PMT18-02066 City of Menifee Permit No.: PMT18-02066
29714 HAUN RD.
�C 3- MENIFEE, CA 92586 Type: Residential Re-Roof
cO'""" t SO.'` MENIFEE Date Issued: 0 4/3 012 01 8
PERMIT
Site Address: 29694 SQUAW VALLEY DR, MENIFEE, Parcel Number: 338-263-035
CA 92586 Construction Cost: $10,200.00
Existing Use: Proposed Use:
Description of TEAR OFF 1 LAYER ROOFING, REROOF W/OWENS CORNING COOL ROOF IN AMBER
Work: CRRC#0890-0009 AGED-.21frHERMAL.92/SRI 21
Owner Contractor
DOROTHY BERRY ARMOUR ROOFING
29694 SQUAW VALLEY DR 24372 KENTUCKY DERBY WAY
MENIFEE,CA 92586 MURRIETA, CA 92562
Applicant Phone: 9517608029
SHAUN SCHARTNER License Number:984307
ARMOUR ROOFING
24372 KENTUCKY DERBY WAY
MURRIETA,CA 92562
Fee Description Qty Amount 1$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_Templale.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 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.Cc�a the following reason:
License Class G 3 c( License No. ��t G� 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
WORKER'S COMPENSATION DECLARATION improvements covered hyepermit.)cannot legally sell a structure that I
have built as an owner-builder if it has not been constructed in its entirety by
)5•1 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
this permit is issued. www.leeinfo.ca.eov/calaw.html.
Policy qU !L 72 .S c7 Date
❑I 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 I have provided is correct.I agree to comply
Carrier Wc,c 14RS -A, C' with all applicable city and county ordinances and state laws relating to
�, (� building construction.I authorize representatives of this city or county to
Policy q5'c "--71 ' 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
c I cerllfy that in the performance of the work for which this permit is issued, /s^�� �1
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSER V91PIOg
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,I shall farj¢wit complyXp�itl7 those provisions. C' Will the applicant or future building occupant handle hazardous material or a
Applicant / '/ r Date LJ' 3 IJ 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 15 ❑Yes yF No
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 Coast Air quality Management District(SC construction
or See permitting from
checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forst Ai.r lnes
Qua
CONSTRUCTION LENDING AGENCY ciYes psi No
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 10G0 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 �No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractors License Law for the reason(s)Indicated below by the California Health&Safety Cade,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material lrreporting
.
Business and Professions Code).Any city or county that requires a permit to .4Yes o No ,/ / Date S,- -3' - ( r
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWN/EAR OR AUTHORI'ED 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 fRRP1
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 Iicensure 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 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 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. ❑No EPA Lead-Safe Certified Firm is required for this project because:
o I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code: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/PLAN CHECK APPLICATION MENIFEE
DATE: O PERMIT/PLAN CHECK NUMBER I O��OL7IO
PLANNING CASE NUMBER
TYPE: 0 COMMERCIAL kAESIDENTIAL 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 PLUMBING erRE-ROOF NUMBER OF SQUARES 1, 5-6 7
DESCRIPTION OF WORK CIO 0009
C&AIG CIS
PROJECTADDRESS a �( �l `� Squ/k� V,a\\rti j)C ZIP
ASSESSOR'S PARCEL NUMBER -33�c�(c3S LOT a3 TRACT aa2-lo-�
OWNER NAME D U-V
ADDRESS c] 6 cl C up, tII Ll D S� Vwl If Pr e1�.SFt
PHONE -7/CV Z -r 5 - ,EO c/15- EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME 07v CGY u OWNER BUILDER? W YES O NO
BUSINESS NAME -r cy 0 J`t' Q UG
ADDRESS c� a Z 4e ✓C le- De.it i'( W 1°{Lf My f-r;eZ-
PHONE I s( / D q 6 Z Z c6 EMAIL J p� i'1^�v rcLaFi u j .
CONTRACTOR'S STATE LIC NUMBER `-1 �f 4-1,3 O -7 LICENSE CLASSIFICATION C -3 I g
VALUATION$- le, t 2 SO FT /J L SQ FT u
APPLICANT'S SIGNATURE .� / / '_l / DATE
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF IFEE BV40ISINES;LCENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE 6
INVOICE TOTAL I GREEN SMIP
OWNER BUILDER VERIFIED OYES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES () NO
City of Menifee Building &Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
www.ciTyofinenifee.us �
MENIFEE
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