PMT14-03230 y
City of Menifee Permit No.: PMT14-03230 j
29714 HAUN RD.
MENIFEE, CA 92586 Type: Residential Plumbing 1,
MENIFEE Date Issued: 12/08/2014
i
i
PERMIT
Site Address: 27753 BLUFF VISTA WAY, MENIFEE, CA Parcel Number: 340-431-004 -
92584 Construction Cost: $2,395.00
Existing Use: Proposed Use:
Description of REPLACE WATER HEATER 50 GAL SAME LOCATION IN GARAGE
Work:
Owner Contractor
DON PACOCHA AFFORDABLE WATER HEATERS AND PLUMBING
27753 BLUFF VISTA WAY INC
MENIFEE, CA 92584 28372 CONSTELLATION ROAD
Applicant - Phone: 8553459087
DANIEL MATA License Number: 627368
AFFORDABLE WATER HEATERS AND PLUMBING INC
28372 CONSTELLATION ROAD
VALENCIA, CA 91355
Fee Description QQtr Amount($)
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 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 n my license is in full fo c de ct. Code:The Contractor's License Law does not apply to an owner of a property
License CI ss Licen No. — ,,C— who builds or improves thereon, and who contracts for the projects with a
Expire S O Signatu /a _e 1 licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLA TION l J ��/
❑ I 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' 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.J.re
icy# ht�built as an owner-building if it has not been constructed in its entirety by licensed
F 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: '//www leoinfo ca pov/calaw html.
pmit is issued.My workers'compensation insurance carrier and policy number are:
Carrier V Property Owner or Authorized Agent Date
Expires \ I \ h� Policy# 1)01411 1A
El 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 represent es 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 identi d property for Kinsn 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 provi SIQ s of Section 3700 oft Labor roperty Owner or thorized Agent Date
Code, I shall fo with comply with those provi 'ons.
/ City Business License# U
Date; l Applica ,
_ WARNING: FAILURE TO SECLAE 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 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 DYES 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 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, ❑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 (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 DYES 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($500).) CODE SECTION
uS I ON 25505RIAL 1)E 5533 AND 25534 CONCERNING
❑ 1, as owner of the property, or my employees with wages as their sole
compensation,will do( )all of or( ) porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
CITY OF ME IEEE PLCK No. P;W-mil N QI A
29714 Haun Road Date: Date: �/Vl
Menifee, CA92586 (-a.1g
lig
Phone: (951)672-6777 Amount: Amount:Il'
Fax:(951)679-3843 Ck#: Ck#
Building Combination Permit U �
To Be Completed By Applicant
Legal Description: O Planning Case: F: L: Rt: R:
Pr perty Address: , Assessor's Parcel Number: 21,_ _ ��
Project/TenantLPA
Name: Unit#: J`� Floor#:
1tP� Name, Pj�gq No. ' Fax No.
Property Addres : V a Unit Number vt Zip
Owner f '
Emall Address:
V Na a Phone No. Fax No.
7� _ o - 2- to
Applicant Address: Unit Number Zip Code
-3� -7,2 o SS
Email Address:
Namh1p Phone No. _ (No.' 2, -
Contractor Address: a Ci C Q State Zip Code S
Contractor s�ity usineas License o. Contract is City State of California License No. Classification:
Number of Squares:
Square Footage
Description of Work: gu� f O �� C ost of Work:CL
/ Applicant's Signature l.l• Date:
To Be Completed By.G'rfyht$i Illy - -
Indicate As R-Received or N/A-Not Applicable
5 Completes sets of fully dimensioned,drawn to sale plans which include: t 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 S 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 ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration` Addition' Means/Methods
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 rf Indicate all Geo-tech.Haz.Zone
At Project Indicate Spdnklered YES or NO that a Coastal Zone
Construction PP y
Completion: Type(s): C Of O Noise Zone
Required? YES or NO 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.
Official A mval
Expedite Project(s): Child Care City Projec[ Green Building Landmark Affordable Housing
For Staff Use Only
Building/Safety BuildingiSafety Permit Specialist City Planning IGivil Engineering EPWIvt-Admin Transportation Mgmt. Rent Control
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