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PMT14-02298 City of Menifee Permit No.: PMT14-02298 29714 HAUN RD. Type: Residential Plumbing 'W CCEL-A�. MENIFEE, CA 92586 MENIFEE Date Issued: 08/2712014 PERMIT Site Address: 27777 CANNON DR, MENIFEE, CA 92585 Parcel Number: 333-243-027 Construction Cost: $700.00 Existing Use: Proposed Use: Description of REPLACE 40 GALLON WATER HEATER LOCATED IN GARAGE Work: Owner Contractor ANTONIO GONZALEZ INTER-CITY ENERGY SYSTEMS INC 27777 CANNON DR 12252 MC CANN DRIVE MENIFEE,CA 92585 SANTA FE SPRINGS, CA 90670 Applicant Phone: 5627771142 TERESA DINTERMAN License Number: 587709 INTER-CITY ENERGY SYSTEMS INC 12252 MC CANN DRIVE SANTA FE SPRINGS, CA 90670 Fee Description Qty Amount 1$1 Residential Water Heater 1 83.00 Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 $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_Bldg_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 farce and effect. Code:The Contractor's License Law does not apply to an owner of a property License Class ice` )tJ Licenses� �� who builds or improves thereon, and who contracts for the projects with a Expires Signature' %��-S -� licensed contractor(s)pursuant to the Contractors State License Law). WORKE S'C E SATION DECLARATION ❑ 1 am exempt from licensure under the Contractors'State License Law for the ❑ 1 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' gy my signature below 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 far at least one year prior to completion of Section 3ssu of the Labor Code, for the performance of work for which this improvements covered b this permit, I cannot legally sell a structure that I have permit is issued. P Y P 9 Y Policy# built as an owner-building if it has not been constructed in its entirety by licensed 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 section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:hftp://www.leginfo.ca.aovicalaw.html. permit is.issued.My workers'compernssaation insurance carrier and policy number are: Carrier_ LVvly-. 5� ')`-/✓.�L cS�+��j Property Owner or AuthorizedAgent Date Expires 24, // S Policy# ❑ 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.I authorize representatives of this city or county to enter the above- El I certify that in the performance of the work for which this permit is issued,I identified property for the inspection purposes. shall not emolov 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 of Section 3700 of the Labor Property Owner or Authorized Agent Code, I shall forthwith comply with those provisions. %�-�,J P Y 29e ,rt Date 71 Date; ���" / Applicanh� /6��' City Business License# J t� y 1 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, OYES OCCUPANT HANDLEA HAZARDOUS MATERIAL ORA DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL LABOR CODE, INTEREST,AND ATTORNEYS FEES ONO EQUAL TO OR GREATER THAN THE AMOUNTS CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS I hereby affirm that under the penalty of perjury there is a construction lending INFORMATION GUIDE? 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 OYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION FROM THE SOUTH COAST AIR QUALITY MANAGEMENT Lender's Address ❑NO DISTRICT(SCAQMD) SEE PERMITTING CHECKLIST FOR _ OWNER BUILDER DECLARATIONS GUIDE LINES I hereby affirm under penalty of perjury that I am exempt from the Contractor's PRINT NAME: License Law for the reason(s)indicated below by the checkmark(s)I have placed AYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY next to the applicable item(s)(Section 7031.5. Business and Professions Code: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A Any city or county that requires a permit to construct, alter, improve, demolish, ❑NO 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 provisions of the Contractor's State License Law (Chapter9 (commencing with I HAVE READ THE HAZARDOUS MATERIAL Section 7000)of Division 3 of the Business and Professions Code)or that he or ❑YES INFORMATION GUIDE AND THE SCAQMD PERMITTING 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 ($500).) CODE, SECTION 25505, 25533 AND 25534 CONCERNING ❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL REPORTING. compensation,will ( )all of or ( )porting of the work, and the structure is PROPERTY OWNER-OR AUTHORIZE 7 not intended or offered for sale.(Section 7044, Business and Professions Code; The Contractor's State License Law does not apply to an owner of a property X - who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale.If,however, the building or improvement is sold within one year of completion, the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). CITY OF MIENI FIEIE PLCK No: P ", 4—c); `r s 29714 Haun Road Date: Date: Menifee, CA 92586 QX7 1 Phone: (951)672-6777 Amount: Amount: Fax:(951)679-3843 Ck#: Ck# ' 114,0 Building Combination Permit G To Be Completed By Applicant Legal Desaiption: k110270.6 �1 Planning Case: F: L: Rt: R: Props Address: _ O_ Assessor's Parcel Number. ra 333 -7 ProJec o nJ Unit#: Floor#: Name: -. 6 ,j_ ? Phor�@.�Jo Fax No. Property Owner Address: �' '7 7 l(J 'C.Z� r_ Unit Number Zip Cotle .�, ��—SG Email Address: eo J t/ Name: -!�' Phpne No. Faz No. Applicant Address: / /, Unit Number Zip Code ✓ "i.CI .-.ZJ Email Address: Name: y P ne No. Fax No. Contractor Address: City ) Stgte 2iC- V C p r Contractors OUST ess License o. Contractor's City S�a[a of Cal omia License No- Classification:/ -i 0 - �5i - a Number of Squares: Square Footage Desc'ption yJodc: b IZ` Z�4 Cost of Work$ Applica 's Signature _ y- Dale: l \o Be-Completed ByClty Staff Only - - - Indicate As R-Received or NIA-Not Applicable 5 Completes sets of fully dimensioned,drawn to sale plans which include: 1 set of documents which include ❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Geo Tech/Soils 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 elec.services over 400 AMP ❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan I ❑ Sound Report-Residential Class Code: Indicate New Construction Alteration' Addition" I Means/Methads Work Type: Repair* Retrofit• Revislon to Existing PemtiY Required? YES NO Proposed Building Use(s): Existing Building Use(s): #Buildings: #Units: #Stories: Will the Building Have a Basement? Y of N Bldg.Code Occupancy Group Indicate indicate if YES or NO Indicate all Geo-tech.Haz.Zone At Project Construction Spdnklemtl that apply: Coastal Zone Completion: Type(s): C Of O 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 I JElec.Vehicle Charger Landmark Seismic Retrofit Special case.Bfd . Official Approval Expedite Project(s): Child Care City Project Green Building Landmark I Affordable Housing For Staff Use Only Buiidmitisalely Permit Specialist I City Planning I Civil Engineenng I EPWM-Admin I Transponalion htgmt. I Rent Control THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY CITY OF MENIFEE Department of Building and Safety N1F Contractor Declaration LICENSED CONTRACTORS DECLARATION: I hereby affirm under penalty of perjury that I am licensed under the provisions of Chapter 9 (connecting with Section 70000))!of Division 3 of the Business and Professions code and my license is in full force and effect. License Class: C d'fJ License No: SY 77© / Exp.Date ©1 Contractor: 7rrl/- U Y YIPc�'Ga,G, l �Y'o-✓Y+cj ❑ OWNER BUILDER DECLARATION: I hereby affirm under penalty of perjury that i am exempt from the Contractors License Law for the following reason: (Sec 7031.5 Business and Professions code. Any City or County which requires a permit to construct,alter,improve, demolish or repair any structure prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(chapter 9[commencing with Section 7000]of wenDivist that 3 of the Business and Professions Code)or that he or she is exempt there from and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars Any violation ❑ I,as the owner of the property,or my employees with wages as their sole compensation,will be the work,and the structure is not intended or offered for sale(Sec.7044,Business and Professions code: The Contractor License Law does not apply to the owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such 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 he/she did not build or Improve for the purpose of sale). ❑ I,as owner of the property,am exclusively contracting with license contractors to construct the project(Sec.7044 Business and Professions Code: The Contractor License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s)license pursuant to the Contractors License Law). ❑ I am exempt under Sec. ,B& P.C.for the reason Date: Owner: WORKERS COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self-insure for worker compensation,as provided for by Section 370 of the Labor Code, for the performance of the work for which this permit is issued 2fl`have and will maintain workers compensation insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. // My Workers Compensation Insurance carrier and policy Number are: '/ r'Carrier:J_t�t��`Y. � � J—r'y® t y '-79, W,4� ox n/�7 4�• Policy Number: 1 (This section need not be completed if the permit is for one hundred dollars($100.00)or less. I certify that in the performance of the work for which this permit is issued,I shall not employ any person 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 of Sec.3700 of the Labor Code,I shal orthwith comply with those provision Date: Applicant• � �.•+� ,�_�_ WARNING: FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SEC.3706 FOR THE LABOR CODE,INTERST,AND ATTORNEY FEES. CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there is a construction-lending agency for the performance of the work for which this permit is issued(Sec.3097,Civic C.). Lender's Name: Lender's Address: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify that I have read this application and state that the above information is correct. I agree to comply with all City ordinances and state laws relating to building construction,and hereby authorize representativ 3 of the City to enter upon the above mentioned property for Inspection purposes. Signature of �plican Agent Print Applicant ant Name Date INSPECTION INFORMATION:Work may proceed only at the direction of the field inspector. To request an inspection of work completed,call the number(951)672-4777. Inspection request must be called in the day before to assure next day inspections.