PMT15-01235 City of Menifee Permit No.: PMT15-01235
29714 HAUN RD.MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE Date Issued: 05/11/2015 !!
N
PERMIT
Site Address: 28269 CHULA VISTA DR, MENIFEE, CA Parcel Number: 336-212-010 d
92586 Construction Cost: $8,500.00
E
Existing Use: Proposed Use:
Description of INSTALL DUAL SWEEP CLEANOUT ON MAIN SEWER LINE
Work:
Owner Contractor
THOMAS CAMPANILE RESCUE ROOTER/ARS
28269 CHULA VISTA DR 1520 W LINDEN STREET
MENIFEE, CA 92586 RIVERSIDE, 92507
Applicant Phone: 9513419371
ANDREW ALLEN License Number: 765155
RESCUE ROOTER/ARS
1520 W LINDEN STREET
RIVERSIDE, CA 92507
Phone: 9513419371
Fee Description ON Amount l$)
e s lXue
Building Permit Issuance 1 27.00
$144.00
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 affi m 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
li Professions Code ap y license is in fu c a d effect. Code:The Contractor's License Law does not apply to an owner of a property
License Claps �- License No. who builds or improves thereon, and who contracts for the projects with a
7 Expires ) Signature licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ I am exempt from licensure under the Contractors'Slate 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.
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
N- 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:htto/Nvww.leqinfo.m.(iov/calaw.html.
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier ,' �� j W' Property Owner or Authorized Agent Date
Expires Policy#��(•�G�f�62563
❑ 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 r rese atives of ' city or county to enter the above-
0 1 certify that in the performance of the work for which this permit is issued, I identified property f edion p ses.
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 sbguld begTne /
subject to the workers'compensation provisions of S ion 3,700 of t bor Property Owner or Authorized A ent Date
Code,I shall forthwith comply with those prowsio (j 'y}�
( �� City Business License# 01"X
Date; �r I � � � � 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 ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES EJNO 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 ❑YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address -E NO 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, 'D 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 eYES 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 EP RTING.
compensation,will do( )all of or( ) porting of the work, and the structure is PROPERTY O UTHORIZ GENT
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).
i
BUILDING & SAFETY PERMIT/PLAN APPLICATION
I
Menifee
DATE 5��^/ j PERMIT/PLAN CHECK NUMBER
TYPE: ❑COMMERCIAL E@RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ❑SIGN
SUBTYPE: [—]ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑MECHANICAL
❑NEW [Z]PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK h t'thc,.— u L S� EEP L f EAA,dU — oN
MGiIIJ E.�e,tIc IYv
PROJECT ADDRESS Lr-1 \/1 `1 A OIL
ASSESSOR'S PARCEL NUMBER ?j I��p�0 LOT '7)t4 TRACT
OWNER NAME / p - Q I
ADDRESS 2&Z /p L A V I - K
PHONE �E r (o "� 9 Zy2C/SI EMAIL
APPLICANT NAME rv0/2-C= J-�LLp'I..
ADDRESS /�o L 7,1 L S r 1�24_
PHONE 5�C/ 3L// �'3 7 EMAIL
CONTRACTOR'S NAME `-,C L, cg�". 5 OWNER BUILDER? ❑YES❑NO
BUSINESS NAME
ADDRESS 1, '' S 7�✓='
PHONE 5r/ 5q( f15 -7 EMAIL
CONTRACTOR'S STATE LIC NUMBER r
I LICENSE CLASSIFICATION
VALUATION $ L SQ FT
APPLICANT'S SIGNATURE DATE I'
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF WNIFLE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE G O GREEN SMIP �/��/ 10"27
INVOICE tO PAID AMOUNT
AMOUNT C% CASH :"CHECK# 'OCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT CASH "CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED ?YES <' NO DLNUMBER NOTARIZED LETTER (:'; YES `% NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofnlenifee.usInspection Request Line 951-246-6213
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