs paint in a pre-1978
Section 7000)of Division 3 of the Business and Professions Code)or that he or residence or childcare facility to be RRP-certified firms and comply with
she Is exempt from licensure and the basis for the alleged exemption. Any required practices.This includes rental properly owners and property
violation of Section 7031.5 by any Applicant for a permit subjects(he applicant to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than(S500).) employees.For more information about EPA's Renovation Program visit:
❑ I, as owner of the property, or my employees with wages as their sole www.epa.goWlead or contact the National Lead Information Center at
1-800-424-LEAD(5323).
compensation,will do( )all of or( )porting of the work, and the structure is
not intended or offered for sale.(Section 7044,Business and Professions Cade,
The Contractor's State License Law does not apply to an owner of a property ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
who, through employees' or personal effort, builds or improves the property,
provided that the Improvements are not intended or offered for sale.If,however, Certified Firm Name:
the building or imprgvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the purpose of sale). Firm Certification No.:
❑ I, as owner of the property an exclusively contracting with licensed No EPA Lead-Safe Certified Firm is required for this project because:
contractors to construct the project(Section 7044, Business and Professions
Code:The Contractor's License Law does not apply to an owner of a property
who builds or improves thereon, and who contracts for the projects with a
licensed contractor(s)pursuant to the Contractors State License Lawl. If vour omiert does not rmmnly with FPA RRP ndp nlaaap mi n,n n.p RRP
APPLICATIONI LBUI:LDING & SAFETY PERMIT/PLAN CHECK
Menifee
DATE ' — j —/ 7 PERMIT/PLAN CHECK NUMBER I _
TYPE: ❑COMMERCIAL ®RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOUSPA ❑SIGN
SUBTYPE: []ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL El MECHANICAL
❑NEW ❑PLUMBING [9RE-ROOF-NUMIBEROF SQUARES
aZ
DESCRIPTION OF WORK�(� [�j ( . Yl L 4l e,5 S1 Cti 1 +
,A1c >
PROJECTADDRESS o� L�J a aj�rl-tI`
J%A "/D n L�CI k.
ASSESSOR'S PARCEL NUMBER 33-] 'I I a • CQU LOT TRACT
PROPERTY OWNER'S NAME �01/1 r`F`(G' l /�
ADDRESS :. 6 a 6 YJ u ( /�V1 Y-a M W�
PHONE//Ij�'l j -7 i-f(p -_26 -pj EMAIL
APPLICANT NAME (rl rf j�
ADDRESS S L C-t.v1 l� .I
PHONE q-51 - 0?55 7 Q EMAIL r Cd
i
CONTRACTOR'S NAME C4 LAV,en e--e- a,L4 OWNERBUILDER? ❑YESNO
BUSINESS NAME oC b
ADDRESS I cA1
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PHONE 1 51^ 55-M3I ! EMAILP,
O6 e
l L
CONTRACTOR'S STATE LIC NUMBER C. � q �1 9 ( LICENSE CLASSIFICATION
VALUATION$ f e) 3 S0 SQ FT �r/Yy-T J L SQ Fi
APPLICANT'S SIGNATURE DATE i �- // f 7
CITYSTAFFUSEONLY
DEPARTMEM DISTRIBUTION v CITY OF fIpENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I' SMIP
INVOICE PC I
AMOUNT PAID AMOUNT C CASH ^CHECK# CCREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0 CASH C.CHECK# O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES C NO DL NUMBER NOTARIZED LETTER 0 aWbMenifeRf
130dinn Dent
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee,CA 92586 951-6
www.cityofinenifee.us Inspection Request Line 951-246-6213 7NZ0I`
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