PMT18-01506 City of Menifee Permit No.: PMT18-01506
29714 HAUN RD.
49.�CCEL/� MENIFEE, CA 92586 Type: Residential Re-Roof
MENIFEE Date Issued: 04102/2018
PERMIT
Site Address: 25807 PELION RD, MENIFEE, CA 92584 Parcel Number: 339-233-001
Construction Cost: $8,000.00
Existing Use: Proposed Use:
Description of TEAR OFF EXISTING ROOF, REROOF W/OWENS CORNING COOL ROOF IN SHASTA WHITE
Work: CRRC#0890-0008
Owner Contractor
ROSIEL BURNS J D F CONSTRUCTION INC
25807 PELION RD 201 GEMINI AVE
MENIFEE, CA 92584 BREA,CA 92821
Applicant Phone:7145261120
NATHAN KELSEY License Number.956749
J D F CONSTRUCTION INC
201 GEMINI AVE
BREA, CA 92821
Fee Description QtV Amount
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 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 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 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 o I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Clas zV '�J Lic a No. JF�J C
o, By my signature below I acknowledge that,except for my personal residence
Expires / 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
❑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 worker's 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 www.leeinfo.ca.eov/alaw.html.
this permit is issued.
Policy# Date
AI have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
s coon 3700 of the Labor Code,for the performance of the work for which D By my signature below I certify to 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 applicable city and county ordinances and state laws relating to
I,,_ building construction.I authorize representatives of this city or county to
Policy# T�rst oor&5 —UL Expires /T enter the above identified property for inspection purposes.
(This section need not to he completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
O I certify 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 become subject to the CITY BUSINESS UCENSE#
worker's compe I laws of California,and agree that if I should became HAZARDOUS MATERIAL DECLARATION
subject to the rker' compensation provsionsof5ectlon3700 fthe Labor
Code,I shall f9fthwitlYcoTply with tho rovisions. WIII the applicant or future building occupant handle hazardous material or a
Applim Date $r mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURETO SECURE WORKER'S COMPENSATION CO ERAGE IS ❑Yes zcy No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES A
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000J,IN Will the intended use of the building by the applicant or future building
ADDITION 70 THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)75ee permitting checklist
for guid Ines
CONSTRUCTION LENDING AGENCY Dyes iNo
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 bo dory of a school?
(Section 3097 Civil Code) D Yes No
OWNER BUILDER DECLARATIONS I have r9zfd6_t�thj Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that 1 am exempt from the permi ing the klist.I understand m requirements under the State of
Contractor's License Law for the reasons)indicated below by the Calif nia Hea h&Safety Cade action 25505 and 25534 co erning
haz rdo m teria re orti
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 s
Business and Professions Code).Any city or county that requires a permit to Date Z O
construct,alter,improve,demolish or repair any structure,prior to its rAOPERTf OWNER ORAUTH GENT
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(FIRM
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.S 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
o 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.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 Contractor's State License Law does not apply to an owner of a O 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:
o 1,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 fill out the RRP
XAcknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE
DATE: PERMIT/PLAN CHECK NUMBER g�O
PLANNING CASE NUMBER
TYPE: O COMMERCIAL ARESIDENTIAL 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 PLLUU[M'BING k RE-RROOOF�NUUMBER OF SQUARES I!D
DESCRIPTION OF WORK
PROJECT ADDRESS aS%-*04 Q1197n����JJod. ZIP
ASSESSOR'S PARCEELJNUMBER � 'd;t; LOT I TRACT
OWNER NAME OS IC� bux-Y7,r (�� Op
ADDRESS p✓8O PE FdYD D'Cp . ��e�1)�e
PHONE EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME F $ OWNER BUILDER? OYES NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER 15(Q f y / LICENSE CLASSIFICATION
VALUATION$ O 600' oa SQ FT LSQ FT
APPLICANT'S SIGNATURPi DATE 2 O
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE soLlOa
INVOICE TOTAL V GREEN I SMIP
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE N NOTARIZED LETTER 'J YES ` NO
City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
www.cityofinenifee.us R
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