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PMT17-04453
City of Menifee Permit No.: PMT17-04453 29714 HAUN RD. <X-CCII-70 MENIFEE,CA 92586 Type: Residential Re-Roof MENIFEE Date Issued: 1 211 8/2 01 7 PERMIT Site Address: 26540 MEHAFFEY ST, MENIFEE, CA Parcel Number: 335-281-008 92586 Construction Cost: $1.0,000.00 Existing Use: Proposed Use: Description of TEAR OFF 2 LAYERS, REROOF W/OWENS CORNING COOL ROOF IN AMBER Work: CRRC#0890-009 Owner Contractor DAN PUSZERT HOUSETOP ROOFING 26548 MEHAFFEY ST 31760 BRIGGS ROAD MENIFEE,CA 92586 MENIFEE,CA 92584 Applicant Phone: 9516798369 RICH CARROLL License Number:371783 HOUSETOP ROOFING 31760 BRIGGS ROAD MENIFEE, CA 92584 Fee Description QtV 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_Blog_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 perjury that 1 am under provisions of with a licensed contractor(s)pursuant to the Contradors State License Law). Chapter!)(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure under the Contractors5tate License Law for Professions Code and my license is in full force and effect C the following reason: License Class (2 ` 3 f License No. By my signature below I acknowledge that,except for my personal residence Expires Z Signature in which I must have resided forat least one year pdorto completion of WORKER'S COMPENSATION DECLARATION Improvements covered bythis permit.I cannot legallysell a structure that I 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.leeinfo.ca.euv/calaw.html. Policy# Date W16e 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 1 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 l� (�� with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy# ' Expires y enter the above identified property for inspection purposes. (This section need not to be completed is the permit is for one-hundred Date dollars($300)or less PROPERTY OWNER OR AUTHORIZED AGENT �0-certtfy that in the performance of the work for which this permit is issued, Ishallnotemolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# 17yT) 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,Ishall forthwith comply with those provisions. I Will the applicant or future building occupant handle hazardous material or rL �� mixture containing a hazardous material equal to or greater that the -Applicant C! Date amounts specified on the Hazardous Materials Information Guide? WARNING: URE TO SECURE WORKER'S COMPENSATION COVERAGE IS oyesKO UNLAWFUL,AND SHALLSUBJECfAN 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($100,00D),IN occupant require a permit for the construction or margination from South IN SECTION ON TO OF LABOR CODE,INTERTION,DAMADATTOGES AS ROVIDEDS Coast Air Quality Management District(SCAQMD)7 See permitting checklist IN SECIlON 37060E THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelin CONSTRUCTION LENDING AGENCY oYes No 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 PWO 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 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 / construct,alter,improve,demolish or repair any structure,pnorto its Date 2r� issuance,also requires the applicant for the permit to file a signed statement PROPEg WNER OR AUTHORIZED AGENT that he or she is licensed pursuant to the provisions of the Contractors State EPA RE OVATION,REPAIR AND PAINTING IRRPI 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 far a permit subjects the applicant to a civil penalty of not more required practices.This includes rentalproperty than($500). q P owners and property managers who do the paint-disturbing work themselves or through their rs 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.eoa.eov/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 oAn 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. o No EPA Lead-Safe Certified Firm is required for this project because: ❑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 does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP Acknowledgement. PERMIT/PLANUILD MG & SAFETY APPLICATION •Menifee DATE: lZ /e3' PERMIT/PLAN CHECK NUMBER �'O TYPE: O COMMERCIAL 41tSIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PLUMBING `„FRfROOF NUMBER OF SQUARES Zf �A1 DESCRIPTION OF WORK PROJECTADDRESS �f/,.�ry� S/ / 2 ZIP ASSESSOR'S PARCEL NUMBER .aS� V LOT TRACT OWNER NAME ADDRESS PHONE �f/Cy) ��,�,Zlll9 EMAIL APPLICANT NAME ADDRESS 31,2dzoD- PHONE /7// EMAIL h., . ' C•Cr/ CONTRACTOR'S NAME OWNER BUILDER? O YES ONO BUSINESS NAME ADDRESS PHONE EMAIL CONTRACTOR'S STATE LIC NUMBER '/70GG3 LICENSE CLASSIFICATION —� VALUATION$ �U� ©GG SQ FT sZ7 //G L SQ FT APPLICANT'S SIGNATURE DATE I2 JTYSTAFF USE ONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE ACCEPTED BY:---+ PERMIT FEE SMIP r-- GREEN PLAN CHECK FEE INVOICE TOTAL OWNER BUILDER VERIFIED OYES O NO DRIVERS LICENSE# NOTARIZED LETTER 0, YES O NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 925S6 951-672-6777 www.cityofmenifee.us N o nc m rl HD 9 m r^ 4 111 w N N 3 °� N p a m n .�-� n ca m m N a > >• J p d 9 f, m 1D w v a Z = O oe 7 ° O "'� O Q 6 N 1 ' l J O. m J a n SL A ='' nT(� m> c o°. z N o n a m O m r m 1 g '""�n s a T D ~ J On T N O O N OJNO 2 O w m 2 ° O n n J < O j O N m a o 3 r p MN J M N � � S .=i n in w m nn D A n < 'c^ J m w 0 Z 3. 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