PMT18-04956 City of Menifee Permit No.: PMT18-04956
29714 HAUN RD. Type: Residential Re-Roof
MENIFEE, CA 92586
MENIFEE MENIFEE Date Issued: 10/11/2018
PERMIT
Site Address: 27855 VAN BUREN AVE, MENIFEE, CA Parcel Number: 329-143-006
92585 Construction Cost: $3,500.00
Existing use: Proposed Use:
Description of REMOVE ALL EXISTING ROOFING LAYERS, INSTALL NEW TORCH-DOWN ROOFING MATERIAL
Work: INSPECTOR TO VERIFY COOL ROOF CERTIFICATION
Owner Contractor
VANESSA ESPINOZA TRUSTED PATH ROOFING INC
27855 VAN BUREN AVE 276 WEST HOWARD ST
MENIFEE, CA 92585 PASADENA, CA 91103
Applicant Phone:6263169456
JOSE MEDINA License Number: 1039857
TRUSTED PATH ROOFING INC
276 WEST HOWARD ST
PASADENA, CA 91103
Fee Description Qtv Amount t$)
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 carded 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_eldg_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 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 under the Contractors State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class G•16 Licens 03`7 S*- B m signature below I acknowledge that,except for m y y g g p my personal residence
Expires 5•�/ -20-z- Signature in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARAT N improvements covered by this permit.I cannot legally sell a structure that I
� have built as an owner-builder if it has not been constructed in its entirety by
dThemby 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 Cade,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
this permit is issued. www.leginfo.ca.gov/calaw.html-
Policy# 72 3f 322 Date
,fir, 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 fallowing: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: L application and the information I have provided is correct.I agree to comply
CarrierSfi�G (9,10„rn 54-4-ioil t;nSulr4 N 4C roywd with all applicable city and county ordinances and state laws relating to
—7 building construction.I authorize representatives of this city or county to
Policy# Expires • J ( •Z,/cf enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)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 Ows of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workegco en Von provsions of Section 37DO of the Labor
Code,I shall fortly it ose�Fovisions. Will the applicant or future building occupant handle hazardous material or a
Appliunt / Date •f(.QNv mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:F URE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes ❑No
UNLAWFUL, NO SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES
AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARS($100,000),IN occupll eintended a ermitf of the building st the applicant or futurebuilding
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 ❑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 boundary of a school?
(Section 3097 Civil Code) ❑Yes ❑No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
hereby affirm under penalty of perjury that 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 California Health al Safety Cade,Section 25505 and 25534 concerning
hazardous material reporting.
che[kmark(s)I have placed next to the applicable item(s)(Section 7031.5 oyes ❑No
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED AGENT
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 Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRPI
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 orshe is exemptfrom 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 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 than($500). required practices.This includes rental property owners and property
managers who do the paint-disturbing work themselves or through their
❑1,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( I all of or( )portion of the work,and the structure is www.epa.goy/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
p D An EPA Lead-Safe Certified Renovator will he 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 III MENIFEE
A' IA
DATE: 10 vk PERMIT/PLAN CHECK NUMBE
PLANNING CASE NUMBER
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATIONN O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW OlPLUMBING 046-ROOF NUMBER OF SQUARES !r:
DESCRIPTION OF WORK iwsS "En &64 (p.ca. Wet
c d I t In df.
PROJECTADDRESS 2'7855 VAr% BNdtr Avv- ZIP �IZSSS
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNERNAME VA11f.. 5w Building Dept.
ADDRESS Zq$5$ LIA N t3v Q C^ m-�J- OCT
PHONE C.qSI�T, EMAIL
T
APPLICANTNAME V e- Receive(
ADDRESS 478 N•VhCA. AV-&- P'V WJAk ^ Vie,. 01 1(D 3
PHONE �a?4L� 51q EMAIL l'o6 Gb/-+
CONTRACTOR'S NAME 1� OWNER BUILDER? O YES E*NO
BUSINESSNAME 'fCG� �14C{-(. ob^ ie-,
ADDRESS 4 (-AowLxrOIL P'4u0Le.n., v[q- 67/103
PHONq (r7(, rS 31 G^OI E/(5(, EMAIL uS .c.D( ft1'(.dDoP•Y\ eM
CONTRACTOR'S STATE LIC NUMBER (03 Q�S-7 LICENSE CLASSIFICATION b'
J VALUATION$ sg ' ( L SQ FT
APPLICANT'S SIGNATURE DATE /D
DEPARTMENT DISTRIBUTION ACCEPTED BY: ,A CITYOF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE 1\"'��i/✓1
INVOICE TOTAL I 11�0 qo GREEN 1 SMIP X
OWNER BUILDER VERIFIED OYES 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.cityofm e n i fee.us
NIF