PMT19-00129 City of Menifee Permit No.: PMT19-00129
29714 HAUN RD.
' MENIFEE, CA 92586 Type: Residential Re-Roof
m E N IFE E MENIFEE Date Issued: 01/10/2019
PERMIT
Site Address: 29037 GRIFFITH DR, MENIFEE, CA Parcel Number: 336-100-014
92587 Construction Cost: $7,000.00
Existing Use: Proposed Use:
Description of REMOVE ALL EXISTING LAYERS OF ROOFING MATERIAL, INSTALL NEW COOL ROOF
Work: "CRRC 0890-0024
Owner Contractor
DONNA NEWMAN SUDDUTH CONSTRUCTION INC
29037 GRIFFITH DRIVE 1010 N BATAVIA ST STE F
MENIFEE, CA 92587 ORANGE, CA 92867
Applicant Phone: 7146333619
DOUG LARTER License Number: 847279
SUDDUTH CONSTRUCTION INC DBA GUARDIAN ROOFS
1010 N BATAVIA ST STE F
ORANGE, CA 92867
Fee Description Qtv Amount f$1
Buiidinc Perm,ri t&Etiarace 1 27,00
Inspections not specified 98 98.00
GREEN F EE 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
spedficaflons or from preventing buNding 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
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 Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:_
License Class A� 2:2 License No. �� 2 / By my signature below I acknowledge that,except for my personal residence
Expires_ � �`�G Signature in which I must have resided for at least one year prior to completion of
Pq 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 worker's 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 Code,for the performance of work for which
this permit is issued. wwwJeginFo.ca,i&av Calaw.html.
Policy# Date
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 I certify to each of the following:I am the property
this permit is issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
Carrier
with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy#_ 7] j Expires enter the 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
❑I certify that in the performance of the work for which this permit is issued,
I shall m employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Cade,I steal rthwlth compl with those roVisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date Y �/ mixture containing a hazardous material equal to or greater that the
amounts spec d on the Hazardous Materials Information Guide?
WARNING:FAILURE O SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes n a
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 TO ONE HUNDRED THOUSAND DOLLARS($300,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Air A
t Coas A Qualit nagement District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for ir in
CONSTRUCTION LENDING AGENCY ci Yes No
I hereby affirm that under the penalty of perjury there is a construction Will the propos u!lding or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer be ry of a school?
(Section 3097 Civil Code) ❑Yes le
OWNER 8UILDER 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
Contractor's License Law for the reason(s)indicated below by the California Healt Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous terial reporting.
Business and Professions Code).An city or count that requires ❑Yes N�AUTHORIZED
Y Y Y es a'ermit t• Dateconstruct,alter,improve,demolish or repair any structure,priorto its —issuance,also requires the applicant for the permit to file a signed statement PROPERTY NT
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION REPAIR AND PAINTING IRRP
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 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 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.goyllead 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
not built or improved for the purpose of sale. o 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 Contractor's 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 f MENIFEE
DATE: PERMIT/PLAN CHECK NUMBER Qg g nifee
— building Dept,
GRADING/PLANNING CASE NUMBER/OTHER RELATED CASES ;
TYPE: COMMERCIAL RESIDENTIAL MULTI FAMILY MOBILE HOME P00 A i0 51
SUBTYPE: ADDITION `::'ALTERATION DEMOLITION 0 ELECTRICAL E)C it v: r,�
u
NEW PLUMBING RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK "e
J� r 2y c Cc�
OCCUPANCY GROUP •[.�L4ONSTRUCTION TYPE SPRINKLERS :'`YES ::° NO
PROJECT ADDRESS 2?0_5 7 (p/L/r-�jCjr �12- - ZIP 2S
ASSESSOR'S PAR L NUMBER +;/`Q'��• ol� LOT TRACT
OWNER NAME l
ADDRESS 4��^ 6 3 �] Lr7 rl 6/2, G '
PHONE / 2/ / EMAIL
APPLICANT NAME /�7
�r7 -�
ADDRESS 6 I �, y�19 S/ ��L�I- �Z/ s- �2
PHONE EMAIL
CONTRACTOR'S NAME 4 01V . 0 OWNER BUILDER? YES NO
BUSINESS NAME
ADDRESS �'•� ,� / I. �!e- y Z 4
PHONE 7/ EMAIL
CONTRACTOR'S STATE LIC NUMBER C� 72 7( LICENSE CLASSIFICATION �� C
VALUATION$ 7, SQ FT r Z� ® L SQ FT
APPLICANT'S SIGNATURE ��' DATE r 16) -
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
INVOICE TOTAL 130 O GREEN 1 SMIP
OWNER BUILDER VERIFIED YES .` NO DRIVERS LICENSE# NOTARIZED LETTER YES NO
City of Menifee Building & Safety Department 129714 Haun Rd., Menifee,CA 92586 (951)672-6777
www.cityofinenifee.us
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