PMT18-00032 City of Menifee Permit No.: PMT18-00032
_ 29714 HAUN RD.
�l-�CCELA— MENIFEE, CA 92586 Type: Residential Re-Roof
MENIFEE Date Issued: 0110 312 01 8
PERMIT
She Address: 27873 HILL POINTE DR, MENIFEE, CA Parcel Number: 333-241-008
92585 Construction Cost: $8,000.00
Existing Use: Proposed Use:
Description of REMOVING& REPAIRING EXISTING TILE ROOF 20 SQUARES, INSTALLATING 30#FELT, REROOF
Work: W/TILE
Owner Contractor
RHONDA KING AUS ROOFING
27873 HILLPOINTE DR 20690 OLD ELSINORE ROAD
MENIFEE, CA 92585 PERRIS, CA 92570
Applicant Phone:9512295783
AL GRAY License Number:716337
AL'S ROOFING
20690 OLD ELSINORE ROAD
PERRIS,CA 92570
Fee Description Qty Amount t$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 orfrom 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 Pemrit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
l hereby affirm under penalty of perjury that l 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 o l am exempt from licensure under the Contractors Slate License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class -3 ( License No. - '7 By my signature below l acknowledge that,except for my personal residence
Expires , 9 Signature in which l must have resided for at least one year prior to completion of
RKER'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
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 ofselbinsure 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 wsvw.leainf.,.ca.eov/calaw.lztml.
this permit is issued. 277d
Date-
Policy N /
O l have 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 l certify to each of the following:I am the property
this permit is issued.Myworkees compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
number are: /j /( application and the information l have provided is correct.l agree to comply
Carrier 1/,( A with all applicable cityand county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy N f,-�,a 277e:,-1 `Expires 7 / enter the above identified property far 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
of certify that in the performance of the work for which this permit 4 issued, 34sS p 1�4-
Ishallnotemolov any persons in any manner so as to become subject to the COY BUSINESS LICENSE Is ✓ D 1
workers compensation laws of California,and agree that if l should becomeFn /e
ARDOUS MATERIAL DEC 710
subject to the workers compensation provisions of Section 3700 of eLabor
de,I shall forthwith com ywit [those provisions. l the applicant or future building occupant handle hazardous material or
i �/ f ture containing a hazardous material equal to or greater that the
pliant Date unts spe III, d on the Hazardous Materials Information Guide?
WARNING:FAILURE O SECURE WORKER'S COMPENSATION OVERAGE 15es oL .
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES l the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND D OLLARS($100,000),INpant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FORst Air Quality Management District(SCAQMD)?See permltfing checklist
IN SECTION 37060E THE LABOR CODE,INTEREST,AND ATTORNEYS FEES uldelfnes
CONSTRUCTION LENDING AGENCY s Eiji.,
I hereby affirm that under the penalty of perjury there is a construction 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 rboun f'yofaschool?
(Section 3097 Civil Code) s o
OWNER BUILDER DECLARATIONS ve read the Hazardous Material Information Guide and the SCAQMD
I hereby afRrtn under penalty of perjurythat lam exempt from the itting checklist)understand my requirements under the 5tste of
California Health&Safety Cade,Section 25505 and 25539 concerning
Contractors License Law for the reason(s)Indicated below by the rdous ma�al reporting.
checkmark(s)I have placed next to the applicable Item(s)(Section 7031.5 s u N
Business and Professions Code).Any city or county that requires a permittere Date �3
construct,alter,improve,demolish orrepalr anystructure,prior to its ROPERfYOWNERQ AUTHORIZED AGENT
issuance,also requires the applicant for the permit to file a signed statement i4/
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATIO REPAIR AND PAINTING(RRPI
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-certifsed 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($50D). managers who do the paint-disturbing work themselves or through their
ol,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit
compensation,will do( tall of or( I portion of the work,and the structure is mm.eoasav/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code,The Contractors State License Law does not apply to an owner of a aAn EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or Improves the
property provided that the improvements are not intended or offeredfor Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No:
completion,the Owner-Bullder will have the burden of proving that it was
not built or improved for the purpose of sale, O No EPA Lead-Safe Certified Firm Is required for this project heause:
o I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please rill aut the RRP
Acknowledgement.
DATE: PERMIT/PLAN CHECK NUMBER ( I VVO
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA OSIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK lze 9 �—I e
PROJECTADDRESS 2 7173 Wit H :t e- z�r ZIP O"/ z S ZS
ASSESSOR'S PARCEL NUMBER
/ LOT _ TRACT 1
OWNER NAME
ADDRESS ' �-
PHONE EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME JtI GrS OWNERBUILDER? OYESONO
r �r
BUSINESS NAME C S /`�u �h
ADDRESS Z�GSa orb /.Ir,o.r
PHONE Sjr EMAIL
CONTRACTOR'S STATE LIC NUMBER 7( C-3 7 LICENSE CLASSIFICATION C `
VALUATION$ Aeo00//� SQFT Z (D LSQFT
APPLICANT'S SIGNATURE DATE I
aTYSTAFF USEONLY
DEPARTMENT DISTRIBUTION M ' CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE ACCEPTED BY__ J
PERMIT FEE (30,�0 SMIP GREEN -�
PLAN CHECK FEE INVOICETOTAL r-!)o ,CIO
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
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