PMT15-01693 City of Menifee Permit No.: PMT15-01693
29714 HAUN RD.
L MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE Date Issued: 0611812016
6G
PERMIT
Site Address: 26098 CRESTONE DR, MENIFEE, CA Parcel Number: 335-261-030
92586 Construction Cost: $700.00
Existing Use: Proposed Use:
Description of REPLACE 40 GAL WATER HEATER, SAME LOCATION IN GARAGE
Work:
Owner Contractor
EDDIE BERNARDINIS INTER-CITY ENERGY SYSTEMS INC
26098 CRESTON DR 12252 MC CANN DRIVE
MENIFEE, CA 92586 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 Q,ty Amount isl
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 Permil_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 effec Code:The Contractor's License Law does not apply to an owner of a property
License Class 6-S-0 License N / who builds or improves thereon, and who contracts for the projects with a
Expires 2k ' )& Signature ' «--- licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ 1 am exempt from Iicensure 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 im m proveents covered by this permit, cannot legally sell a structure that have
permit is issued. built as an owner-bullding 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
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.leainfo.ca.gov/calaw.htmi. -
permit is issued.My workers'compensation insurance carrier and policy number are:
jj
Carrier J � Property Owner or Authorize Agent Date
Cidi ✓1- r
Expires Policy# 03�?. �'7�
Name of Agent Phone# ❑ By my Signature below, I certify to each of the following: I am the property
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-
❑ I certify that in the performance of the work for which this permit is issued, I identified prope bir 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 `�L_._�
subject to the workers' compensation provisions of Section 3700 of the Labor -
Code,I shall forthwith comply with those provisions. Property Owner or Authorized Li Agent / Date
Date; /7z J Applicant; City Business cense# �1 (f�
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 HANDLEA HAZARDOUS MATERIAL ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE /"MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES 1; EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY 777 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 fX, 0 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 Slate 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 Iicensure 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
El1, as owner of the property, or my employees with wages as their sole HAZARDOUS MATEER16LF}EPNffING,
compensation, will do ( )all of or ( ) porting of the work, and the structure is PROPER NER OR AUTHORIZE A T"`J
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 bullding 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).
%C-A . Jl OF MlUNllli'EE PLCA P it
29714 Haun Road Date: Date: 3
Menifee, CA 92586 1S
Phone: (951)672-6777 Mount: o Ill n
rro
Fax:(951)679-3843 ckt ck#
Building Combination Permit G�
To Be Completed By-Applicant
Legal Descdption: —7 ly Planning Case: F: L: Fit: R:
Property Address: Assessor's Parcel Number. -�
Projeoutenant Name: ,nr Unit#: Floor#:
r t
Name: 1 Pho 4/q3 No Fax No.
Owner Proerty Addr ss� n� e Unit Number Zip Code p �/
Email Address:
,1,
Applicant Addres� n �t� D - Unit Number Zip Code
12 tClt c
mail Rddrags: !.
Name: b Phone No. ax No.
Contractor AddQ 'ly Stale 21p Cade
! 7(,
Contra CtoYs C us,ne s License No. Contracbr's Ci late of qal mis License No. ClassifiCatfaa:�
Number of Squares: LJ
95a Footage
De d20 of Work: Cos[of Wodc
Applicants Sign a
To.Be Completed By City Staff0* -
Indicate As R-Received or NIA-Nat Applicable
5 Completes sets of Fully dimensioned,draym to sale plans which include: 1 set of documents which include
® title Sheet ❑ Elevations Electrical Plan
® ® Geo Tech/Solls Report(on cd only)
J ❑ Plot/Site Plan ❑ Roof Plan ® Mechanical Plan I
❑ Tille 24 Energy(on 8 y.x 11)
,� ❑ Foundation Plan ❑ Structural Calculations
Crass Section ❑ Plumbing Plan ❑ Single Line diagram for also.services over 400 AMP
(] Floor Plan ® StructuralFraming Plan&Mails ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate Naw Construetion Alteration" Addition' Means/Malhods
Work Type. Repair Retrofit` Revision to ExisOng PefmB'Requiretl? YES NO
Proposed Building Use(s): Existing Building Use($):
#Buildings: #Units: it Stories: Will Ne Building Have a Basement?
Y of N
Bldg.Code Occupancy Group indicate Indicate if yES or NO Indlaate all Geo-tech.Haz.Zane
At Protect Spdnkiared that apply: Cosatal Zone
Completion: Construction
Type(s): C or O YES or NO Noise Zone
lRequirad? Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board Landmadc Comm. Planning Comm.Zoning Administratar
Fee Exempt: City Project Elec.Vehicle Charger Landmark Seismic Retrol-rt Spicl.1 case:alcg-
o/tidal Aoomval
Expedite Project(s): Child Care City Project Green Building Landmark I ASordable Housing
For Staff Use Only
6uildinglSalely Penult Specialist City Planning I Civil Engineenng EPWM•Admin Tmnspodalion MgmL Renl Cantral
THANK YOU FOR HELPING US CREATE ABETTER COMMUNITY
rt CITY OF MENIFEE
Department of Building and Safety
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 7000)of Division 3 of the Business and Professions code and my license is infull force and effect.
License Class:_ License No:
Exp.Date x�oZ 9�,'--d& Contractor: Cc
S�QrYIs,
—�
13
OWNER BUILDER DECLARATION: I hereby affirm under penalty of perjury that 1 am exempt from the "r,,t,,s 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 Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom 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 [$500.00]:
M 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:
I 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
I 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 its issued. My Workers Compensation Insurance carrier and policy Number are:
r.t e I CarrieGy�1Y-hJ (In in 9/.C�- Policy Number: O 34.3&,3D_7S—
(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 shall forthwith comply with those provisions..
Date: v �/�7�/ Applicant:- � .G�✓S� Q
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
representatives of the City to enter u on the above mentioned property for inspection purposes.
x ,�c �✓�rh+
Signature o ApplicintlAgent Print ApplicantlAgent 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.
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