PMT18-02282 City of Menifee Permit No.: PMT18-02282
29714 HAUN RD.
�l1CCELA? MENIFEE, CA 92586 Type: Residential Re-Roof
n�...,,-me s��..t,• MENIFEE Date Issued: 05/09/2018
PERMIT
Site Address: 28951 CROSBY DR, MENIFEE, CA 92586 Parcel Number: 337-383-008
Construction Cost: $16,102.01
Existing Use: Proposed Use:
Description of TEAR OFF EXISTING 1 LAYER, REROOF W/OWENS CORNING COOL ROOF IN SHASTA WHITE
Work: SUPREME
CRRC#0890-0001
Owner Contractor
ALBERT COMANDA SEARS HOME IMPROVEMENT PRODUCTS INC
28951 CROSBY DR P O BOX 522290
MENIFEE,CA 92586 LONGWOOD, FL 32752
Applicant Phone:4075516000
NATE COLYOTT License Number:721379
SEARS HOME IMPROVEMENT PRODUCTS INC
P 0 BOX 522290
LONGWOOD,CA 32752
Fee Description DQt Amount ISl
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 Peonit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
with a licensed contractors)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of
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. 7�9 the following reason:
License Class `_ ZLTz C3a License No. 74� / "I
By my signature below I acknowledge that,except formy personal residence
Expires .iV ,7✓ 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 wvnv.leeinfs.ca.eov/calaw.html.
this permit is issued.
Policy fl Date
141 have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZEDAGENT
/
section 3700 of the Labor Code,for the performance of the work forwhich o 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 am:
,, application and the information I have provided is correct.I agree to comply
r&l
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#GJCtJC�NkI'33�� Expires 511 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
Zlcerllfy that in the performance of the work for which this permit is issued,
shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE 11 "�(✓V
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 forth rth comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
',�/p� �z ^ mixture containing a hazardous material equal to or greater that the
Applicant _� v '^� Date l `T t r7 amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS oYes ❑No
UNLAWFUL,AND SHALL SUB1ECr 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 Duality Management District construction
t(SCtionor modee ification
checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATrORNEY5 FEES Coast Airllnes
Qua
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 100O 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
1 hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractor's License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material reporting.
Business and Professions Cade).Any city or county that requires a permit to oYes o No
construc /z�� Date
issuance,alsoalter,improve, applicantsh for he permiany tofilestructure,sign is 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 Contractor's State EPA RENOVATION,REPAIR AND PAINTING(FIRM
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 Rcensure 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($SOD). managers who do the paint-disturbing work themselves or through their
o 1,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 Contractor's 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. o 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 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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE
DATE: (- PERMIT/PLAN CHECK NUMBER �� O
PLANNING CASE NUMBER
TYPE: O COMMERCIAL "ESIDENTIAL 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 RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK ' " ,'AJ r,`ui)uL 5AA5rei
PROJECTADDRESS ( 1`(OS(� DuuL ZIP �i25'S�ly
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME GCt L 'E
ADDRESS 21! !s / C?OSI L( DP`
PHONE G/44 2 , 2^,17 - 5 30Y�— EMAIL
APPLICANT NAME
ADDRESS /
PHONE 7(() LI'2q 3,7t/2- EMAIL
CONTRACTOR'S NAME S OWNER BUILDER? O YES O NO
BUSINESS NAME ADDRESS '15K N-,T(zkev-Tiv4 AVC 5,0gPi4,0 CA c1Z121
PHONE 19 - (--30 - o l y S EMAIL
CONTRACTOR'S STATE LIC NUMBER '?21 3 7 a7 LICENSE CLASSIFICATION
VALUATION$ RJ.la1 SO FT/ Lf Z L SQ FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE O
INVOICE TOTAL GREEN SMIP
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
City of Menifee Building &Safety Department 129714 Haun Rd., Menifee,CA 92586 (951)672-6777
www.cityofmenifee.us
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