PMT18-02132 City of Menifee Permit No.: PMT18-02132
29714 HAUN RD. Type: Residential Re-Roof
MENIFEE,CA 92586
rm«..'l smt,, MENIFEE Date Issued: 0 5/0 312 01 8
PERMIT
Site Address: 28134 GOETZ RD, MENIFEE, CA 92587 Parcel Number: 341-020-024
Construction Cost: $1,500.00
Existing Use: Proposed Use:
Description of REMOVE ALL EXISTING ROOF LAYERS ON THE GARAGE, INSTALL NEW COOL ROOF SHINGLES
Work: CRRC#0890-0002"
Owner Contractor
HT PROPERTIES clo STEVE HADLEY
28134 AVENIDA EVITA
SAN JUAN CAPISTRANO, CA 92675
Applicant License Number:
HT PROPERTIES c/o STEVE HADLEY
28134 AVENIDA EVITA
SAN JUAN CAPISTRANO, CA 92675
Phone:7146245771
Fee Description otty. 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 far construction under which no work is commenced within sbc
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 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 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
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I
have built as an owner-builder if it has not been constructed in its entirety by
D 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 appliwti�is s Ltted or at[e following website:
by Section 3700 of the Labor Code,for the performance of work for which www.le in pv c w.h[ at
this permit is issued.
Polity# s Date t Z/I
E R
❑I have and will maintain workers compensation insurance,as required by PRO ERN OWN THORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which 0 By my Sig natu elow I certify to each of the following:I am the property
this permit is issued.My worker's compensation insurance carrier and polity owner or authorized to act on the property owners behalf.I have read this
number are: application and the information 1 have provided is correct.I agree to comply
Carrier with all applicable city and county ordinances and state laws relating to
building co struction.I authorize representatives of this city or county to
Policy d Expires enter th ove id " d property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date `A
dollars($100)or less 0kRTY OWNER AUTHORIZED AGENT
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 U E#
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 15 D Yes O 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(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes ❑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 ❑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
1 hereby affirm under penalty of perjury that I am exempt from the
California
Contractor hazardous s License Law for the reasons)indicated below by the Health al Safety Code,Section 25505 and 25534 concerning
rdo
hus material reporting.
checkmark(s)I have placed next to the applicable item(s)(section 7031.5 ayes D 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 fRRP)
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt from licensure The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
and the basis for the alleged exemption.Any violation of Section 7031.5 by receiving compensation for most work that disturbs paint in a pre-1978
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
than($Scan. required practices.This includes rental property owners and property
y managers who do the paint-disturbing work themselves or through their
14 as owner of the pro ty,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will all of or( )portion of the work,and the structure is www.epa.gov/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 D 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. D No EPA Lead-Safe Certified Firm is required for this project because:
D 1,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.
APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK
M_ENIFEE
New. Better. Best.
DATE 3 I d PERMIT/PLAN CHECK NUMBER
TYPE: O.COMMERCIAL M ESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA 0 SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING jME-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK CRiioldong ity of Menee DEI t.
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER '-CQO C LOT TRACT Geiv d
OWNER NAME
ADDRESS
PHONE /\ � � l U EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME 0 OWNER BUILDER? )iDYES O NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE�LIIC NUMBER LICENSE CLASSIFICATION
VALUATION$ I /J ,o. S FT LSQ FT
APPLICANT'S SIGNATURE DATE S�3/jo
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN 1 SMIP
INVOICE Ql, PAID AMOUNT Q��
AMOUNT lV i tO • Ill Q CASH O CHECK# C CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT CASH 0 CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES 0 NO DL NUMBER NOTARIZED LETTER O YES 0 NO
City of Menifee Building&Safety Dept
29714 Haun Road i Menifee,CA 92586
951-672-6777
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