PMT18-03444 City of Menifee Permit No.: PMT18-03444
29714 HAUN RD.
IF MENIFEE,CA 92586 Type: Residential Re-Roof
MENIFEE MENIFEE Data Issued: 07/11/2018
PERMIT
Site Address: 27037 MONK ST,MENIFEE, CA 92586 Parcel Number: 335-304-001
Construction Cost: $6,500.00
Existing Use: Proposed Use:
Description of TEAR OFF EXISTING ROOF, INSTALL 30#FELT AND REROOF W/OWENS COOL ROOF IN SIERRA
Work: GRAY
CRRC#0890-0013
Owner Contractor
TERRY GUPNGERICH SUDDUTH CONSTRUCTION INC
27037 MONK ST 1010 N BATAVIA ST STE F
MENIFEE,CA 92586 ORANGE, CA 92867
Applicant Phone:7146333619
MENIFEE, CA License Number: 847279
Fee Description gyt Amount fSl
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_Permit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
1 hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapler9(commencing with section 7000)of Division 3 of the Business and a 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 /3/ �35 LIFinse No. �G/�z By mysignature below I acknowledge that,except formypersonal residence
Expires 930/g- Signature_- in which lmust have resided for at least one year pdorlo completion of
p
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot leg llVsell constructed
structure that I
have built as an owner-builder if it has not been constructed in its entirely by
o I hereby affirm under penalty of perjury one of the fallowing declare lions:I licensed contractors.I understand that a copy of the applicable law,Section
have and will maintain a certificate of consent of self4nsure 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 car at the following websile:
by Section 3700 of the Labor Code,for the performance of work for which winopplic Lion is submitted
[ml.
this permit is issued.
Policy R Date
'cfFa—ve and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the La bar Code,for the performance of the work for which o By my signature below I certify to each of the following:I am the property
this permit is issued.My workefs 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 S''7/� with all applicable city and county ordinances and stale laws relating to
building construction.I authorize representatives of this city or county to
Policy `TD'TT3�S-�f Expires 3 " /Y-� 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
a I certify that in the performance of the work for which this permit is issued, ems'
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE 9
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions or Section 3700 of the Labor
Code,lshall.)ortlhwilhcom(p1'y vrit revisions. Will the applicant or future building occupant handle hazardous material ora
Applicant_ l' -rV�^"� Date S-�L��y� mixture containing a hazardous material equal to or greater that the
amounts spe9ed on the Hazardous Materials Information Guide.
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS aYes 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 3705 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY aYes e'I o4—
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 fee[of the
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Cade) ayes a4z
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Gufdeand the SCAQM0
I hereby affirm under penalty of perjury that 1 am exempt from the permitting checklist.I understand my requirements under the State of
California Health&Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the hazardou aI rial reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 s o No
Business and Professions Code).Any city or county that requires a perrnit to n--, Date,}
construct,alter.improve.demolish or repair any structure,prior to its PROPERTY WNER OR Al1THORREO 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 IRRPI
License Law(Chapter 9(commencing with Section 70001 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 Iicensure 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
a1,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-BOM24-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a o 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 Finn 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:
o I,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 RII out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION ME IFE
31,
bidd- 11a
DATE: PERMIT/PLAN CHECK NUMBER 1
GRADING/PLANNING CASE NUMBER/OTHER RELATED CASES
TYPE: O COMMERCIAL CI-RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAAL� O MECHANICAL
O NEW O P!!L/U'+MBING O RE-ROOF NUMBER OF SCLUARES 2e
DESCRIPTION OF WORK
OCCUPANCYGROUP CONSTRUCTION TYPE J�®D)`' /�J' SPRINKLERS OYES ONO
PROJECTADDRESS ZIP
ASSESSOR'S PARCEL NUMBER 3?j5�3V "" ' LOT 1;)L4_ TRACT kG13I p6.
OWNER NAME
ADDRESS / 2 7 a 3 7 O
PHONE �n7 �-rEMAIL
APPLICANT NAME C,-/� /
ADDRESS/ Q22 (/ /
J
PHONE 17�G� 36 EMAIL
CONTRACTOR'S NAME vim" �j¢/Z /`P OWNER BUILDER? OYES OfQt __
e
BUSINESS NAME
ADDRESS /V //�♦ 11 /^ —� �JIZi` /� ��
PHONE /G/� '3(0/ EMAIL
CONTRACTOR'S STATE LICNUMBER 5 LICENSE CLASSIFICATION
VALUATION$ `p Q SO FT L SO FT
APPLICANT'S SIGNATURE DATE
OTYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: CnY OF MENIFEE B-USJNES ICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE 44
INVOICETOTAL I0,50 -010 GREEN SMIP �
OWNER BUILDER VERIFIED O YES 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
www.cityofinenifee.us
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