PMT18-02941 City of Menefee Permit No.: PMT18-02941
29714 HAUN RD.
//,r MENIFEE, CA 92586 Type: Residential Re-Roof
MENIFEE MENIFEE Date Issued: 06/14/2018
PERMIT
Site Address: 23830 VISTA WAY, MENIFEE,CA 92587 Parcel Number: 351-083-020
Construction Cost: $8,000.00
Existing Use: Proposed Use:
Description of REMOVE ALL EXISTING ROOF LAYERS, INSTALL NEW COOL ROOF SHINGLES
Work: **CRRC#0668-0051 **
Owner Contractor
DAVID BERGER DONNOR ENTERPRISES INC
23830 VISTA WAY 20221 PEAR CIRCLE
MENIFEE,CA 92587 PERRIS,CA 92570
Applicant Phone: 9519433344
RON HEARTZ License Number:800984
DONNOR ENTERPRISES INC
20221 PEAR CIRCLE
PERRIS, CA 92570
Fee Description ON 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 81dg_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 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. the following.reason:
License Class C— 3 el License No. 2 O V 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 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 www.leeinfo.ca,eov/calaw.html.
this permit is issued.
Policy# �J Zo ft 9 22 „ A Date
PROPERTY OWNER OR AUTHORIZED AGENT
o I have and will maintain worker's compensation insurance,as required by
section 3700 of the Labor Cade,for the performance of the work for which D 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 C C. with all applicable city and county ordinances and state taws relating to
building construction.I authorize representatives of this city or county to
Policy# Expires ( / g 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
❑I certify that in the performance of the work for which this permit is issued,
1 shall not ample v any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's compensation laws of C ifomia,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's co li�povmonsf5ectoCdeIE 'rtl nc— Will the applicant or future building occupant handle hazardous material or a
Applicant Date /'�j mixture cons ' ing a hazardous material equal to or greater that the
amounts ecified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o 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
INSELSLON3MaTHE LABOR CODE,INTEREST,ARD ATTORNEYS FEES --- -Coast ALr Qual' Management District(SCAQMD)?See permitting checklist .
for guidelin
CONSTRUCTION LENDING AGENCY ❑Yes o
1 hereby affirm that under the penalty of perjury there is a construction Will the propos bullding or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit Is issued outer bounofy of a school?
(Section 3097 Civil Code) ❑Yes o4o
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCADMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contracto(s License Law for the reason(s)indicated below by the California Health al Safety Code, coon 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous terial reporting.
j,q1_�a
oyes i^"
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve, applicanemolisht
for
permi any t
filestructure,signeor d
statement
PROPERTY OWNER THORIZED 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 fRRPI
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RAP)Rule requires contractors
Business and Professions Code)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 7032.5 by residence or childcare facility to be RRP-certiried 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 1,as owner of the property,or my employee with wages as their sale 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.aov/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 ❑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 RAP
Acknowledgement.
BUILDING & SAFETY PERIMIT/PLAN CHECK APPLICATION L1 MENIFEE
A-
DATE: PERMIT/PLAN CHECK NUMBER
PLANNING CASE NUMBER
TYPE: O COMMERCIAL Z RESIDENTIAL O MULTI-FAMILY O MOBILE HOME C POOL/SPA O SIGN
SUBTYPE: O ADDITION 0 ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK 7'C.Grt_ .® iz;-!t/ +
.!Ak z 3 c
PROJECT ADDRESS 2-3S3[? (N ZIP
ASSESSOR'S PARCEL NUMBER- = LOT TRACT
OWNER NAME A ( ], ) Ls IQ L Building Dept.-
City of Menifee
ADDRESS 203 V
PHONE -7/00 - (a 2Z - 2- 9- Y y EMAIL JUN 9 4 7.018
APPLICANT NAME VON
Received
ADDRESS Z O Z'L1 v-/9i0--
PHONE 14V - eI3 -"3,3 CC EMAIL
CONTRACTOR'S NAME J OWNER BUILDER? 0 YES (5 N0
BUSINESS NAME
ADDRESS z C922 Pa-wq- L /��/Z✓t�
�7
PHONE / �t�3 — sj 3�� EMAIL
CONTRACTOR'S STATE LIC NUMBER 6001904 LICENSE CLASSIFICATION �— 3
T
VALUATION$ Cd 90 O Q FT L SQ FT
APPLICANT'S SIGNATURE DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS UCENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
INVOICETOTAL .90 GREEN ` - SMIP x
OWNER BUILDER VERIFIED OYES 0 NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
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