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PMT18-04913 City of Menifee Permit No.: PMT18-04913 29714 HAUN RD. Type: Residential Re-Roof 1/0 MENIFEE,CA 92586 MENIFEE MENIFEE Date Issued: 10/0912016 PERMIT Site Address: 25820 MCCALL BLVD, MENIFEE,CA Parcel Number: 335-092-037 92586 Construction Cost: $7,145.00 Existing Use: Proposed Use: Description of REMOVE EXISTING COMP ROOF TO DECK RE-ROOF WITH COOL ROOF CRRC#0890-0012 Work: Owner Contractor CLIFFORD BUTLER JOHN RICHARDSON INC 25820 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 QQt( Amount 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. Page 1 of 1 AA_Bldg_Permil_Template.rpt i 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( J pursuantto 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 my license is in full and a ect. the following reason: License Class — Licens a. By my signature below I acknowledge that,except for my personal residence Expires Signa` t� .,([� in which I must have resided for at least one year prior to completion of WORKER'S COMPENSATION DECLA ON improvements covered by this permit.I cannot legally sell a structure that I ❑I hereby affirm under penalty of perjury one of the following declarations:I have built as an owner-builder if it has not been constructed in its entirety by have and will maintain a certificate of consent of self-insure for walkers licensed contractors.I understand that a copy of the applicable law,Section compensation,issued by the Director of Industrial Relations as provided for 7044 of the Business and Professions Code,is available upon request when by Section 3700 of the Labor Cade,for the performance of work for which this application Is submitted or at the fallowing website: this permit is issued. www.Ieginfia.ca_gov/caIaw.htmI. Polity# Date o l 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 ❑By my signature below 1 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 /N� with all applicable city and county ordinances and state laws relating to //__ building construction.I authorize representatives of this city or county to cf Pabcy p 2 Expires enter the above identified property for inspection purposes. (This section need not to be cam pleted is the permit is for one-hundred dollars($100)or less Date certify that in the performance of the work for which this permit is issued, PROPERTY OWNER OR AUTHORIZED AGENT shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE JJ worker's cam ensation o if nia,and agree that if I should become subje the work rs -pens n provisions of that 3700 of the Labor HAZARDOUS MATERIAL DECLARATION Co e,I shall fart c° I i those ovisions. q (�� Will the applicant or future building occupant handle hazardous material or a A plicant Date mixture containing a hazardous material equal to or greater that the amounts specified an the Hazardous Materials Information Guide? WARNI • AILURETO SECURE WORKER'S COMPENSATION COVERAGE 15 ❑Yes "-94No 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 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)?See permitting checklist forguidelines CONSTRUCTION LENDING AGENCY ❑Yes ❑No 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 bou all Iry of a school? (Section 3097 Civil Code) ❑Yes -,(L.Np OWNER BUILDER DECLARATIONS I 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 alth afety Code, ion 25 5 and 25534 concerning checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous m ter' I reporting. Business and Professions Code).Any city or county that requires a permit s ❑ construct,alter,improve,demolish or repair any structure,prior to Its / Date issuance,also requires the applicant for the permit to file a signed statement P OF W E OR AUTHORIZED GENT that he or she is licensed pursuant to the provisions of the Contractors State EP RENOVATION REPAIR AND PAINTING 1RRP1 Ucense Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt from licensure The EPA Renovation,Repair and Painting(RRP)Rule requires contractors and the basis for the alleged exemption.Any violation of Section 7031.5 by receiving compensation for most work that disturbs paint in a pre-1978 an Applicant for a permit subjects the applicant to a civil penalty of not more residence or childcare facility to 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 or through 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()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 property who,through employees'or personal effort,builds or improves the o An EPA Lead-Safe Certified Renovator will be responsible for this project 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. ❑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. I„ BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE DATE: Q ( PERMIT/PLAN CHECK NUMBER ( �r 13 PLANNING CASE NUMBER TYPE: O COMMERCIAL - RESIDENTIAL 0 MULTI-FAMILY O MOBILE HOME O POOL/SPA 0 SIGN SUBTYPE: O ADDITION O ALTERATION '0 DEMOLITION O ELECTRICAL O YECHANICAL ONEW OPLUMBING RE-ROOF NUMBER OIFSQUARES V DESCRIPTION OF WORK PROJECTADDRESS eCS 75 o�L-� M c �-/'u" " ZIP ASSESSOR'S PARCEL �NUMBER .,�p� LOT TRACT OWNER NAME /� � � ADDRESS 7 6�/�+(,`/' r- CA" l Y� PHONE EMAIL 36 APPLICANT NAME ADDRESS PHONE(�I ��s� �r f�EMAIL OWNER BUILDER? OYES 0 CONTRACTOR'S NAME BUSINESS NAME :�CV/' ,�� ADDRESS �( �0 e/ l `"' C'77�P� GU �"Pv lam--C. �jC7Ck �(Z2 PHONE Q�;('zl2_ a '�//..��^�•� EMAIL CONTRACTOR'S STATEE''LIC NUMBER CL2-�' / LICENSE CLASSIFICATION VALUATION$ `7t`r�'- Q�F/T;� .�Y" L SO FT APPLICANT'S SIG ATURE (�w` DATE vOlq CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION ACCEPTED BY: CITYOF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE SMIP GREEN INVOICETOTAL O OWNER BUILDER VERIFIED O YES O 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 PMWNIFEVj a V C l7 N ; _ O a m w Y c E LL O Z• O d q « A = m co E 0 C a E ` w u a a ¢ ¢ t � E LU z 3 v N d a y N W N J a p u C pt Q d a C U a D N at+ T H V OO U O m E drl u 5 c O m � V O m l > O j u 'd-' G C d ` « w ai 0 a a .o o m. `° n ..0'•aOd' voO`No32' �NvE pm pem m O amo O > p °o mNJacaEm6 r�a=uaa�od wa0um•6mmcoaaJ ot o o V Om V V dO • o v E na w oV m u r y c Y pm OM�? 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