pmt16-03183 City of Menifee Permit No.: PMT16-03183
29714 HAUN RD. Type: Residential Re-Roof
<A_CCEL/_k> MENIFEE, CA 92586,
MENIFEE Date Issued: 09127/2016
P E R M I T
SiteAddress: 27910 LEXINGTON CT, MENIFEE, CA Parcel Number: 335-091-011
92586 Construction Cost: $6,840.00
Existing Use: Proposed Use:
Description of TEAR OFF EXISTING LAYERS, INSTALL NEW COOL ROOF SHINGLES
Work: CRRC#0676-0097
Owner Contractor
DON&LINDA HATFIELD RANDY'S CLASSIC ROOFING
27910 LEXINGTON COURT 32960 DAILY DR
MENIFEE, CA 92586 MENIFEE,CA 92584
Applicant Phone: 9516729411
SUZANNE BALL License Number.726425
RANDY'S CLASSIC ROOFING
32960 DAILY DR
MENIFEE, CA 92584
Fee Description 0
A Amount($
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 building 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_Pe=ftTeMp1ate.rpt Page I 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 a rn under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapterfl(commencing with section 7000)of Division 3 of the Business and ci 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 followmg reason:
License Class C -3 47' License No. )Z& / By my signature below I acknowledge that,except for my personal residence
Expires i?- 7 Signature in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION 1) 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
a 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 me intain a certificate of consent of self-insu re 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. wvvw.leainfo.ca.gov/caIavv.htmL
Policy# Date
di 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 a By my signature below I certify to each of the following:I am the property
this perm it is issued.My worker's compensation insurance carrier and policy owner or authorized to act an the property owner's beha If.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# 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
ci I certify that in the performance of the work for which this permit is issued,
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
vv�rkees 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
Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant �Pl'49�& Date lure containing a hazardous material equal to or greater that the
V amounts specified on the Hazardous Materials Infonnation Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS m Yes a No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the build Ing by the applica nt or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN
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 AGEN uYes oNo
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) a Yes n No
OWNER BUILDER DECLARATIONS I have mad 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
California Health&Safety Code,Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5
Business and Professions Code).Any city or county that requires a permit to uYes a No
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 PROPERTY OWN ER OR AUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRPI
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 ficensure
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-certlfled firms and comply with
then($500), required practices.This includes rental property owners and property
managers who do the paint-disturbing work themselves or through their
o 1,as owner of the property,or my employee with wages as their sole employees.For mom information about EPA's Renovation Program visit:
compensation,will do( )all of or( I 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 Contractoes 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 Firm Certification No.;
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sole. ci No EPA Lead-Safe Certified Firm is required for this project because:
a 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 701K 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.
1,111111112E.- Menifee
DATE PERMIT/PLAN CHECK NUMBER PM ILP
TYPE: 0 COMMERCIAL '��RESIDENTIAL 0 MULTI-FAMILY - MOBILE HOME 0 POOL/SPA 0 SIGN
SUBTYPE: 01ADDITION OALTERATION ODEMOLITION CIELECTRICAL OMECHANICAL
ONEW OPLUMBING XRE-ROOF-NUMBER OF SQUARES ;2-/
DESCRIPTION OF WORK �:2L44, 5�� ,;56 2��(
a�W2_ ariLd -00g7l
41
PROJECTADDRESS a-7 Z 51�1,12 a,4
ASSESSOR'S PARCEL NUMBER LOT TRACFBUjI oil, 01=1re"Oph-
OWNER NAME
ADDRESS I -LU]b
PHONk�ii�j/ 297 3e :z EMAIL Received
APPLICANTNAME
ADDRESS3 2-,?&c) 1_1 zXf ,�eW Ale_�,/-r_c
PHONE if-IS EMAIL ZaL,,�4 43K�S-s
CONTRACTOR'S NAME OWNERBUILDER? OYES9,NO
BUSINESS NAME
ADDRESS 32-q6o
L)
PHONE(91ZLIL_6 EMAIL
5 ela 5r5 o 0 c- -h
CONTRACTOR'S STATE LIC NUM13ER 7,71, V;2-5 LICENSE CLASSIFICATION
VALUATION$ SO FT L SO FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICE SE NUMBER
BUILDING PLANNiNG ENGINEERING FIRE I GREEN smip k
INVOICE I
AMOUNT , PA�DAMOUNT _CASH 0 CHECK# OCREDITCARD VISAIMC
PLAN CHECK FEES PA D AMOUNT 0 CASH 0 CHECK# C)CREDIT CARD VISAIMC
OWNER BUILDER VERIFIED 0 YES 0 NO DLINUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA-92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
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