PMT14-01913 i
a
City of Menifee Permit No.: PMT14-01913
29714 HAUN RD.' Type: Residential Plumbing
�CCCC✓E MENIFEE, CA 92586 {
c�u,,..�..:t'k." MENIFEE Date Issued: 07/23/2014
I
PERMIT
Site Address: 28831 W WORCESTER RD, MENIFEE, Parcel Number: 339-131-006
CA 92586 Construction Cost: $1,150.00
Existing Use: Proposed Use:
Description of REPLACE 38 GALLON GAS WATER HEATER
Work:
Owner Contractor
EVAAVENELL CALIFORNIA DELTA MECHANICAL INC
28831 W WORCESTER RD 6056 E BASELINE ROAD#155
MENIFEE, CA 92586 MESA,AZ 85206
Applicant Phone: 6192296800
RUMYANA ATANASOVA License Number: 811114
CALIFORNIA DELTA MECHANICAL INC
6056 E BASELINE ROAD#155
MESA, CA 85206
Fee Description Qtv Amount l$1
Building Permit Issuance 1 27.00
$111.00
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_Bidg_Permit_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION
I hereby affirm under penalty or perjury that I am licensed under provisions of ❑ I, as owner of the property an exclusively contracting with licensed
Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professions
Professions Code and my license is in full force and effect. Code:The Contractor's License Law does not apply to an owner of a property
License Class License No. who builds or improves thereon, and who contracts for the projects with a
Expires Signature _ licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION ❑ 1 am exempt from licensure under the Contractors'State License Law for the
❑ I hereby affirm under penalty of perjury one of the following declarations:
following reason:
I have and will maintain a certificate of consent of self-insure for workers' By my signature below I acknowledge that, except for my personal residence in
compensation,issued by the Director of Industrial Relations as provided for by which I must have resided for at least one year prior to completion of
Section 3700 of the Labor Code, for the performance of work for which this improvements covered by this permit, I cannot legally sell a structure that I have
permit is issued. built as an owner-building if it has not been constructed In its entirety by licensed
Policy# contractors. I understand that a copy of the applicable law, Section 7044 of the
I have and will maintain workers' compensation insurance, as required by Business and Professions Code,Is available upon request when this application is
lion 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:http'//www.leoinfo.ca.gov/calaw.htrnl.
permit is issued.My workers'compensation insurance carrier and policy number are:
S(� T Property Owner or Authorized Agent Date
Carrier 17-n S It Y CkT)C 2 /� r�— (7 /1'�7
Expires / N�Policy# a, an J p d ,3 't/ /
❑ By my Signature below, I certify to each of the following: I am the property
Name of Agent Phone# owner or authorized to act on the property owner's behalf. I have read this
(This section need not be completed if the permit is for application and the information I have provided is correct. I agree to comply
one-hundred dollars($100)or less) with all applicable city and county ordinances and state laws relating to building
construction. ayth u representatives of this city or county to enter the above-
❑ I certify that in the performance of the work for which this permit is issued,I identified pro 6rt o the inspection purposes,
shall not employ any persons in any manner so as to become subject to the -
workers' compensation laws of California, and agree that if I should become
subject to the workers'compensation provisions gf_Section 3700 of the Labor Property O ner or Authorized Agent Date
Code,I shall forthwith comply with those provisions.
L City Business License#
Date; Applicant;
WARNING: FAILURE TO SECURE WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDING
($100,000), IN ADDITION TO THE COST OF COMPENSATION, ❑YES OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES N0 EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS
INFORMATION GUIDE?
I hereby affirm that under the penalty of perjury there is a construction lending
agency for the performance of the work which this permit is issued (Section WILL THE INTENDED USE OF THE BUILDING BY THE
3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE
Lender's Name DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address N0 DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR
GUIDE LINES
OWNER BUILDER DECLARATIONS PRINT NAME:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the reason(s)indicated below by the checkmark(s)I have placed OYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable item(s) (Section 7031.5. Business and Professions Code: C I BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A
Any city or county that requires a permit to construct, alter, improve, demolish, SCHOOL?
or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the I HAVE READ THE HAZARDOUS MATERIAL
provisions of the Contractor's State License Law (Chapter 9 (commencing with INFORMATION GUIDE AND THE SCAQMD PERMITTING
Section 7000)of Division 3 of the Business and Professions Code)or that he or '(ES
she is exempt from licensure and the basis for the alleged exemption. Any /% CHECKLIST. I UNDERSTAND MY REQUIREMENTS
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE, S STION 25505,
0 R P533 AND 25534 CONCERNING
HAZARD❑ I, as owner of the property, or my employees with wages as their sole
compensation,will do( ) all of or ( ) porting of the work, and the structure is PROPER NER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code; X
The Contractor's State License Law does not apply to an owner of a property y
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion,the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
CITY OF MEl®llFEE PLCK No: jDate:
29714 Haun Road �— (3
Date: ^ShMenifee, CA 92586 I.Phone: (951)672-6777 Amount:
Fax:(951)679-3843 Ck#: Ckit
Building Combination Permit G1
To Be Completed By Applicant
Legal Descriptiorw�y Planning Case: F:
Prop I Addres l FF 0 --le r un ^/h Assessor's Parcel Numher. �1p^ I�' co(o
Preti soon, ame: (/ Unit#: 7 1 Floor#:
Name: a Fax No.
Ad _D�7y
Property
Owner 8 A) r r - nit Nu er Zip Code Q�S p/_
Email Address: L —1 O IG
N ,e h e o. Fax No.
a s va ,?-Ta 7
Applicant Ad ess: I E.
e I r� �� �� Unit Nu ber zip C
Em it Addres a m 6/a .1 i /
Name I��1
a a P o o N
F -J rf.Contractor Address: Zip Cntract tSu icensie o. Contract ' i i pteofCaliforniaLicenseNo. fication:
Number of Squares: �"� L
Square Footage
Description of Work: of Work:.$ 1150
Applicant's Signa r:- I U
'f ?
Dale
To Be Completed By,City-Staff Only
Indicate As R-Received or N/A-Not Applicable
5 Completes sets of fully mmensioned,drawn to sale plans which include: 1 set or documents which include
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Goo Tech/Boils Report(on cd only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8 Y,x 11)
❑ Structural Calculations
❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Single Line diagram for else.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan I ❑ Sound Report-Residential
Class Code: Indicate New Consfmdion Alteration' Addition' Means/Methods
Work Type: Repair" Retrofit Revision to Existing PermiP Required? YES NO
Proposed Building Use(s): Existing Building Use(s):
#Buildings: #Units: #Stories: Will the Building Have a Basement?
Bldg. Code Occupancy Group Y of N
p y p Indicate Indicate if Indicate all Geo-tech.Haz Zone
At Project Sprinklored YES or NO
Completion: Construction that apply: Coastal Zone
Type(s) C of0 YES or NO Noise Zone
Required? Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board Landmark Comm. Planning Comm.Zoning Administrator
Fee.Exempt: City Project Elec.Vehicle Charger Landmark Seismic Retrofit Special Case:Bldg
OfficialA rove?
Expedite Project(s): Child Care City Project Green Building Landmark Affordahle Housing
For Staff Use Only
Building/Safely Permit Specialist I City Planning I Civil Engineering I FPWM-Admin I Transportation Nigmt. I Rem Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY