PMT18-01565 City of Menifee Permit No.: PMT18-01565
29714 HAUN RD.
<XCrE ;/ > MENIFEE,CA 92586 Type: Residential Re-Roof
MENIFEE Dale Issued: 04/03/2018
PERMIT
Site Address: 26225 LANCASTER DR, MENIFEE, CA Parcel Number: 335-132-018
92586 Construction Cost: $8,500.00
Existing Use: Proposed Use:
Description of INSTALL NEW COOL ROOF LAYER OVER EXISTING SINGLE LAYER OF SHINGLES
Work: CRRC#1214-0003
Owner Contractor
LAJUANA MALONE PINEDA GENERAL CONSTRUCTION INC
26225 LANCASTER DRIVE 15323 AGUILA PASS
MENIFEE,CA 92586 NUEVO,CA 92567
Applicant Phone: 9513859149
ARTURO PINEDA License Number:889740
PINEDA GENERAL CONSTRUCTION INC
15323 AGUILA PASS
NUEVO, CA 92567
Fee Description C& Amount f$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_Bldg_Permit_Templatexpt Page 1 of 1
CITY OF MENIFEE
property who builds or improves thereon,and who contracts for the projects
LICENSED DECLARATION with a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of D I am exempt from Iicensure under the Contractors5tate License Law for
Chapter9(commencing with section 700D)of Division 3 of the Business and the following reason:
Professions Code and my license Is in full force and effect.
License Class T License � � personal residence
,�Se N° u By my signature below I acknowledge that,except far
�\ in which I must have resided for at least one year prior
or to completion of
Expires 1 I Signature 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 anti Serctoety ny
❑I hereby affirm under penalty of perjury one of the following declaration:) licensed contractors.I understand that a copy of the applicable
have and will maintain a certificate of consent of self-insure for workers 704 of the
Business and professions
the folder is available websi upon request when
t
compensation,issued by the Director of Industrial Relations as provided for in is submitted
milatted ced or a
by Section 370D of the Labor Code,for the performance of work for which www leeinfo
this permit is issued. Date
Policy# AI, 0'3 PROPERTY OWN ER OR AUTHORIZED AG ENT
❑I have and will maintain workers compensation insurance,as required by By my signature below I certify to each of the following:I am the property
section 3700 of the Labor Code,for the performance of the work for which owner or authorized to act on the property owners behalf.I have read this
this permit is issued.My workers compensation insurance carrier and polity application and the information I have provided is correct.I agree to comply
number are: with all applicable city and county ordinances and state laws relating to
A`
Carrier <A- e— C-04 �fLS � � building construction.I authorize representatives of this city or county to
Polity# i3a�,� Expires r t rD �1
enter the above identified property for Inspection purposes.
Date�
(This section need not to be completed is the permit is for one-hundred pROPERN OWNER OR AUTHORIZED AGENT
dollars($100)or less
❑I certify that in the performance of the work for which this permit is issued, CITY BUSINESS LICENSE#
I shall not emolov any persons in any manner so as to become subject to the HAZARDOUS MATERIAL DECLARATION
workers compensation laws of California,and agree that if I should become
subject to the worke compensation provisions of Section 3700 of the Labor Will the applicant or future building occupant handle hazardous material or a
Code,I shlu�o
hwit ca ly with those provisions. mixture containing a hazardous material equal to or greater that the
Applicant Date �1.� amounts specified on the Hazardous Materials Information Guide?
DYes oNo
WARNIN S E WORKER'S COMPENSATION COVERAGE IS WLII the intended use of the building by the applicant or future building
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will th mendedquire use of theit r ildinjhe structlon or modification from South
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($300,000),IN occCoast Air Quality Management District(SCAQMD)?See permitting checklist
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
o Yes oNo
CONSTRUCTION LENDING AGENCY
Will the proposed building or modified facility be within 1000 feet of the
I hereby affirm that under the penalty of perjury there is a construction outer boundary of a school?
lending agency for the performance of the work which this permit is issued ❑Yes o No
(Section 3097 Civil Code)
I have read the Hazardous Material Information Guide and the SCAQ
MD
OWNER BUILDER DECLARATIONS permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the California Health&Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason hazardous material reporting.$)indicated below by the checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Dyes O No Date
Business and Professions Code).Any city or county that requires a permit to
e PROPERTY OWNER OR AUTHORIZED AGENT
construct,alter,improve,demolish or repair any structure,prior to its
issuance,also requires the applicant for the permit to file a signed statement EPA RENOVATION REPAIR AND PAINTING(RRP)
that he or she is licensed pursuant to the provisions of the Contractors State The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the receiving compensation for most work that disturbs paint in a pre•1978
Business and Professions Cade)or that he or she is exempt from Iicensure residence or childcare facility to be work
disturbs
firms and complypre-19th
and the basis for the alleged exemption.Any violation of Section of not by required practices.This includes rental property owners and property
an Applicant for a permit subjects the applicant to a civil penalty of not more
than 15500). managers who do the paint-disturbing work themselves or through their
or my employee with wages as their sale employees.For more information about EPA's Renovation Program visit:
❑I,as owner of the property, eoa aov/lead or contact the National Lead Information Center at
compensation,will do( )all of or( )portion of the work,and the structure is 1-8013 424-LEAD(5323).
not intended or offered for sale.(Section 7044,Business and Professions
Code;The Contractors State License Law does not apply to an owner of a D An EPA Lead-Safe Certified Renovator will he responsible for this project
property who,through employees'or personal effort,builds or improves the Certified Firm Name:
property provided that the improvements are not intended or offered for Firm Certification No.:
sale.If,however,the building or improvement is sold within one year of
completion,the Owner-Builder will have the burden of proving that it was D No EPA Lead-Safe Certified Fmi is required for this project because:
not built or improved for the purpose of sale.
❑1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,BusinessProfessions
Code:The Contractor to an owner of a
s State License Law does not apply your project
does
not comply with EPA RRP rule please fill out the RAP
Acknowledgement.
_ __sue=��'��� Il,r•l�r A E
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFE
DATE: I PERMIT/PLAN CHECK NUMBER Q)'
PLANNING CASE NUMBER
TYPE: O COMMERCIAL XRESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA 415Rf Men fee
DUIIUIIIY 1-
Ud
SUBTYPE: O ADDITION OALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL Pt.
ONEW OPLUMBING 'gRE-ROOF NUMBER OF SQUARES 'L-S APR fl 18
DESCRIPTION OF WORK 004�— &.zcr\q 'L parry TCf ti \ OQ(�Q Q
'u_w Loa\ =o0� o� `.w\} V% Y��. ecei eta'
PROJECT ADDRESS tk-L-2S �c7L,t\''C��gs^^,frpfQ�C: �� C� ��t ZIP 0I2g61D
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME L a uqn� M0.�aL�
ADDRESS 'L(p2LS l_Okmco' 1-ej Or' v G
PHONE (yi�) 2L1� —Q110 I EMAIL '��
APPLICANT NAME
ADDRESS
PHONE<gs,'S405_—giL4cj EMAIL
CONTRACTOR'S NAME �v�e-�.a� a C-0�1 JC�toy� .Y OWNER BUILDER? O YES NO
BUSINESS NAME .qe o\ a 5 , v ckwn 3
ADDRESS 'L20\0 OS �.. `NQ-P 0 (fl4 tp
PHONE Q'1Sf)3b5--,i ►L-1'1 EMAIL a„`, co,
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
a
VALUATION$ g,SOD. SQFT ?,So() St (ri LSO FT ^ 9, 'sss
APPLICANT'S SIGNATURE DATE I S
CITY STAFF USE ONLY AM
DEPARTMENT DISTRIBUTION ACCEPTED BY: ,n cIT/OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE IN13K/
INVOICE TOTAL W qo GREEN 11 SMIP
OWNER BUILDER VERIFIED OYES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
G,-n oA
www.cityofinenifee.us
MENIFEE
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