PMT15-00909 j
City of Menifee Permit No.: PMT15-00909
29714 HAUN RD, j
MENIFEE, CA 92586 Type: Commercial Plumbing
s.A W`" MENIFEE Date Issued: 04/10/2015
j
PERMIT
Site Address: 26125 MENIFEE RD, MENIFEE, CA 92586 Parcel Number: 331-230-003
Construction Cost: $15,000.00
Existing Use: Proposed Use:
Description of 270 If NEW 2"WATER LINE
Work:
Owner Contractor
SOUTHERN CALIFORNIA EDISON DUMARC.CORPORATION
2244 WALNUT GROVE 187 W ORANGETHORPE AVE STE R
ROSEMEAD, CA 91770 PLACENTIA, CA 92870
Applicant Phone:7149930909
SOUTHERN CALIFORNIA EDISON License Number: 167616
2244 WALNUT GROVE
ROSEMEAD, CA 91770
Phone: 8183849633
Fee Description gtv Amount
I .S .
Inspections not specified 129 - 129.07
$157.07
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications orfrom preventing building 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 an my license is in ful force and affect. Code:The Contractor's License Law does not apply to an owner of a property
License Cl
License No. 1 who builds or improves thereon, and who contracts for the projects with a
E Signature licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
_ n ❑ I am exempt from licensure under the Contractors'Slate License Law for the
7�' 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 iss�uedp.� q �b6�o- 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
section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:http'//www lepinfo ca pov/calaw html.
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier Property Owner or Authorized Agent Date
Expires Policy#
y my Signature below, I certify to each of the following: I am the property
Name of Agent Phone# caner 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 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 of Section 3700 of the Labor t
ate
Code,I shall forthwith comply with those provisions. Property Owner or ed Agent
City Business License#
Date,z 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, 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 'RA0 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 f4.,
O
DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR
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, %Q 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 UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE
SECTIOUS ON
25505RIAL 1)E 5533 AND 25534 CONCERNING
❑ 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 PROELgLY=DWNFaA H R T
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).
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DAT ® ' PERMIT/PLAN CHECK NUMBER 7 0
TYPE: OMMERCIAL RESIDENTIAL 0 MULTI-FAMILY C? MOBILE HOME - POOL/SPA U SIGN I
SUBTYPE:. ADDITION C% ALTERATION - DEMOLITION ::) ELECTRICAL C% MECHANICAL
% NEW ` UMBING % RE-ROOF-NUMBER OF SQUARES
(DESCRIPTION OF WORK r ®tA(:: F .
PROJECT ADDRESS2 iQ�2-S
ASSESSOR'S PARCEL NUMBER 2�-a O ®O'er LOT � TRACT C.
OWNER NAME
ADDRES \ G
PHONE 1� 1 �� ' (J3� EMAIL a
APPLICANT NAME- y�. c;.
ADDRESS
PHONE ��'71�p • �J (� EMAIL cAtj
CONTRACTOR'S NAME G Ca OWNER BUILDER? YE NO
BUSINESS NAME
ADDRESS
PHONE c71� -7-1 EMAIL QU AAW C.
CONTRACTOR'S STATE LIC NUMBER -"�(o((„ LICENSE CLASSIFICATION
VALUATION $ e ® SOFT L SQ FT
APPLICANT'S SIGNATU RE DATE
TYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP c'J38Z2
INVOICE PAID AMOUNT
AMOUNT - CASH •`.}CHECK# C.CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0CASH %-CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED ID YES , NO DL NUMBER NOTARIZED LETTER '"% YES NO
City of Menifee Building&Safety Department29714 Houn Rd. Menifee, CA 92586 951-672-6717
www.cityofinenifee.Lis Inspection Request Line 951-246-6213