pmt18-02084 City of Menifee Permit No.: PMT18-02084
29714 HAUN RD.
' C:CELA�. MENIFEE,CA 92586 Type: Residential Re-Roof
MENIFEE Date Issued: 0 510112 01 8
PERMIT
Site Address: 29315 PEBBLE BEACH OR, MENIFEE, Parcel Number: 338-073-016
CA 92586 Construction Cost: $10,000.00
Existing Use: Proposed Use:
Description of REMOVE ALL EXISTING ROOF LAYERS, INSTALL NEW COOL ROOF SHINGLES
Work: •'CRRC#:
CERTAINTEED BIRCHWOOD
Owner Contractor
STEVE NELSON HOUSETOP ROOFING
29315 PEBBLE BEACH DRIVE 31760 BRIGGS ROAD
MENIFEE, CA 92586 MENIFEE,CA 92584
Applicant Phone:9516798369
RICH CARROLL License Number:371783
HOUSETOP ROOFING
31760 BRIGGS ROAD
MENIFEE,CA 92584
Fee Description Ciyt Amount fEl
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 erors 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
LICENSED DECLARATION pmpertywho builds orimproves thereon,and whocontracts forthe 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 in I am exempt from Iicensure under the Contractors Rate License Law for
Professions Code and my license is in full force and effect G the following reason:
License Class (2 `39 License No. 37/ 7//O � By my signature below I acknowledge that,except for my personal residence
Expires )Z—/& Signature in which l must have resided for at least one year prior to completion of
N// improvements covered by this permit.l cannot IegallYsell a structure that I
WORKERS COMPENSATION DECLARATIO have built as an owner-builder if it has not been constructed in its entirety by
o I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that 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 Code,for the performance of work for which ,,h.��v-leeinfo.ca.eov/calaw.html.
this permit is issued.
Policy g Date
Wave 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 o By my signature below I certify to each of the following:I am the property
this permit is issued.My workers compensation insurance carder 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 li1(/� with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy p t2 Expires / enter the above identified property for inspection purposes.
(This section need not to he completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
-0�&rtify that in the performance of the work for which this permit is issued, '—C(�
I shall not errolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE It 2 y Y;i541
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those provisto s. t� Will the applicant or future building occupant handle hazardous material or
Applicant Date Z Zd mixture containing a hazardous material equal to orgreater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FaURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o YesKO
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicanlor future building
AND CIVIL FINES UP TO ONE 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 Alt Duality Management District cons(SCtionor See cation ingfrom
checklist
IN SECTION 3705 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guid Coast
Airlin
CONSTRUCTION LENDING AGENCY 0Yes 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 Y^vo
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 checklisL I understand my requirements under the State of
California Health&Safety Code,Section 25505 and 25534 conceming
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 oyes R
Business and Professions Code).Any city or county that requires a permit to Date 2
construct,alter,improve,demolish or repair any structure,prior.to its PROPWNER OR AUTHORIZED AGENT
issuance,also requires the applicant far the permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors State EPA RE OVATION,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 or she is exempt from Iicensure 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 he 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 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( )all of or( )portion of the work,and the structure is www.eoa.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-SOD-424-LEAD(5323).
Code,The Contractors State License Law does not apply to an owner of D 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. D No EPA Lead-Safe Certified Firm Is required for this project bemuse:
D 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 PERM IT/PLAN CHECK APPLICATION
Menifee
DATE: 'S//bt PERMIT/PLAN CHECK NUMBER '
TYPE: 0 COMMERCIAL RESIDENTIAL 0 MULTI-FAMILY O MOBILE HOME O POOL/SPA 0 SIGN
SUBTYPE: O ADDITION 0 ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
NEW CPLUMBING k9E-ROOF NUMBER OF SQUARES a�
DESCRIPTION OF WORK /CUjP
44/9
eG 410 /rt'I SU2 �O�C�
PROIECTADDRESS ZIP
ASSESSOR'S PARCEL NUMBER "d—�!h �� LOT TRACT
OWNER NAME V 4!9, 11_16$5z
_5�714,1 City of Me, ifee
ADDRESS /^�i ,<f Building Dept.g
PHONE gSZ'^ ,, 0�9 EMAIL
APPLICANT NAME [� L
ADDRESS �/C .s gyp. Received-
PHONE EMAIL
CONTRACTOR'S NAME /C OWNER BUILDER? O YES "O
BUSINESS NAME
ADDRESS j �J Q/l(' 01 /D
PHONE �'� " /7/� EMAILAx
CONTRACTOR'S STATE LIC NUMBER ! LICENSE CLASSIFICATION C'�3
VALUATION $ //i GOl1 SQFT LSQFT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY _ _ __ __ _ _ _
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE ACCEPTED BY:
PERMIT FEE 1 SMIP K GREEN
PLAN CHECK FEE INVOICE TOTAL
OWNER BUILDER VERIFIED 0 YES 0 NO DRIVERS LICENSE 8 NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us
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