PMT18-04094 City of Menifee Permit No.: PMT18-04094
29714 HAUN RD.
1 8 MENIFEE, CA 92586 Type: Residential Re-Roof
MENIFEE MENIFEE Date Issued: 08/27/2018
PERMIT
Site Address: 27635 AVENIDA INTERNO, MENIFEE, CA Parcel Number: 333-271-025
92585 Construction Cost: $16,950.00
Existing Use: Proposed Use:
Description of REMOVE EXISTING TILE ROOF, REMOVE EXISTING FELT, REPLACE W130#FELT, REPLACE
Work: EXISTING TILE ROOF
Owner Contractor
DWIGHT ZIEGLER PETERSEN-DEAN INC
27635 AVENIDA INTERNO 39300 CIVIC CENTER DRIVE
MENIFEE,CA 92585 FREMONT, CA 94538
Applicant Phone:5103716500
ASIA THOMAS License Number:468117
PETERSEN-DEAN INC
39300 CIVIC CENTER DRIVE
FREMONT,CA 94538
Fee Description o_yt Amount ISl
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_Pemft Templale.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 contractor(s)pursuant to the Contractors Stale License Law).
Chapter9(commencing with section 70D0)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\o919 Ucennsse��No. `A- Oyll � By my signature below l acknowledge that except for my personal residence
Expires 1 7 I Signature jryAt C�— �� in which l must have rm;ded for at least one year prior to completion of
improvements covered by this permit.I cannot legally sell astructure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
o I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.)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 wsnv leeinfo.ca.eov/calasv.html.
this permit is issued.
Polity 0 Date
,a'f 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 o 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: \!o application and the information I have provided is correct.I agree to comply
Carrier T"� (.J L�-'�` with all applicable city and county ordinances and state laws relating to
(+� building construction.I authorize representatives of this city or county to
Policy R ,�l(-�V��`( _ _ Expires y� r�y 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
a 1 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 0
worker's compensation laws of California,and agree that if I should become AZyRDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Cade,I shall rthwith comply with those provisions. /� Q (,,� Will the applicant or future building occupant handle hazardous material or a
h
Applicant (rf 1 1'I cY fl/l C6 Date `T �`-' mixture containing a hazardous material equal to or greater that the
J amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ayes "o
UNLAWFUL,AND SHALL SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UPTO 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 oYes PMo
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 10DO 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) ayes 9d4o
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMO
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.i understand my requirements under the State of
Contractor's License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material reporting. AAA -
Business and Professions Cade).Any city or county that requires a permit to oyes "o ( 1 t_ /A !l fA
li /N 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 1RRPI
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 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 complywith
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
a 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.eov/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 he 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. 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 oamptyw)th EPA RRP rule please rill out the RRP
Acknowledgement.
IVfeni{ee -
$ 0
DATE jI PERMIT/PLAN CHECK NUMBER �
TYPE: ❑COMMERCIAL ORESIDENTfAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ❑SIGN
SUBTYPE: []ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL [I MECHANICAL
[3NEW [:]PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK "� ' •'�i i
PROJECTADDRESS If', j �. '
v i I.1
ASSESSOR'S PARCEL NUMBER LOT TRACT
—7
PROPERTY OWNER'S NAME ,I�)( L ' I l 1 �" ` I T
ADDRESS - �l`ter `<
PHONE L� ; LI EMAIL
APPLICANT NAME -) I
ADDRESS 1 Y _' ( l
PHONE '-II I. ( k 1�I '�`, �,�-1 +`.�-1 11 A �J
EMAIL
CONTRACTOR'S NAME _rsenneavn Inc. OWNER BUILDER? ❑YES NO
BUSINESS NAME
ADDRESS Ub p ��1 , n -e
G� //'/I
PHONE ,J L / ` - p EMAIL
CONTRACTOR'S STATE LIC NUMBER _ 40111 LICENSE CLASSIFICATION �- I
VALUATION$ I I ( UT' SQ FT\, Z L SO FT
APPLICANT'S SIGNATURE _ -- - - - it DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN .� SMIP
INVOICE PAID AMOUNT
AMOUNT ':CASH vCHECKk OCREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH CCHECK# OCREWCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZED LETTER O YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd.Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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