PMT18-04011 City of Menifee Permit No.: PMT18-04011
29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Re-Roof
MENIFEE MENIFEE Date Issued: 08/14/2018
PERMIT
Site Address: 26275 CHERRY HILLS BLVD, MENIFEE, Parcel Number: 337-044-005
CA 92586 Construction Cost: $9,700.00
Existing Use: Proposed Use:
Description of REMOVE ALL EXISTING ROOF LAYERS, INSTALL NEW COOL ROOF SHINGLES
Work: •'CRRC#0890-0009"
Owner Contractor
JERRY SEBASH DAN'S ROOFING INC
26275 CHERRY HILLS BLVD 19011 MERMACK AVENUE
MENIFEE, CA 92586 LAKE ELSINORE, CA 92532
Applicant Phone:9514710008
CHRIS VEDENOFF License Number.491438
DAN'S ROOFING INC
19011 MERMACK AVENUE
LAKE ELSINORE, CA 92532
Fee Description QtV Amount ISI
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_Permi1_Template.rpt Page 1 of 1
C)rnv:�s \3e&x oVV - rAn s
CITY OF MENIFEE o- ' \!�
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 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 341 License/e�,q/,/yIo. 11N316 By my signature below I acknowledge that,except for my personal residence
A 3D
Expires IB Signature C�v= 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 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.IegInfo.ca.gov/ca permit is issued.
Policy# Date
❑I have and will maintain workers 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 workers compensation 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
with all applicable city and county ordinances and state laws relating to
Cartier 5kck Rkr,,cK building construction.I authorize representatives of this city or county to
Policy#(tZ9-k0t0Q— la Expires `� '� 11 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
o I certify that in the performance of the work for which this permit is issued,
1 shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the wos compensation provisions of Section 3700 of the Labor
Code,I shall fo w'h comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
n o mixture containing a hazardous material equal to or greater that the
Applicant Date PJ /e amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SE URE WORKER'S COMPENSATION COVERAGE IS ❑Yes in 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 37060FTHE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguideiines
CONSTRUCTION LENDING AGENCY o Yes o No
I hereby affirm that under the penalty of perjury there is a construction Will 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) o Yes D No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractors 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 next to the applicable item(s)(Section 7031.5 oYes cr No
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED 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(RRP)
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 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($500), managers who do the paint-disturbing work themselves or through their
01,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. 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 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.
—.a
r v¢3L
City of Menifee
Building Dept.
AUG 14 2018
19011 MERMACK AVENUE•LAKE ELSINORE,CA.92532
PHONE(951)471-0008•FAX(951)471-0071
CA License#49143 8 Received
04-11-2018
To whom it may concern: The following employees are authorized to pull permits and
pick up plans on behalf of Dan's Roofing, Inc.
Chris Vedenoff Dan Williams Dave Douglas
Mike Blackburn Robert Brian Themins
If you tV any questions,p ease feel free t contact the office.
Daniel Williams,President/Kim Teran, office manager
A wtWy public a ether otficar coinpatinp Us
cm"Cate wdPu 0*-ftweinityorine .
State of CGI�-�r n t Q musk xno s0,w tnd dowment 1,tla ,gns
certificate is aeW.and not the tmtl�fulneas,
acuaacy,or validity of that dmment
County of rst Q -Q
On lipmI l I . '1OI ip. beforemex- 1K Morke.n ser- ,
(name of notary public)
personally appeared k l M Te C-1QLr't who proved to me on the basis of satisfactory
evidence to be the person(a)whose nameWisWsubscribed to the within instrument and who acknowledged to me that
he/she/t e(�y executed the same in(qei ' uthorized capacity(iss),and by his/he eir ignatureo)on the instrument the
persoaK or entity upon behalf of which the person(s)Scted,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.
WITFIE hen and Gcfa�lsrea].
Ir JN� anninnm minnoinnnnnnnunnnunmm�nnnnnnnnimnimnnnux
J.M.MORTENSEN =
(Signature of Notary) SEAL = cOMM.#220909s
-=-^.A Notary Public-California �
- s Riverside County e
.. My Comm.Expires Aug.22,202[
innnini annmm�nnwnnnmmnnnunnnnnnnnnnnuunuinmwZ
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE
DATE: Iq 16 PERMIT/PLAN CHECK NUMBER
PLANNING CASE NUMBER
TYPE: 0 COMMERCIAL I9LRESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING KLRE-ROOF NUMBER OF SQUARES_
DESCRIPTION OF WORK �TLroo� u �T'pn hlin �0
PROJECTADDRESS Z(,Z'15 r h" �3�Jd ZIP L ZJ &
ASSESSOR'S PARCEL NUMBER LOT TRACT City of Menifee
13uilding Dept.
OWNER NAME
ADDRESS of -15 -�t, s BWA
qQ
PHONE _ 6'1Z.-1°l9� EMAIL Receivec
APPLICANT NAME l oell L'�""
ADDRESS Ql• L 'G.. )QI .M_ C, A Z Z
PHONE Q$I- `{-ll-C)D(j$ EMAIL �t�5 �- AAas(bd-qA .c00%
CONTRACTOR'S NAME
F� OWNER BUILDER? O YES OCNO
BUSINESS NAME 5 D '�TT71_ry
ADDRESS I I_Df%oor, C4 S3 Z
PHONE Q����{��OLY6 e. EMAIL r1 t (p0 � - ooh
CONTRACTOR'S STATE LIC NUMBER 'q l n LICENSE CLASSIFICATION C J
VALUATION$ 0% -100 SQ FT a B0 L SQ FT
APPLICANT'S SIGNATURE DATE $ 14 /S
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
INVOICETOTAL GREEN I„ SMIP x
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
City of Menifee Building & Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777cK
www.cityofmenifee.us
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