PMT18-02064 City of Menifee Permit No.: PMT18-02064
29714 HAUN RD.{ Type: Residential Re-Roof
'\CCEL/� MENIFEE,CA 92586
MENIFEE Date Issued: 04/30/2018
PERMIT
Site Address: 27679 MEDFORD WAY, MENIFEE, CA Parcel Number. 335-254-006
92586 Construction Cost: $7,000.00
Existing Use: Proposed Use:
Description of REMOVE 2 LAYERS OF ROOFING, REROOF W/GAF COOL ROOF IN BIRCHWOOD
Work: CRRC#0676-0096
Owner Contractor
GERALD A FAVIA
27679 MEDFORD WAY
MENIFEE,CA 92586
Applicant License Number:
GERALD A FAVIA
27679 MEDFORD WAY
MENIFEE, CA 92586
Phone:9514407641
Fee Description City Amount I81
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.rpl Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
1 hereby affirm under penalty of perjury that 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 o I am exempt from licensure under the Contractors State License Law for
Professions Code and my license is In full force and effect. the following reason:
License Class License No. 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 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
this permit is issued. www.leeinfo.ca.eov/calaw.html.
Policy# Date
❑I 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 1 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: 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
building construction.I authorize representatives of this city or county to
Policy# Expires the hove!den'fieci grop rty car inspection purposes.
(This section need not to be completed is the permit is for one-hundred (� Date
dollars($100)or less ROPERTY OWNdR 09 AUTH IZED 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 LICENSE K
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date 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 IS ❑Yes o No
UNLAWFUL,AND SHALLSUBIECT AN EMPLOYERTO CRIMINAL PENALTIES Will the intended use ofthe building by the applicant orfuture building
AND CIVIL FINES UPTO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGESAS PROVIDED FOR Coast Air Quality Management.District(SCAQMD)?See permitting cheddist
IN SECTION 3706 OFTHE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY o Yes o 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) o Yes o No
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 perjury that I am exempt from the California Health&Safety Code,Section 25505 and 2SS34 concerning
Contractors License Law for the reasons)indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oyes in No
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED AGENT
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 Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRP)
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 Cade)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 7031.5 by residence or childcare facility to he 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 car( )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 70",Business and Professions 1-800-424-LEAD(5323).
Code;The Contractors 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. o 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
Cade: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/PL
AN CHECK APPLICATION MENIFEE
DATE: PERMIT/PLAN CHECK NUMBER I��O
PLANNING CASE NUMBER
TYPE: 0 COMMERCIAL C RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOLISPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK &6I,
Im
Qj
PROJECiADDRESS ZIP
ASSESSOR'S PARCEL NUMBER J� v✓Y/ LOT P� TRACT • I�. r
OWNER NAME G
ADDRESS /�°?
PHONE q SI yLI Q ZA EMAIL
•
APPLICANT NAME GQ 0, A 11Q
ADDRESS O
PHONE 9 Ej L.t LF�6 [.F f EMAIL
CONTRACTOR'S NAME OWNER BUILDER? O YES O NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ :7 nod.e SO FT yI�� LSO FT
APPLICANT'S SIGNATURE �' /�+� DATE
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITYOF MENIFEE BUSINESS UCEN5E NUMBER
BUILDING PLANNING ENGINEERING FIRE
INVOICE TOTAL GREEN SMIP
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES U NO
City of Menifee Building &Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
www.cityofinenifee.us
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Qualifying Residential GAF Cool Roof Shingles CRI
GAF has the following shingles available that are Title 24 compliant and are listed with the Cool Roof Rating Council.
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CRRC Product IN 0676-0041 -._CRRC Product ID#0676-0043- __ CRRC Product IN 0676 0042
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17 r I
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CRRC Product ID#0676-0103 �\ CRRC Product ID#0676-0094"%� CRRC Product IN 0676.0099
Timberline HV
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'11 CRRC Product ID#0676-0097 CRRC Product IN 0676.0098 CRRC Product ID#0676-0089
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CRRC Product IN 0676.0100 CRRC Product IN 0676-0033
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