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PMT18-03583 City of Menifee Permit No.: PMT18-03583 29714 HAUN RD. I Type: Residential Re-Roof 1 MENIFEE,CA 92586 MENIFEE MENIFEE Date Issued: 07/18/2018 PERMIT Site Address: 29677 PARKCITY AVE, MENIFEE,CA Parcel Number: 339-223-016 92584 Construction Cost: $14,000.00 Existing Use: Proposed Use: Description of TEAR OFF EXISTING SHINGLES 2400SF, REROOF CRRC#1214-0005, IKO CAMBRIDGE COOL Work: SERIES VALLEY OAK Owner Contractor BARTON HANEY JAX J C C INC 29677 PARK CITY AVE 1270 COLUMBIA AVE STE F8 MENIFEE,CA 92584 RIVERSIDE,CA 92507 Applicant Phone:8332677663 JAX J C C INC License Number:992388 1270 COLUMBIA AVE STE F8 RIVERSIDE,CA 92507 Fee Description ON Amount($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_Bldg_Permit_Template.rpl 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 ❑I am exempt from licensure under the Contractor's State License Law for Professions Code and my license is in full farce and effect. the following reason: License Class License No. Iq 23!gfl By my signature below I acknowledge that,except for my personal residence Expires Signature�.l.(-���S 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 ,ZI 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.leginfo.ca.gov/calaw.htmi. this permit is issued. Policy#14� Date y 1,have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT section 3700 of the Labor Cade,for the performance of the work for which ❑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 SS'tATf �tT,vu.^�AJS .Tro,v �vLa� with all applicable city and county ordinances and state laws relating to 1 building construction.I authorize representatives of this city or county to Policy# �12)I Soo) Expires G— 2— 19 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 AJ certify that in the performance of the work for which this permit is issued, 'I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# 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 fo (:wit amply with those provisions. C, will the applicant or future building occupant handle hazardous material or a Applicant II Date -7— O 9 mixture containing a hazardous material equal to or greaterthat the amounts specified on the Hazardous Materials Information Guide? WARNING:FAILUR TO SE URE WORKER'S COMPENSATION COVERAGE IS ❑Yes Po 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 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines CONSTRUCTION LENDING AGENCY ❑Yes No I hereby affirm that under the penalty of perjury there is a construction WIII the proposed building or modified facility be within 1000 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) ❑Yes �No OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD permitting checklist.I understand my requirements under the State of I hereby affirm under penalty of perjurythat I am exempt from the Contractor's License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning hazardous material reporting. checkmark(s)I have placed nett to the applicable Item(s)(Section 7031.5 Y..L,�� !; Business and Professions Code).Any city or county that requires a permit to oyes H. � (I/I �A` ' Date �� construct,alter,improve,demolish or repair any structure,priorto its PROPERTY O17WNER R AU I ORI D 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 IRRP) 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 Cade)or that he or she is exempt from licensure receiving compensation far 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($500). managers who do the paint-disturbing work themselves or through their ❑I,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.epa.gov/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. ❑No EPA Lead-Safe Certified Firm is required for this project because: ❑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: 7 PERMIT/PLAN CHECK NUMBER GRADING/ PLANNING CASE NUMBER/OTHER RELATED CASES TYPE: O COMMERCIAL ARESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL ONEW O/PLUMBING XRE-ROOF NUMBER OF SQUARES 2Z1 DESCRIPTION OF WORK /� �� 5)r! i G OCCUPANCY GROUP Q I n CONSTR<)CTION TYPE SPRINKLERS O YES ANO PROJECT ADDRESS 0%?-7JAKh��L'y,•, 'ny'L- ^/2bE.ti'iFcL�C IF zipCity ZSS ASSESSOR'S PARCEL NUMBER 3�jCt` �iZ� 6—Q16COT TRACT BuilofMenefee OWNER NAME 7bjh�,M_ eJ E ADDRESS Z -7 r-k Cj t' E1V/ 2�5— CA PHONE qoq -S18 - 54j& EMAIL j S G/vvP ceived APPLICANT NAME ADDRESS PHONE EMAIL CONTRACTOR'S NAME r ' ..IonJE.S OWNER BUILDER? OYES CANO BUSINESS NAME _,4 0 C.0 ,.Jc . RA - ADDRESS Z( LU r%a AL/C. I Ca. -s 9 2� PHONE J01 L{-j EMAIL j-3 pM $off 6'I ..'sr Ca/JST�uCT�e� CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION$ Jrf/066'6b SOFT 2-gDO LSQFT O APPLICANT'S SIGNATURE . - DATE g 0 DEPARTMENT DISTRIBUTION ACCEPTED BY: ry ,�` CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE INVOICETOTAL 1 2,0, O' GREEN 1 SMIP OWNER BUILDER VERIFIED OYES 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 KAIIIIIIIIIIA ENIF M i; ZG�O ,p � t N N m Z V a Y a Ey 0 — O m ]PO m K2GO ° cEC- cm V N O a) O N ¢ a t > E E 0 -0 S V j Ct O N :3 d o ` E e C U m a •o u n ° Y + LL y n + vm u o N 10 m « m o m _ u c 0 -aYC°cwma o 0 W w 0 °m=o o E aao c w $o 3:1 o ° N cm om o Nw c, nn°1.o m c 2- o 0 o y „ E Z ` > c = �_ E G 0 w n ut u a o M u m o o m O a` ? v u �. V 00 `u 't; O m ' 6 w } K u a N C O V V O d C O e9 0 C p Y 6' y C tl. 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J ; 3 03 `o = - To whom it may concern, Billy Thompson as an agent of Jax J CC Inc. dba AMS construction has my permission to conduct business on my behalf. Signed �E2�kMiE �}Or��S ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of CalifomiR County of L .b,kA-PLbs ( Q, ) (� On Jx q ��� before me, CSC c� L U�OTa �+�i �1 JOIi (insert narn nd title of the officer) personally appeared 4 -e-, '`,c)r'Q S who proved to me on the basis of satisfactory evidence to be the person(p)whose name(O is/ape subscribed to the within instrument and acknowledged to me that he/sire/grey executed the same in his/tjer/tt}eir authorized capacity(ips),and that by his/h,or/Weir signature(%%)on the instrument the person(), or the entity upon behalf of which the person(s)acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. STACky_POLK WITNESS my hand and official seal. ComrMnioo r 2133M Notary POWIc•Ctll im@ Skn.9anardino County_. - M Comm.Ei hl Nor 13.2019 Signature (Seal) _ � -ORIV.ERlI �SE LN q �� FN.JE END NONE 19DSD.WgRREN RD AYNE RIVERSIDE Dq RD- 2 Dos 03ry7N9 /JRST DNE - ,. _. . - WGT 2591b EYES.GI�N ` Do osnaizalassscimocwly j155 -' _ 07/96/2977