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PMT18-04910 City of Menifee Permit No.: PMT18-04910 29714 HAUN RD. Type: Residential Re-Roof Or MENIFEE, CA 92586 MENIFEE MENIFEE Date Issued: 1 010 912 01 8 PERMIT Site Address: 25830 MCCALL BLVD, MENIFEE, CA Parcel Number: 335-092-036 92586 Construction Cost: $7,145.00 Existing Use: Proposed Use: Description of REMOVE EXISTING COMP ROOF TO DECK, RE-ROOF WITH COOL ROOFCRRC#0890-0012 Work: Owner Contractor ED PIETSKOWSKI JOHN RICHARDSON INC 25830 MCCALL BLVD P 0 BOX 6083 MENIFEE,CA 92586 MORENO VALLEY,CA 92554 Applicant Phone:9516536132 JOHN RICHARDSON License Number:643209 JOHN RICHARDSON INC P 0 BOX 6083 MORENO VALLEY, CA 92554 Fee Description Oft 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.rpl Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects 1 hereby affirm under penalty of perjury that 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 o I am exempt from licensure under the Contractors State License Law for Professions Code and my license is infull.Eerc andd'�ef effect., the following reason: License Class - Ucens Jo. �' � By my signature below I acknowledge that,except for my personal residence Expires / gnat.,._,� ,,([/ in which I must have resided for at least one year prior to completion of WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I i 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 by Section 3700 of the Labor Code,for the performance of work for which this application is submitted or at the following website: this permit is issued. www.leginfo.ca.gov/calaw.htmi. Policy p Date - o 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 O 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 Carrier i v N� with all applicable city and county ordinances and state laws relating to /_�"'r-t/Tzm building construction.i authorize representatives of this city or county to Policy g7cY Expires 2 (y enterthe above identified property for inspection purposes. (This section need not to be completed Is the permit is for one-hundred dollars($100)or less Date PROPERTY OWNER OR AUTHORIZED AGENT certify that in the performance of the work for which this permit is issued, shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE g workers com ensatian la sc�dfOa'f Pia,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subj'et the work rs -0mpens n provisions of Section 3700 of the Labor Co e,I shall fort co I i thosee/pprovisions. /q /('�/ Will the applicant or future building occupant handle hazardous material or a A piicant Date (] 9 �S� mixture containing a hazardous material equal to or greater that the amounts specified on the Hazardous Materials Information Guide? WARN[ • AILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 ❑Yes 'No UNLAWFUL,AND SHALL 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 OFTHE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)?See permitting checklist for guidelines CONSTRUCTION LENDING AGENCY Dyes ONO 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 boary of a school? (Section 3097 Civil Code) a Yes OWNER BUILDER DECLARATIONS 1 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 C Mi aith afety Code, ion 25 65 and 25534 concerning checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous an er' I reporting. Business and Professions Code).Any city or county that requires a permit t If—es O �x construct,alter,improve,demolish or repair any structure,prior to its Date -L issuance,also requires the applicant for the permit to file a signed statement P OP WE OR AUTHORIZED GENT that he or she is licensed pursuant to the provisions of the Contractors State EP RENOVATION,REPAIR AND PAINTING(RRPI 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 apre-1978 and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be rk that i disturbs firms and comply withan Applicant for a permit subjects the applicant to a civil penalty of not more required orc Mies ref includes rental property than($500). p p rty owners and property managers who do the paint-disturbing work themselves or through their o I,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 completion,the Owner-Builder will have the burden of proving that it was Firm Certification No.: not built or improved for the purpose of sale. O No EPA Lead-Safe Certified Finn is required for this project because: o 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.