PMT18-00019 City of Menifee Permit No.: PMT18-00019
29714 HAUN RD.
<A_CCEL/_> MENIFEE, CA 92586 Type: Residential Re-Roof
MENIFEE Date Issued: 01/03/2018
PERMIT
Site Address: 29266 CARMEL RD, MENIFEE, CA 92586 Parcel Number: 338-071-002
Construction Cost: $8,100.00
Existing Use: Proposed Use:
Description of RE-ROOF, REMOVE EXISTING COMP TO THE ROOF DECK AND REPLACE WITH OWENS
Work: CORNING SHASTA WHITE COMP CRRC#0890-0013
Owner Contractor
MYRA DE LA TORRE A T S CONSTRUCTION
29266 CARMEL RD 6154 BALTIMORE DR
LA MESA, CA 91942
Applicant Phone:6197417397
THOMAS EGGERT License Number: 905583
A T S CONSTRUCTION
6154 BALTIMORE DR
LA MESA, CA 91942
Fee Description ,city Amount 1$1
Building Permit Issuance 1 27.00
Inspections not specified 96 96.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 2.00
General Plan Maintenance Fee-Building 1 4.80
$130.80
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_Bldg_Permk_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 Contractor's State License Law for
Professions Code(�7�p "Id my license is in full force and effect. the following reason:
License Class V License)-, re 3 By my signature below I acknowledge that,except for my personal residence
Expires ID� 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
Thereby 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 �y�v�v-leginfo.ca.gov/calaw.htmi.permit is issued.
Policy n Date
❑I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which c By my signature below I certifyto each of the following:I am the property
this permit is issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
Carrier with all appy ble city and unty ordinances and state laws relating to
building co u- n.l hbrize representatives of this city or county to
PolityN Expires enter the i 'ied propert/yy for inspection purposes.
(This section need not to be completed is the permit is for one-hundred ✓` Date �B
dollars($100)or less PROPER WNER OR HORIZEDAGENT
ceNfy 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 became subject to the CITY BUSINESS LICENSE k
worker's compens ion laws of California,and agree that if I should become ,HAZARDOUS MATERIAL DECLARATION
subject to the k scamp t�s tion provisions of Section 3700 of the Labor
Code,I shall w I com y with tha provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date rg 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 ❑Yes 40
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 Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION.3706 OF THE LABOR CODE,_INTEREST,AN_DATTORNEYS FEES --for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes 'NNo
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 Cade) ❑Yes No
OWNER BUILDER DECLARATIONS I have(ed the Hazardous Material Information Guide and the SCAQMD
hereby affirm under penalty of perjury that I am exempt from the permittin ecklist.I u rstand my requirements under the State of
Contractors License Law for the reason(s)indicated below by the Califor H al &Sa t Code,Section 25505 and 25534 con erning
h ar ous a ial porting.
checkmark(s)I have placed next to the applicable Items)(Section 7031.5 Yes ❑N �f
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,prior to its PROP O NER 0 THORIZED 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 Contractor's State EPA RENOVATION,REPAIR AND PAINTING IRRP)
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
❑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( I 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 1-8D0-424-LEAD(5323).
Code;The Contractor's 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 70",Business and Professions
Code:The Contractor's 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.
: SAFETY PERMIT/PLAN CHECK APPLICATION mil
%ic- IT%�
DATE: Oct g PERMIT/PLAN CHECK NUMBER -
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDI ION O ALTERATION O DEMOLITION O ELECTRICA-LL^O MECHANICAL
O NEW O PLUMBING RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK .
PROJECTADDRESS �2y l.Ff'ouH, Vi) ZIP 26
ASSESSOR'S PARCEL NUMBER 3�� �j2_ LOT TRACT
OWNERNAME (l.L ^Q
ADDRESS
PHONE -(51 EMAIL
APPLICANT NAME S
ADDRESS $' I� o� iL MFc'p- (C1 2
PHONE OiQ, jI s- '3rpI4 EMAIL a�S I I koo. COW1
CONTRACTOR'S NAME /�- JU., .�- • OWNER BUILDER? O YES O NO
BUSINESS NAME A-TS//��,,"_�
ADDRESS CI5 t"�LnI?46k DR. G Wf/J a C'( fCj 7
PHONE 6[� EMAIL C&hDD4 CV
CONTRACTOR'S STATE LIC NUMBER 0 6583 LICENSE CLASSIFICATION `J _
00
VALUATION$ l( (00 FT L SQ FT
APPLICANT'S SIGNATURE G DATE ' 3 S
OTYSTAFF USEONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
ACCEPTED BY:
BUILDING PLANNING ENGINEERING FIRE
PERMIT FEE SMIP GREEN
L
CHECK FEE INVOICETOTAL
BUILDER VERIFIED OYES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
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