PMT18-04212 City of Menifee Permit No.: PMT18-04212
29714 HAUN RD. Type: Residential Re Roof
�A ff MENIFEE, CA 92586
MENIFEE MENIFEE Date Issued: 08/2712018
PERMIT
Site Address: 25768 ROANOKE RD,MENIFEE, CA Parcel Number: 339-042-015
92586 Construction Cost: $9,000.00
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
TIM MATTHEWS DONNOR ENTERPRISES INC
25768 ROANOKE 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, CA92570
Fee Description OQt Amount I51
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.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 l am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter!)(commencing with section 7000)of Division 3 of the Business and o I am exempt from Iicemure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. n the fallowing reason:
License Class C' n7 I license No. Q C( By my signature below l acknowledge that,except formy personal residence
Expires 11 b Signature ��— in which I must have resided for at least one year prior to completion of
WORKERS COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that 1
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.I understand that a ropy of the applicable law,Section
have and will maintain a certificate of consent of self-insure for warker'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 websile:
by Seaton 37GO of the Labor Code,for the performance of work for which tvt"v.leginfo.ca.gov/calaw.htmi.permit is issued.
Policy R Date
D I have and will maintain worker's compensation imamate,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 l certify to each of the following:I am the property
this permit is issued.My workers compensation insurance asrderand policy owner or authorized to act an 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 Y with all applicable city and county ordinances and state laws relating to
G� building construction.I authorize representatives of this city or county to
Policy yfr Yq'7--' x O r enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-1 undred Date
dollars($1GO)or less PROPERTY OWNER OR AUTHORIZED AGENT
a 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 tothe CITY BUSINESS LICENSE 4
worker's compensation laws of California,and agree that if I should became HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the labor
Code,I shall forthwith com wit those provisions. Will the applicant or future building occupant handle hazardous material or
Applicant Date mixture containing a hazardous material equal to or greater that the
amounts eci0ed on the Hazardous Materials Information Guide?
WARNING: FLUR RKER'S COMPENSATION COVERAGE I a Yes :i No
UNLAW L,A HALLSUB)ECT AN EMPLOYER TO CRIMINAL PENALTIES Will the inended use of the building by the applicant or future building
AND CIVIL FI 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 utility Management District(SCAQMD)?See permitting checklist
IN SECTION 37060FTHE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidef nes
CONSTRUCTION LENDING AGENCY aYes No
I hereby affirm that under the penalty of perjury there is a construction Will the roposed building or modified facility be within 1000 feet of the
lending agencyfor the performance of the work which this permit is issued outer ndary of a school?
(Section 3097 Civil Code) a Yes No
OWNER BUILDER DECLARATIONS Ihawr ad the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that lam exempt from the permitting checklist.I understand my requirements under the State of
Californ�Health&Safety Code,Se ' 05 and 25534 concerning
Contractor's License Law for the reasons)indicated below by the hazards smaterial repo j
checkmark(s)I have placed next to the applicable item(s)(Section 70315 OYes O No
Business and Professions Code).Any city or county that requires a permit to Dale
construct,alter,Improve,demolish or repair any structure,prior to its PROPERTY .R AUTHORI2EDAGENT
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 RENOVATI REPAIRAND PAINTING IRRP
License Law(Chapter 9(commencing with Section 700D)of Division 3 of the
Business and Professions Code)or that he or she is exempt from licensure The EPARenovation,Repair and Paintingat dis(RRPIturbs
Rube painrequt
contractors
receiving compensation for most work that disturbs pain[in apre-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-disturbfng work themselves or through their
O1,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.eoa.eov/lead or contact the National Lead Information Center at
not intended or offered for safe.(Section 7044,Business and Professions 1-800.424-LEAD(5323).
Code;The Contractors State License taw does not apply to an owner of a aAn EPA Lead-Safe Certined 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 said 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 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 71144,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: � 2 7 PERMIT/PLAN CHECK NUMBER
GRADING/PLANNING CASE NUMBER/OTHER RELATED CASES
TYPE: Q COMMERCIAL ESIDENTIAL (F)MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: QADDITION ()ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
ONEW OPLUMBING ORE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK T<e.v V7` �v✓
57,1 rl /4' T -
OCCUPANCY GROUP CONSTRUCTION TYPE SPRINKLERS O YES ONO
PROJECFADDRESS LL �O(iC�S ZIP 6I1
ASSESSOR'S PARCEL NUMBER �� 1��5 LOT 14W TRACT ✓ .N4
OWNER NAME -rj VK
ADDRESS r2-" /C LrX�IiVQCGL-�
PHONE 1�,EMAIL
APPLICANT NAME ��j /
ADDRESS d:IV Z ln-C4� ( Aa--t-� Gkz
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILDER? Q YES®,NO
BUSINESS NAME ��4a2GO �Z@O
ADDRESS
q 20 22 / �cu.r/ 6. 1/ d-c C r p,/s C/
PHONE /s`/ —q cE 3 3 y--je EMAIL
CONTRACTOR'S STATE LIC NUMBER 80znq,.q y LICENSE CLASSIFICATION
VALUATION$ 960 SOFT L sQ Fr 2 r J
APPLICANT'S SIGNATURE DATE 2 C
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
INVOICE TOTAL I A �o1'O GREEN SMIP
OWNER BUILDER VERIFIED 0 YES C NO DRIVERS LICENSE# NOTARIZED LETTER O YES 0 NO
City of Menifee Building &Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6777
www.cityofmenifee.us
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