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PMT18-03011 City of Menifee Permit No.: PMT18-03011 29714 HAUN RD. k MENIFEE,CA 92586 Type: Residential Re-Roof MENIFEE MENIFEE Date Issued: 0 6/1 91201 8 PERMIT Site Address: 26197 LAZY CREEK DR, MENIFEE, CA Parcel Number: 338-272-010 92586 Construction Cost: $9,500.00 Existing Use: Proposed Use: Description of TEAR OFF EXISTING ROOF LAYERS, INSTALL NEW COOL ROOF SHINGLES Work: **CRRC#0890-0009 Owner Contractor DON HAAS BAKER ROOFING CORPORATION 26197 LAZY CREEK DRIVE 29515 DUNKIRK STREET MENIFEE,CA 92586 MENIFEE,CA 92586 Applicant Phone: 9512557237 LARRY BAKER License Number:884731 BAKER ROOFING CORPORATION 29515 DUNKIRK STREET MENIFEE,CA 92586 Fee Description Qtv Amount t51 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_BIdr_Permit_Template.rpt Page 1 of 1 City Of Menifee LICENSED DECLARATION ❑ 1 am exempt from Ilcensure under the Conlractod 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 on license is in full force and effect. which I must have resided for at least one year prior to completion of License Class t r�2q License O. ". k��)r7<3 1 improvements covered by this permit,I cannot legally sell a structure that I have Explres 3-1'� Signature Z"_ built as an owner-building if it has not been constructed in its entirely 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 this application is submitted or at the following Web site: ElI hereby affirm under penalty of perjury one the following declarations: htto://w .leginfo.ca.gov/mlaw.htmi. 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 gale Section 3700 of the Labor Code, for the performance of work for which this permit is issued. Property Owner or Authorized Agent Policy# ❑ By my Signature below, I 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 cured. I agree to comply permit Is issued.My workers'com ensation insurance carrier and policy number are: with all applicable oily and county ordinances and slate laws relating to building c,r- t construction.I authorize representatives of this city or county to enter the above- Carrier �qq"T[A"r:0Z,7J identified property for the inspection purposes. Policy#_Lp l'iw l'/1 Expires to--j gate - I - - Property Owner or Authorized Agent �'�/r (This section need not be completed If the permit is for City Business License# ©p� I J� one-hundred dollars(S100)or less) ty ❑ I certify 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 became 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 amountls�a Willed on the Hazardous Materials Information Guide? Code,I shall forthwith �coompplly with those provisions. DYES ,LINO Applicant•„C..-r `� Date; Will the(inttended 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)?See permitting checklist COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES ( O 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 ❑YES yeuNO 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 construction 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&Safely Code,Section 25505 and 25534 concerning 3097 Civil Code) hazardouusfpaterial reporting. OWNER BUILDER DECLARATIONS DYES I hereby affirm under penalty of perjury that 1 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 item(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 Contractors Slate 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 rams 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 anyApplicanl for a permit subjects the applicant to managers who do the paint-disturbing work themselves or through their a civil penalty 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.govllead or contact the National Lead Information Center al compensation,will do( )all of or( )porting of the work,and the structure is 1-BODd24-LEAD(5323). not intended or offered for sale.(Section 7044.Business and Professions Code; The Contractor's Stale License Law does not apply to an owner of a properly ❑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 Firm Name: the building or imprgvement 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 Firm Certification No.: purpose of sale). ❑ 1, as owner of the property an exclusively contracting with licensed No EPA Lead-Safe Certified Firm 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 oontractorfs)Pursuant to the Contractors State License Lawl. If vour oroierl does not rmmnly with rPA Rita ndo nlP...fill,,,n rl—RRP BUILDING & SAFETY PERMi i/PLAN CHECK APPLICATION ARAB, ME. [FEE DATE: ( — a PERMIT/PLAN CHECK NUMBER PLANNING CASE NUMBER TYPE: O COMMERCIAL ARESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA OSIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW O PLUMBING O'RE-ROOF NUMBER OF SQUARESo�3 DESCRIPTION OF WORK r PROJECT ADDRESS )of- . ZIP ASSESSOR'S PARCEL NUMBER - LOT TRACT CitV of Menifee Building Dept. OWNER NAME ADDRESS JUN 19 2018 PHONE EMAIL Rece' ved APPLICANT NAME ADDRESS Y PHONE q ]r, - ,7 ! r/ EMAIL CONTRACTOR'S NAME b OWNER BUILDER? O YES "0 BUSINESS NAME ` ADDRESS PHONE �t 5� 55 �� EMAIL CONTRACTOR'S STATE LIC NUMBER y� "] LICENSE CLASSIFICATION VALUATION $ qj c Q SO FT L SQ FT p �P,ij NT'S SIGNATURE k'_€ t CITYSTAFF USE ONLY DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE INVOICE TOTAL I "lO GREEN 1 SMIP �( OWNER BUILDER VERIFIED OYES O NO DRIVERS LICENSE# NOTARIZED LETTER 0 YES O NO City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586(951)672-6777 www.cityofmenifee.us 'J^ o s 0 n m m � v_I y n m M 0 W N F• .+ d m O m O A O O 3 R`� 'D GI IT1 n m n J O J p c o, vmi 3 m O d N d m n T (p m o ?. J wo " �. d a F, m wJ 'o om. Z — oT n � G M C p O p 9 '� w 7 O. m < O u m D a O g S 0 3 O D d 0 ID p N ry d -1 0 3 n o- m A N m p m a M m :0m o D A p S 0 .^.. 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