PMT18-04211 City of Menifee Permit No.: PMT18-04211
29714 HAUN RD.
ff MENIFEE, CA 92586 Type: Residential Re-Roof
MENIFEE MENIFEE Date Issued: 08/27/2018
PERMIT
Site Address: 28941 W WORCESTER RD, MENIFEE, Parcel Number: 339-141-009
CA 92586 Construction Cost: $10,000.00
Existing Use: Proposed Use:
Description of TEAR OFF 2 LAYERS, INSTALL 30#FELT AND CERTAINTEED COOL ROOF IN AGED CEDAR
Work: CRRC#0668-0055
Owner Contractor
ROBERT BRIGGS DONNOR ENTERPRISES INC
28941 W WORCESTER RD 20221 PEAR CIRCLE
MENIFEE, CA 92586 PERRIS, CA 92570
Applicant Phone: 9519433344
RON HEARTZ License Number:800984
DONNOR ENTERPRISES INC dba JARCO ROOFING
20221 PEAR CIRCLE
PERRIS, CA 92570
Fee Description QQt Amount[51
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 staled,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_Pennit_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 contractor(s)pursuant to the Contractors Stale License Law).
Chapler9(commencing with section7000)of Division 3 of the Business and of 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 rt q
7 l License No. 1�r? tl O c( By my signature below l acknowledge that,except for my personal residence
Expires 11 b Signature 2 in which I must have resided for at least one year prior to completion of
improvements covered by this permit.1 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
a 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 ceniricateof 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 OF at the following websile:
by Section 370Dof the Labor Code,for the performance of work for which wsnv.leeinfo.ca.eov/calaw.html.
this permit is issued.
Policy K Date
PROPERTY OWNER OR AUTHORIZED AGENT
O 1 have and will maintain workers compensation insurance,as required by
section 3700 of the Labor Code,for the performance of the work for which a By my signature below l 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 owner's behalf.I have read this
number are: application and the Information I have provided is correct.I agree to comply
Carrier / 14
with all applicable city and county ordinances and state lava relating to
((,� nnn building construction.I authorize representatives of this city or county to
Policy 4L.,Y6f -�2 xpir. r 441
enter the above identified property for inspection purposes.
un(This section need not to be completed Is the permit is for one- dred Date
dollars($300)or less PROPERTY OWNER OR AUTHORIZED AGENT
O I certify that in the performance of the work for which this permit is issued,
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE II
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 forthwith cam wit those provisions. Will the applicant or future building occupant handle hazardous material at
mixture containing a hazardous material equal to or greater that the
Applicant Date amounts ecifred on the Hazardous Materials Information Guide?
WARNING: ECUp iRKER'S COMPENSATION COVERAGEI ayes allo
UNVIW L,A HALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the in ended use of the building by the applicant or future building
ANDCIVILFI S UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant equire a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air uality,Management District(SCAQMDI?See permitting checklist
IN SECTION 37060E THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guider nes
CONSTRUCTION LENDING AGENCY oYes No
I hereby affirm that under the penally of perjury there is a construction Willthe roposed building or modified facility be within 100o feet of the
lending agency for the performance of the work which this permit is issued ou ter b ndary of a school?
f5ection 3097 Civil Code) aYes No
OWNER BUILDER DECLARATIONS 1 have r ad the Hazardous Material Information Guide and the SCAQMD
I hereby arm under penalty of perjury that I am exempt from the permitting checklist I understand my requirements under the State of
Californ�Health&Safety Code,Se 05 and 2S534 concerning
Contractors License Law for the reason(s)indicated below by the hazards smaterial repo
checkmark(s)I have prated next to the applicable item(s)(Section 7031.5 oyes o No
Business and Professions Codel.Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY R AIJTHORIZEDAGENT
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 ItZ'V TI REPAIRAND PAINTING IRRP
License Law(Chapter 9(commencing with Section 7000)of Division 3 or the The EPA Renovation,Repair and Painting jRRP)Rule requires contractors
Business and Professions Code)or that he or she is exempt from licensure receiving compensation for mast 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 far a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property
than(SSDD). managers who do the paint-disturbing work themselves orihrough their
al,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( I portion of the work,and the structure is www.eaa.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 aAn EPA Lead•SafeCertified 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. a No EPA Lead-Safe Certified I=is required for this project because:
D 1,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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION �' r, MENIFEE
DATE: 'Z PERMIT/PLAN CHECK NUMBER
GRADING/PLANNING CASE NUMBER/OTHER RELATED CASES
TYPE: @ COMMERCIAL O RESIDENTIAL O MULTI-FAMILY ®MOBILE HOME O POOL/SPA 0 SIGN
SUBTYPE: (j)ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
ONEW OPLUMBING ORE-ROOFNUMBB�ER OF SQUARES
DESCRIPTION OF WORK 2 r2o t= 'T-�aL. ¢ 2
Annr�vl o
OCCUPANCY GROUP CONSTRUCTION TYPE SPRINKLERS O YES ONO
PROJECT ADDRESS ZYJ°j'�/ k? cS'1` V p -�I�-tS y�L,�IP G orlxs-su
ASSESSOR'S PARCEL NUMBER y3M N-0 / LOT 151 TRACT
OWNER NAME V� � 5 J
ADDRESS WOK C T �Z
PHONE EMAIL
APPLICANT NAME &JE2ol,
ADDRESS C( V
PHONE j-'Cam` / i EMAIL
CONTRACTOR'S NAME e o -re-Om OWNER BUILDER? OYESONO
BUSINESS NAME
ADDRESS 'ZZZ t C/
PHONE � (�EgMfAIL
CONTRACTOR'S STATE LIC NUMBER 0(../,.,fJF 4 LICENSE CLASSIFICATION r�
VALUATION$ /O490 SO 2 l L SO,FT 2 1
APPLICANT'S SIGNATURE DATE 2•J
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE G I�
INVOICETOTAL ���. `�,/ GREEN SMIP
OWNER BUILDER VERIFIED 0 YES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
City of Menifee Building &Safety Department 129714 Haun Rd., Menifee,CA 92586 (951)672-6777
www.cityofm enifee.us
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