PMT18-02642 City of Menifee Permit No.: PMT18-02642
29714 HAUN RD. Type: Residential Re-Roof
�CCELA. MENIFEE, CA 92586
MENIFEE Date Issued: 0 513 012 01 8
PERMIT
Site Address: 28797 THORNHILL DR, MENIFEE, CA Parcel Number: 337-361-004
92586 Construction Cost: $9.000.00
Existing Use: Proposed Use:
Description of TEAR OFF OLD SHINGLES, INSTALL NEW SHINGLES CERTAINTEED COOL ROOF IN BIRCHWOOD
Work: CRRC#0668-0084
Owner Contractor
LARRY GRAHAM BAKER ROOFING CORPORATION
28797 THORNHILL DR 29515 DUNKIRK STREET
MENIFEE, CA 92586 MENIFEE, CA 92586
Applicant Phone: 9512557237
LAWRENCE BAKER License Number:884731
BAKER ROOFING CORPORATION
29515 DUNKIRK STREET
MENIFEE, CA 92586
Fee Description QtV 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
specifirations or from preventing butliding 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_Template.rpl Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ I am exempt from ffeensure under the Contractors State License Law for the
I hereby affirm under penalty or perjury that I am licensed under provisions of following reason:
Chapter 9(commencing With section 7000)of Division 3 of the Business and By my signature below I acknowledge that, except for my personal residence in
Professions Code and my license is in full force and effect which I must have resided for at least one year prior to completion of
License Class ,�-yZq License o. '. F �C7� i improvements covered by this permit, I cannot legally sell a structure that I have
Expires_ ^t `�1 Signature rG-- built as an owner-building if it has not been consWcled in its entirety by licensed
contractors. I understand that a copy of the applicable law,Section 7044 of the
WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when'lhis application is
submitted or at the fcllmving Web site:
❑ I hereby affirm under penalty of perjury one the following declarations: htio:J/www.leeinfo.ca.eov/calawhtml.
I have and will maintain a certificate of consentt of self-insure for workers'
compensation,issued by the Director of Industrial Relations as provided for by Date
Section 3700 of the Labor Code, for the performance of work for which this
permit is issued. Property Owner crAulhorized Agent
Policy# ❑ By my Signature below, 1 certify to each of the following:I am the property
I have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owners behalf. I have read this
section 3700 of the Labor Code, for the performance of the work for which this application and the information I have provided is correct. I agree to comply
permit is issued.My workers'compensation insurance carder and policy number are: with all applicable city and county ordinances and state laws rotating to building
�-'Tfil) L construction.I authorize representatives of this citymcounlyto enter the above-
Carrier D `�-p J l r� Identified property for the inspection purposes.
Policy#Lr:a- T-,/-7 q'?Expires `P'— ('i - Date
' Property Owner or Authorized Agent t�,f�..�(This section need not be completed If the permit is for City Business License# ��� I J
one-hundred dollars(S100)or less) ty
❑ I codify that in the performance of the work for which this permit is issued, I HAZARDOUS MATERIAL DECLARATION
shall not emolov any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or a
workers'compensation laws of California, and agree that if I should become mixture containing a hazardous material equal to or greater that the
subject to the workers'compensation provisions of Section 3700 of the Labor amounts specified on the Hazardous Materials Information Guide?
Code,I shall forthwith comply with those provisions. DYES ()ONO
Applicant Date; WIII the intended use of the building by the applicant or future building
occupant require a permit for the construction or modification from South
WARNING: FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)7 See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES (Qb
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES NO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAQMD
-I hereby affirm that under the penalty of perjury there is a constructlon lending permitting checklist.I understand my requirements under the State of
agency for the performance of the work which this permit is issued(Section California Health&Safety Code,Section 25505 and 25534 concerning
3097 Civil Code) hazardous material reporting.
OWNER BUILDER DECLARATIONS DYES,�LIVOC [�
I hereby affirm under penally of perjury that I am exempt from the Contractor's '/ �j Date
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY OWNER OR AUTHORIZED AGENT
next to the applicable ilem(s)(Section 7031.5. Business and Professions Code:
Any city or county that requires a permit to construct,alter, improve,demolish, EPA RENOVATION,REPAIR AND PAINTING(RRP)
or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
provisions of the Contractor's State License Law(Chapter 9(commencing with receiving compensation for most work that disturbs paint in a pre-1978
Section 7000)of Division 3 of the Business and Professions Code)or that he or residence or childcare facility to be RRP-certified firms and comply with
she Is exempt from licensure and the basis for the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civil penally of not more than(S500).) employees.For more information about EPA's Renovation Program visit:
❑ I, as owner of the property, or my employees with wages as their sole www.epa.gov#ead or contact the National Lead Information Center al
compensation,will do( ) all of or( )porting of the work, and the structure is 1-800-424-LEAD(5323).
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's Slate License Law does not apply to an owner of a property ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however, Certified Finn Name:
the building or imprqvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the Flan Certification No:
purpose of sate).
❑ 1, as owner of the property an exclusively contracting with licensed ❑No EPA Lead-Safe Certified Finn is required for this project because:
contractors to construct the project(Section 7044,Business and Professions -
Code:The Contractor's License Law does not apply to an owner of a property
who builds or improves thereon, and who contracts for the projects with a
licensed contractor(s)Dusuant to the Contractors Slate License Lawl. If your oroiect does nnl cmmnly wan FPA RRP cola ria,cA col ni,r m,o RRP
APPLICATION& SAFETY PERMIT/PLAN CHECK
"Venifee
DATE - 3 PERMIT/PLAN CHECK NUMBER
TYPE: ❑COMMERCIAL WRESIDENTIAL ❑MULTI-FAMILY []MOBILE HOME ❑POOL/SPA ❑SIGN
SUBTYPE: [-]ADDITION ❑ALTERATION ❑DEMOLITION [-]ELECTRICAL [-]MECHANICAL
❑NEW ❑PLUMBING RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
P 'Y& L-- ` t,4
PROJECT ADDRESS oR fir �
ASSESSOR'S PARCEL NUMBER ,.X2 LOT TRACT
PROPERTY OWNER'S NAME L
ADDRESS y/'
PHONE r3 q ` 7 Cll� _ EMAIL
APPLICANT NAME ,p v
ADDRESS ( 40 uk-, ^Y s`
PHONE �,�� `a�ls�'�� � � EMAIL
CONTRACTOR'S NAME c cam. C. OWNER BUILDER? [:1YEStjhO
BUSINESS NAME
ADDRESS [� _57
PHONE / LIZ o�s .7�-� �37 EMAIL
CONTRACTOR'S STATE LIC NUMBER 1 '7 3' LICENSE CLASSIFICATION
VALUATION$ 0-" SOFT Se-Vtl L SQ FT
APPLICANT'S SIGNATURE DATE ` -3 d ^f
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN l SMIP
INVOICE qr,Q PAID AMOUNT
AMOUNT I . 1 C. CASH '"_'CHECK# DCREDITCARD VISA/MC
LaN CHECK FEES PAIDAMOUNT 0 CASH U CHECK# O CREDFf CARD VISA/MC
UILDER VERIFIED G YES Q NO DL NUMBER NOTARIZED LETTER G YES O NO
Cify of Menifee Building&Safety Department 29714 Haun Rd. Ntenifee, CA 92586 951-672-C777
www.EJtyofn.Tenifee.us Inspection Request Lire 951-246-5213
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