PMT18-01078 City of Menifee Permit No.: PMT18-01078
_ 29714 HAUN RD.
�CCELA? MENIFEE, CA 92586 Type: Residential Re-Roof
MENIFEE Date Issued: 0310912018
PERMIT
Site Address: 29600 THORNHILL DR, MENIFEE, CA Parcel Number: 336-120-022
92586 Construction Cost: $7,000.00
Existing Use: Proposed Use:
Description of REPLACE AND REMOVE COMP SHINGLES. REPLACE WITH NEW.
Work:
CRRC:0890-0011
COLOR:ANTIQUE SILVER/GREY
Owner Contractor
OLIVIA NUNEZ L F C CONSTRUCTION
29600 THORNHILL DR 23905 CLINTON KEITH
MENIFEE, CA 92586 #114-182
Applicant Phone: 9514905223
23905 CLINTON KEITH License Number:964147
#114-182
WILDOMAR,CA 92595
Phone:9514905223
Fee Description -0yt Amount(S)
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 tamed on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise 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_Bld(LPermi .Template.rpt Page 1 of 1
CITY OF MENIFEE
Ar 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 contractors)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from Iicensure under the Contractor's State Ucense Law for
Professions Code and my license is in full force and effe the following reason:
License Classy H) L ens o. Sy my signature below I acknowledge that,except for my personal residence
Expires 'a , Signature in which I must have resided for at least one year prior to completion of
improvements covered bythis 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
❑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 yv,�„�,,lezinfo.ca.zov/calaw.h[ml.
this permit is issued.
Policy# Date
Ill 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 ❑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: '1 4�,,� application and the information I have provided is correct.I agree to comply
Carrier IV _ cv W� 1lh�l �.V V'!1's' Y with all applicable city and county ordinances and state laws relating to
�1 1 building construction.I authorize representatives of this city or county to
Policy# Ibl\ Expires 0' q— l enter the above identified property for 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
❑I certify that in the performance of the work for which this permit is issued,
I shall not emplav any persons in any manner so as to become subject to the �//C�ITY BUSINESS LICENSE#
workers compensation laws of California,and agree that if I should become glre�eRDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor 7777 __
Code,I shall orth h com y with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date IJ-1 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 15 ❑Yes wo
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,AND ATTORNEYS FEES —forguidelines—
CONSTRUCTION LENDING AGENCY ❑Yes �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 bqundary of a school?
(Section 3097 Civil Code) ❑Yes ❑ a
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjurythat I am axe m She
Contractors License Law for the reasons)in, t the California He to & porfety Code,Section 25505 and 25534 concerning
hazardous term reportin .
checkmark(s)I have placed next to the applica ection 7031.5
Business and Professions Code).Any ci u t requir permit to bs Date
construct,alter,improve,demolish or re tructure,,T,�(��s its PROPERTY NER OR AUTHORIZED AGENT
issuance,also requires the applicant for the ermit to �sTgned state ,
that he or she is licensed pursuant to the provisin�fe Contract EPA RENOVATION,REPAIR AND PAINTING(RRP)
License Law(Chapter 9(commencing with Secti 000)of Di " o e The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)or that he or she is ezemp Rensure receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violaJJJ,111'000 on 7031.5 by residence or childcare facility to be RRP-certified firms and comply with
an Applicant for a permit subjects the applicant enalty 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( )all of or( )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 Contractors 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 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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION �® MENIFEE
DATE: - - $ PERMIT/PLAN CHECK NUMBER
PLANNING CASE NUMBER
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION ODEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK OU& B Iy COM <;1 I\A (6 t
PROIECTADDRESS --` w �����\ 11I� ZIP y0
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME 01�U JA *t�31AVaj
ADDRESS eL q bo(� J lsv►w'L
1 PHONE W(q •��" 0�0 EMAIL
APPLICANT NAME
ADDRESS
PHONE ��( -5�1." ��/ / EMAIL
CONTRACTOR'S NAME S / �#-,' OWNER BUILDER? 0 YES JNO
BUSINESS NAME �, L O l- �& l`VL-" ,(,
ADDRESS 1. /U�� rVL Y�j T'1'i� 1T L
PHONE � I •l{h V-SLR-3 EMAIL
CONTRACTOR'S STATE LIC NUMBER `� 1� LICENSECLASSIFICATION
VALUATION$ —1 UI OO SQ FT 'V100 L SQ FT
APPLICANT'S SIGNATURE DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BU INESS LICENSE NUMBER
BUILDING PLANNING .ENGINEERING FIRE
INVOICETOTAL GREEN SMIP
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE N NOTARIZED LETTER O YES O. NO
City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
www.cityofinenifee.us City of Menifee
Building Dept. EN�F
MAR 0 9 2018
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