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
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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
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