PMT18-01708 City of Menifee Permit No.: PMT18-01708
29714 HAUN RD. Type: Residential Re-Roof
'3tCCEL1�� MENIFEE,CA 92586
MENIFEE Date Issued: 04/16/2018
PERMIT
Site Address: 29970 CARMEL RD, MENIFEE, CA 92584 Parcel Number: 336-132-008
Construction Cost: $7,000.00
Existing Use: Proposed Use:
Description of REMOVE AND REPLACE COMP SHINGLES WITH COOL ROOF COMP SHINGLES
Work:
CRRC: 0890-0011
OWENS CORNING
ANTIQUE SILVER
Owner Contractor
DALE TEDESCO L F C CONSTRUCTION
29970 CARMEL ROAD 23905 CLINTON KEITH
MENIFEE, CA 92584 #114-182
Applicant Phone: 9514905223
L F C CONSTRUCTION License Number: 964147
23905 CLINTON KEITH
#114- 182
WILDOMAR, CA 92595
Phone: 9514905223
Fee Description Qtv Amount($)
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 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.
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AA_Bldg_Permit_Tem plate.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 ❑I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and efff t. the following reason:
License Class 9 LIcens o. i,Ve 1 By my signature below I acknowledge that,except for my personal residence
Expires�'3��`� 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
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 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/calaw.htrnl.
this permit is issued.
Policy# Date
WT have and will maintain worker's 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 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 1 have provided is correct.I agree to comply
�11 with all applicable city and county ordinances and state laws relating to
Carrier pp��yyhh - building construction.I authorize representatives of this city or county to
Policy# UW Expires ' , 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
o I certify that in the performance of the work for which this permit is issued,
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's compensation laws of California,and agree that if I should becomeeZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor 'IX
Cade,I shall orth h com y with those provisions. Will the applicant or future building occupant handle hazardous material or a
IJmixture containing a hazardous material equal to or greater that the
Applicant Date I amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS D Yes VVo
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
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)?See permitting checklist
for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes Q-3%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 boundary of a school?
(Section 3097 Civil Code) ❑Yes 0 0
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exerts 0 rom the permitting checklist.I understand my requirements under the State of
California He Ith& afety Code,Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicateddo the hazardous teri reporting.
checkmark(s)I have placed next to the applica-Vernop, tion 7031.5 `
Business and Professions Code).Any cityfs,(*yrlft;'tit requir �yaa permit to Cs Date
construct,alter,improve,demolish or real ?s�tructure,(p, 0 its PROPERTY NER OR AUTHORIZED AGENT
issuance,also requires the applicant for t0permit torfi�-a signed staterrkent.,
that he or she is licensed pursuant to the provis�or�`"pf tie Contract�(��te EPA RENOVATION,REPAIR AND PAINTING(RRPI
License Law(Chapter 9(commencing with Section 000)of Div s lido he The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)or that he or she is exempt fr -ensure receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any viola�oinfaf �flon 7031.5 by residence or childcare facility to be RRP-certified firms and comply with (!
an Applicant for a permit subjects the applicant oy c aiWenalty of not more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their If
o I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.epagov/lead/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the Y
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
I
❑1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
����������|�
B[j|LD|��G /� S�`FETYPERK4iT/PLAN (�HE��K ��PPLI[AT|{]N � onxu.m`mmm u~��
- /
DATE: PERMIT/PLAN CHECK NUMBER PWIS - r)1 1109
PLANNING CASE NUMBER
TYPE: C' COMMERCIAL �;KESIDENTIAL 'c) MULTI-FAMILY C MOBILE HOME POOL/SPA C SIGN
SUBTYPE: C) ADDITION ALTERATION C' DEMOLITION C., ELECTRICAL MECHANICAL
NEW PLUMBING RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK QuIvAlL �M Wi
ASSESSOR'S PARCEL NUMBER TRACT
OWNER NAME
ADDRESS
PHONE EMAIL
APPLICANT NAME
PHONE EMAIL
CONTRACTOR'S NAME
BUSINESS NAME Lf C JIL v
ADDRESS C"
CONTRACTOR'S STATE LIC NUMBER bq LICENSE CLASSIFICATION
VALUATION$ SO, L SO.FT
APPLICANT'S SIGNATURE DATE
iCITYSTAFF-USE ONLY_!-.:
M DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERRV6 FIRE �'Q w
OWNER BUILDER VERIFIED C;YES NO DRIVERS LICENSE# NOTARIZED LETTER Q YES NO
City ofK8enifee Building & Safety Department | Z97l4HaunRd, yWenifee, [A9Z5D6 (gS1)67Z'6777
wm/m/.cityofnenifee.us
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