PMT18-01613 City of Menifee Permit No.: PMT18-01613
29714 HAUN RD, Type: Residential Re-Roof
�CCEIjA? MENIFEE,CA 92586
MENIFEE Date Issued: 0410 9/2 01 8
PERMIT
Site Address: 26120 ST MARYS ST, MENIFEE, CA Parcel Number: 337-022-013
92586 Construction Cost: $9,550.00
Existing Use: Proposed Use:
Description of TEAR OFF EXISTING SHINGLES, REROOF W/NEW OWENS CORNING COOL ROOF IN AMBER
Work: CRRC#0890-0009
Owner Contractor
JOYCE REYNOLDS BAKER ROOFING CORPORATION
26120 ST MARYS ST 29515 DUNKIRK STREET
MENIFEE, CA 92586 MENIFEE,CA 92586
Applicant Phone: 9512557237
LARRY BAKER License Number: 884731
BAKER ROOFING CORPORATION
29515 DUNKIRK STREET
MENIFEE,CA 92586
Fee Description Oft Amount($)
Building Permit Issuance 1 27.00
Inspections not specified 9B 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_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ 1 am exempt from licensure under the Contractors'Stale License Law for the
I hereby affirm under penalty or perjury that I am licensed under provisions of following reason:
Chapter 9(commencing with section 7000)of Division 3 of the Business and By my signature below I acknowledge that, except for my personal residence in
Professions Code and my license is in full force and effect. which I must have resided for at least one year prior to completion of
License Class.r r?q Licensee No. ". kF�r7'3I improvements covered by this permit, I cannot legally sell a structure that I have
Expires g"1 Signature a — a— ';-, built as an owner-building if it has not been convicted in its entirety by licensed
contractors. I understand that a copy of the applicable law,Section 7044 of the
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application is
submitted or at the following Web site:
❑ I hereby affirm under penalty of perjury one the following declarations: hfto.,/ANww.leninfo.ca.gov/calawhtml.
I have and will maintain a certificate of consentt of self-insure for workers'
compensation,issued by the Director of Industrial Relations as provided for by Date
Section 3700 of the Labor Code, for the performance of work for which this
permit is issued. Property Owner or Authorized Agent
Policy# ❑ By my Signature below, I certify to each of the following: I am the property
I have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read this
secbon 3700 of the Labor Code, for the performance of the work for which this application and the information I have provided is correct. I agree to comply
permit is issued.My workers'com ensation insurance carder and policy number are: with all applicable city and county ordinances and slate laws relating to building
_l construction.I authorize representatives of this city or county to enter the above-
Carrier O` "�� ''`� Identified properly for the inspection purposes. ..
Policy#63!� --�Fq4 Cte Expires t�--j7 Date
' Property Owner or Authorized Agent(This section need not be completed If the permit is for City Business license# Oyga I J�
one-hundred dollars(5100)or less) Y
❑ I certify that in the performance of the work for which[his permit Is issued,I HAZARDOUS MATERIAL DECLARATION
shall not employ any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or a
workers'compensation laws of California. and agree that if I should become mixture containing a hazardous material equal to or greater that the
subject to the workers'compensation provisions of Section 3700 of the Labor amounts specified can the Hazardous Materials Information Guide?
Code,I shall forthwith
h comply With those provisions. OYES Imp
NO
Applicant, ',�"'� Date; Wili the intended use of the building by the applicant or future building
occupant require a permit for the construction or modification from South
WARNING: FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES (111 b
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES NO
CONSTRUCTION LENDING AGENCY 1 have read the Hazardous Material Information Guide and the SCAQMD
hereby affirm that under the penalty of perjury there is a construction lending permitting checklist.I understand my requirements under the State of
agency for the performance of the work which this permit is issued(Section Califomia Health&Safety Code,Section 25505 and 25534 concerning
3097 Civil Code) hazardous atedal reporting.
n
OWNER BUILDER DECLARATIONS DYES: /< (J
I hereby affirm under penalty of perjury that I am exempt from the Contractors - /l� Ilk Date
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OWNER OR AUTHORIZED AGENT
next to the applicable item(s)(Section 7031.5. Business and Professions Code:
Any city or county that requires a permit to construct,alter,improve, demolish, EPA RENOVATION,REPAIR AND PAINTING(RRP1
or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
provisions of the Conlmclor's State License Law (Chapter 9(commencing with receiving compensation for most work that disturbs paint in a pre-1978
Section 7000)of Division 3 of the Business and Professions Code)or that he or residence or childcare facility to be RRP-certified fins and comply with
she is exempt from licensure and the basis far the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than(S500).) employees.For more information about EPA's Renovation Program visit
❑ I, as owner of the property, or my employees with wages as their sole wwwepa.govAead or contact the National Lead Information Center al
compensation, will do )all of or 1-600.424-LEAD(5323).
( ( )porting of the work, and the structure is
not intended or offered for sale.(Section 7044.Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however, Certified Finn Name:
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the Firm Certification No.:
purpose of sale).
❑ I, as owner of the property an exclusively contracting with licensed 0 No EPA Lead-Safe Certified Ern is required for this project because:
contractors to construct the project(Section 7044.Business and Professions
Code:The Contractor's License Law does not apply to an owner of a property
who builds or improves thereon, and who contracts for the projects with a
licensed conlractor(sl Dursuant to the Contractors State License Lawl. If vour oroiect doss not cmmnty with FPA RRP n rip nlnacp on.ve ihp RRP
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
�Wenifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: ❑COMMERCIAL EZRESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME POOL/SPA ❑SIGN
SUBTYPE: ❑.ADDITION ❑ALTERATION []DEMOLITION ❑ELECTRICAL [:]MECHANICAL
❑NEW ❑PLUMBING ®RE-ROOF-NUMBEROFSQUARES _ Q
DESCRIPTION OF WORK & I I I
C Iles,
PROJECFADDRESS
r-
ASSESSOR'SPARCELNUMBER �J�J7' VAa-�'� LOT _tt)'�J' TRACT K1
PROPERTY OWNER'S NAME tpe
nADDRESS a 0 fop, ✓ 5 - �-.
PHONE EMAIL
--------------
APPLICANT NAME
ADDRESS
o� c� �j o1 �
PHONE q, S I.-o(_7 `" ((�( 3_J EMAIL �p
CONTRACTOR'S NAME - OWNERBUILDER? ❑YES❑NO
BUSINESS NAME
o
ADDRESS
PHONE C'j �j _ pf 'S - EMAIL
CONTRACTOR'S STATE LIC NUMBER rQ� L- ] �j ? LICENSE CLASSIFICATION
VALUATION$ �j Lam` SQ FT L SQ FT
APPLICANT'S SIGNATURE .rs�. DATE LI
CITYSTAFFUSECINLY
DEPARTMENT DISTRIBUTION I BUILDING P CITY OF MENIFEE BUSINESS LICENSE NUMBER
PLANNING ENGI NEERING FIRE GREEN SMIP
INVOICE 0
AMOUNT %. •. ll PAID AMOUNT pCASH GCHECK# <'
•CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT
O CASH OCHECK# ^CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DL NUMBER NOTARIZED LETTER 0 YES O NO
City of Menifee Building&Safety Department 29714 Noun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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