PMT18-03630 City of Menifee Permit No.: PMT18-03630
29714 HAUN RD. Type: Residential Re-Roof
/Ar MENIFEE, CA 92586
MENIFEE MENIFEE Date Issued: 07/20/2018
PERMIT
Site Address: 25455 JUNO ST, MENIFEE,CA 92586 Parcel Number: 339-354-006
Construction Cost: $4,500.00
Existing Use: Proposed Use:
Description of REMOVE TILE AND INSTALL NEW PAPER AND SHINGLES UNDER SOLAR PANELS
Work:
CRRC:0890-0009
Owner Contractor
GUY COFFEE ANDRES LOPEZ
25455 JUNO STREET 8397 6TH AVENUE
MENIFEE, CA 92586 HESPERIA,CA 92345
Applicant Phone:7606692834
ANDRES LOPEZ License Number: 1031055
8397 6TH AVENUE
HESPERIA,CA 92345
Fee Description Qtv Amount f$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_Bidg_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 contractors)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 Contractors State License Law for
Professions Code and
d my license is In full force and effect. the following reason: ^/o.n....
License Clas "C/
-J'�1 License No. 0. � By my signature below I acknowledge that,except for my personal residence
Expires I- l-7.0)9 Signature in which I must have resided for at least one year prior to completion of
improvements covered bythis 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 workers 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.le info.ca. ov calaw.html
this permit is issued. 1
Policy# �'I_ L3 ( 2-L) /J abate I �)�
❑I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,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 workeescompensatlon Insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this
number are: ( � application and the information I have provided Is correct.I agree to comply
Carrier �71�t-C'-c- p)In with all applicable city and county ordinances and state laws relating to
y?-f/2 1 -7 building construction.I authorize representatives of this city or county to
POIity q#� t,: 1-Z 0 a
olff Expires �'"r- 0 I enter the above identified property for inspection purposes. qq ����
(This section need not to be completed is the permit is for one-hundred „�,.,��- Date L.-C7
dollars($100)or less PROPERTY OWNER OR THORI EG NT
❑I 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 became 0MA2ARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with th!p provisions. r, ,f Will the applicant or future building occupant handle hazardous material or a
Applicant Date Zd X mixture containing a hazardous material equal to or greater that the
v amounts s9q��cified on the Hazardous Materials Information Guide?
RE ❑WARNING:FAILURE TO SECURE WORR'S COMPENSATION COVERAGE IS Yes ao
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building bythe applicant or future building _
AND-CIVILFINESUP TO.ONE-HUNDREDTHOUSAND DOLLARS($100,000"N 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 for guideli s
CONSTRUCTION LENDING AGENCY ❑Yes :R•10
I hereby affirm that under the penalty of perjury there is a construction Will the car posed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer bou dary of a school?
(Section 3097 Civil Code) ❑Yes No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that am exempt from the permitting ecklist.I understand my requirements under the State of
California
Contractors License Law for the reason(s)indicated below by the eate ai Safety Code,Section 505 and 25534 concerning
2
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous Dyes To
aerial reporting. --
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish orrepair any structure,priorto its PROPERTY OWNER OR A'G�FOED MENT
issuance,also requires the applicant for the permit to file a signed statement
that he or sheds licensed pursuant to the provisions of the Contractors State EPA RENOVATION.REPAIR AND PAINTING IRRPI
License Law(Chapter9(commencing.with Section 7000)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 licensure 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($500). managers who do the paint-disturbing workthemselves or through their
❑1,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 Contractors 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:
❑II 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 fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE
DATE: ' I PERMIT/PLAN CHECK NUMBER VkATIS - 3 3D
GRADING/PLANNING CASE NUMBER
/III OTHER RELATED CASES
TYPE: 0 COMMERCIAL d6 RESIDENTIAL 0 MULTI-FAMILY O MOBILE HOME O POOL/SPA C SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING &RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK
0
OCCUPANCY GROUP CONSTRUCTION TYPE SPRINKLERS rO YES ,, O NO
PROJECTADDRESS ��,<K 0()Lk,0 i� 613V1 ±)t ZIP qpa' 8(0
ASSESSOR'S PARCEL NUMBER ✓'�591 35L4' V D(P LOT TRACT
OWNER NAME
ADDRESS uno + Spy
PHONE L-� EMAIL
APPLICANT NAME
ADDRESS
PHONE &397 6-11�GtJ EMAIL ok
71zo Gro9—z
CONTRACTOR'S NAME OWNER BUILDER? O YES ®'NO
BUSINESS NAME
ADDRESS / �(1, A-L,,� f l C� C Z
(�PHONE aJ 6(d—2 &::�zq EMAIL V�Ar tom..
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
I
VALUATION$ 'y�®O SOFT Sq L SO FT l/
APPLICANT'S SIGNATURE DATE (I 7�0vD/.y
DEPARTMENT DISTRIBUTION ACCEPTED BY CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE - 1 e,d-,
INVOICE TOTAL G _ez , GREEN 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.cityofinenifee.us City Df Menifee
Building Dept. N,F
JUL 20
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