PMT14-02301 City of Menifee Permit No.: PMT14-02301
29714 HAUN RD. Type: Residential Alteration
�CGEI.A�. MENIFEE, CA 92586
e°'""Asmk""' MENIFEE Date Issued: 08/27/2014
PERMIT
Site Address: 26451 CHAMBERS AVE, MENIFEE,CA Parcel Number: 335-244-002
92586 Construction Cost: $7,000.00
Existing Use: 1 &2 Family Residence Proposed Use:
Description of REPIPE ENTIRE HOME WITH COPPER PIPING, REPLACE TANKLESS WATER HEATER, REPLACE
Work: TUB,2 PLUGS."INSPECTOR TO VERIFY INSTALLATION PRIOR TO DW-
Owner Contractor
ROBERT SYLER PRESIDENTIAL HOME DESIGN INC
26451 CHAMBERS AVE P 0 BOX 4522
MENIFEE, CA 92586 VALLEY VILLAGE, CA 91617
Applicant Phone: 8884663147
MANUEL JIMENEZ License Number: 562932
PRESIDENTIAL HOME DESIGN INC
P 0 BOX 4522
VALLEY VILLAGE,CA 91617
Fee Description Oft Amount 1$1
Receptacle;Switch, Ouflet&Fixture 2 121.00
Plumbing Fixtures and Vents, fixtures 1 116.00
Piping/Repiping Single Family Residential 1 163.00
Residential Water Heater 1 83.00
Building Permit Issuance "1 27.00
GREEN FEE .. _..1 1.00
$511.00
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 force and effect. Code:The Contractor's License Law does not apply to an owner of a property
License��'Class�Licen o. B 7� 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
❑ I 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
y( I have and will maintain workers' compensation insurance, as required by Business and Professions Cade,is available upon request when this application is
sbction 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:hfti)*//www.leginfo.m.ciov/calaw.html.
permit is issued.My workers'compensation insure
we carrier and policy number are:
Carrier �l �C Property Owner or Authorized Agent Date
�i�.,e 1
Expiress Policy �o7o, b32
❑ 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 identifed erty f rthe 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 27-1(/
subject to the workers'compensation provisions of Section 3700 of the Labor Prope ner or Authorized ent Date
Code,I shall forthwith comply with those isions ��-7 It
City Business License# f,
Date; Applicant;
WARNING: FAILURE T 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, DYES 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 J0 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 rhich 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 /V ❑YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
, FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address l�/o DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR
l GUIDE LINES
OWNER BUILDER DECLARATIONS
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 DYES 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, N0 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(Chapter 9 (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 do ( )all of or( )porting of the work, and the structure is PROP T O OR AUTHORIZED AGENT
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 1T'1ENIFEE PLCK No:
29714 Haun Road Date Date:t2
Menifee, CA 92586 C� a1
Phone: (951)672-6777 Amount: Amoutt
Fax:(951)679-3843 Ck#: Ck#:
Building Combination Permit G1
To Be Completed By Applicant
Legal Description: V2 41
ill _ LCrTa Planning Case: F: L: Rt: R
Property Addre Assessor's Parcel Number: 33S _ P "X3L
Project/Tenant Name: Unit#: Floor#:
Name: S one Nq �QO Fax No.
Property Address: Unit Number Zip Code
Owner
Email Address:
Name: / U �hg No. J S7 Fax No.
Applicant Address: - Unit Number Zip Code
Email Address:
Name Phon No. Fax No.
c / Z-, d
Contractor Address: Zvi Gray/ , v1 S?ig_ Zip Code
ontra tors rt O�P' o. Contractor's Cit State of California Li nse No. Classification:a
Number of Squares:
Square Footage
Description of Work: f7. Cast of Work:$7 Q OQ "
Applicant's Signature ,L // Date:
To fie CompletedIlly city Staff CAIV, O
Indicate As R-Received or N/A-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 ❑ Goo Tech/Soils Report(on cd only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on S'/x 11)
[I Foundation Plan ❑ Cross Section El Structural Calculations
❑ Plumbing Plan ❑ Single Line diagram for etec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan I ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration' Addition' MeanslMethods
Work Type: Repair" Retrofit* Revision to Existing Permit' 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 Sprinklered that apply: Coastal Zone
Completion: Type(s): C 0f O Noise Zone
Required? YES or NO Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board Landmark Comm. I I Planning Comm.Zoning Administrator
Fee Exempt* City Project Elec.Vehicle Charger Landmark Seismic Retrofit pe OflicialAroyal
dal case.eras.
Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing
For Staff Use Only
Building/Sate)BuildinglSately Permit Specialist City Planning ICivil Engineering EPWM-Admen I ransportaeon Mgmt. Rent Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY