PMT18-04418 City of Menifee Permit No.: PMT18-04418
Am Am 29714 HAUN RD. Type: Residential Re-Roof
MENIFEE,CA 92586
MENIFEE MENIFEE Date Issued: 0 911 012 01 8
PERMIT
Site Address: 30176 CARMEL RD, MENIFEE, CA 92586 Parcel Number: 336-153-006
Construction Cost: $10,000.00
Existing Use: Proposed Use:
Description of REMOVE 3 LAYER COMP AND LAY NEW COOL ROOF COMPOSITION
Work:
CRRC:0890-0008
Owner Contractor
LINDA SHIFFLETT& DIANE PEARCE J D F CONSTRUCTION INC
30176 CARMEL RD 201 GEMINI AVE
MENIFEE, CA 92586 BREA,CA 92821
Applicant Phone: 7145261120
J D F CONSTRUCTION INC License Number: 956749
201 GEMINI AVE
BREA, CA 92821
Phone:7145261120
Fee Description Qy 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_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 perjurythat I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure underthe Contractors State License Law for
Professions Code and mylicense is in full force and effect. the following reason:
License License No. By my signature below I acknowledge that,except for my personal residence
Expires t Signature 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 DECLARATIO 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.leginfo.ca.gov/calaw.htmi.permit is issued.
Policy# Date
inI 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 carder and policy owner or authorized to act an the property owners behalf.I have read this
number are: 11�� application and the information I have provided is correct.I agree to comply
Carrieru with all applicable city and county ordinances and state laws relating to
A 4 building construction.I authorize representatives of this city or county to
Policy# IFLA 0 OS 86 S!-Expires ! enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for on Date
dollars($300)or less PROPERTY OWNER OR AUTHORIZED AGENT
❑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#
workers compensation laws of 'fomia,and agree that if I should became �•�J1Nh,�^-_�-RDOUS MATERIAL DECLARATION
subject to the workers com n ion provi itins 71 Section 3700 of the Labor
Cade,I shall forthwit a I ith tho ovisi S. /y1 Will the applicant or future building occupant handle hazardous material or a
Applicant Date �� / O mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide.
WARNING:FAILURE SECURE WORKER'S[ PENSATION COVERAGE IS 1JQ/es ❑No
UNLAWFUL,AND SHULL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN Will the intended use of the building by the applicant or future building
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)?See permitting checklist
for guidelines
CONSTRUCTION LENDING AGENCY o Yes XFJo
1 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) ❑Yes eiPo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the
Contractors License Law for the reason(s)indicated below by the California Health al Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed nextto the applicable items)(Section 7031.5 haz ous material reporting.
Business and Professions Code).Any city or county that requires a permit to es ❑No Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED AGENT
issuance,also requires the applicant forthe 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 tRRP)
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
an Applicant for a permit subjects the applicant to a civil penalty of not mare residence ra childcare h facility esto be RRP-certified firms and comply with
than($500). required practices.This includes rental property owners and property
managers who do the paint-disturbing work themselves orthrough their
❑I,as owner of the property,or my employee with wages as their sale 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.eoa.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 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:
❑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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE
DATE: ( PERMIT/PLAN CHECK NUMBER D
PLANNING CASE NUMBER
TYPE: O COMMERCIAL ` ESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION C>ALTERATION C, DEMOLITION O ELECTRICAL " MECHANICAL
NEW <i PLUMBING ARE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK (441.
Ok—
G•
PROJECT ADDRESS 3D "Iry CANA4.:e ✓L b ZIP- Iri�
6
ASSESSOR'S PARCEL NUMBER �' ' .Il,f Lj-f> -C-L VLOT TR.VWT OfMandee
OWNER NAME ,� r A 'r+g Dept.
ADDRESS
PHONE ILO l �4 p 3� .� EMAIL pp
APPLICANT NAME G
perivuu
ADDRESS q I
PHONE C, (,(,q �7`Z�6 Q EMAIL
CONTRACTOR'S NAME C VvV OWNER BUILDER? C YES CVO
BUSINESSNAME
ADDRESS Zo ✓-� p✓�� g2
PHONE t(2 O EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION C
VALUATION$ L D( Z'Z7 6 SO FT D L SO FT
APPLICANT'S SIGNATURE 1 DATE I0
W
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEEE,✓BU-SIINEESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE C1 �-[ L--
INVOICE TOTAL GREEN SMIP
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)672-6777
www.cityofmenifee.us
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CARE PROD.ID MANUFAMFER BRANDANDMODEL PRODUCrTn'E COLOR 501ARREFLECtANCE T !AiIIALEMMANCE 5R1 MOREINFO
INhr LL 3YEAR INMAL 3YEAR INITIAL 3YEAR
0890-D008 Owens Coming TmDefinRlon®Duration&Coal Asphalt5hl Bright 0.25 0.29 0.94 0.87 27 29 +
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Portland,OR 97217
CertiFlcale3I46.01
https:Hcoolroofs.org/directory 9/10/2018