PMT18-04968 City of Menifee Permit No.: PMT18-04968
29714 HAUN RD.
//Jr MENIFEE,CA 92586 Type: Residential Re-Roof
MENIFEE MENIFEE Date Issued 10/12/2018
PERMIT
Site Address: 26021 LANCASTER DR, MENIFEE, CA Parcel Number: 335-132-002
92586
Construction Cost: $8,000.00
Existing Use: Proposed Use:
Description of TEAR OFF 100 PERCENT AND LAY NEW COOL ROOF SHINGLES
Work:
CRRC: 0890-0009
Owner Contractor
FELICITAS HELLMICH M G ROOFING
29867 AVENIDA DE FIESTA 25612 SAN LUPE AVE
MENIFEE, CA 92586 MORENO VALLEY, CA 92551
Applicant
M G ROOFING Phone:9514227660
25612 SAN LUPE AVE License Number: 1015368
MORENO VALLEY, CA 92551
Phone:9514227660
Fee Description Oty Amount I51
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
improves thereon,and who contracts for projects
LICENSED DECLARATION property who builds or
with a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of
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 C. � � Llcen No. lo By my signature below I acknowledge that,except for my personal residence
Expires akoo-AL 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 DECLARATION 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 Cade,for the performance of work for which www.leginfo.ca.gov/calaw.html.
this permit is issued.
�9 ^ ` 7 Date
Policy# b o PROPERTY OWNER OR AUTHORIZED AGENT
❑I have and will maintain workers compensation insurance,as required by
❑BY my signature below I certify to each of the following:I h the property
section 3700 of the Labor Code,for the performance of the work for which ers behalf.I
this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act on the property own have read this
number are: application and the information I have provided is correct.I agree to comply
with all applicable city and county ordinances and state laws relating to
Carrier building construction.l authorize representatives of this city or county to
Policy#B��. 26 O E Expires enter the above identified property for inspection purposes. /
(This section need not to be completed is the permit is for one-hundred M p 1`p(y t gr Date /2
dollars($100)or less PROPERTY OWNER OR AUTHORIZSO 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 ,.L�C,IT/BUSINESS LICENSE#
workers compensation laws of California,and agree that if I should become q'pAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Se n 3700 of the Labor Iyy,ill the applicant or future building occupant handle hazardous material or a
Code,I shall forthwith comply with those r isians..
mixture containing a hazardous material equal to or greater that the
Applicant ate amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S ENSATION COVERAGE IS ❑Yes ❑No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES 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 Cade) ❑Yes ❑No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMO
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the California Health&Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the hazardous m 1 reportin .
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oyes ❑No Q 2
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 PROPE'915Y OWkQLMI&ITHORIZED AGENT
issuance,also requires the applicant for the permit to file a signed statement EPA RENOVATION REPAIR AND PAINTING(RRP)
that he or she is licensed pursuant to the provisions of the Contractor's State
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 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 required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves orthrough 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( )all of or( )portion of the work,and the structure is www eoa 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 Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was ❑No EPA Lead-Safe Certified Firm is required for this project because:
not built or improved for the purpose of sale.
o I,as owner of the property am exclusively contracting with licensed
contactors to construct the project(Section 7044,Business and Professions
Code:The Contactors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill outthe RRP
Acknowledgement.
BUILDING & SAFETY P ERMIT/PLAN CHECK APPLICATION MENIFEE
DATE: PERMIT/PLAN CHECK NUMBER Mum
PLANNING CASE NUMBER
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOLI SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW O PLUMBING RE-ROOF NUMBER OFSQUARES -
DESCRIPTION OF WORK r Cl ,nj )-
� ( SUvA Cl Z�P
PROJECT ADDRESS FQLJA CCL D-Y�.{ �y/��
ASSESSOR'S PARCEL NUMBER V 132 '074Z„LOT TRACT
�[ OWNERNAME \1C) �Y) 6
QP ADDRESS e 15
jk HONE j -' Cp�2'"'`�jB�B� EMAIL VV
APPLICANT NAME Iv\ V O T.
ADDRESS
PHONE EMAIL l��jQ O ,C .
CONTRACTOR'S NAME 010\-(J G OWNER BUILDER? O YES V O
BUSINESS NAME
ADDRESS2,5
PHONE 7 C EMAIL 1 YI,GI�
' CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ SQ FT L SO FT
APPLICANT'S SIGNATURE DATE ( �
DEPARTMENT DISTRIBUTION ACCEPTED BY: CI OF MENIFEE BUSINESS LICENS NUM R
BUILDING PLANNING ENGINEERING FIRE IIILu
/ /JI
INVOICE TOTAL I -U •'" lV I GREEN SMIP
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE p NOTARIZED LETTER O YES O NO
City of Menifee Building &Safety Department 129714 Haun Rd., Menifee,CA 92586 (951)672-6777 -
www.cityofinenifee.91ty of Menifee
Building Dept
FNIFRIM
OCT 12 2018
Received
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0890-0009 Owens Coming TruDefinitionO Duration Cool Asphalt Shi Orange 0.22 0.23 0.92 0.92 22 24 +
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COOL ROOF RATI NG COUNCIL 2435 N.Lombard St. TEL(866)465-2523 EMAIL Info@coolroofs.org O
Portland,OR 97217
CM111-te3A6.0.
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