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PMT15-01695
i City of Menifee Permit No.: PMT15-01695 _ 29714 HAUN RD.MENIFEE, CA 92586 C�L Type: Residential Plumbing 1 P ` MENIFEE Date Issued: 0 6/1 812 01 5 i { PERMIT Site Address: 28761 DEL MONTE DR, MENIFEE, CA Parcel Number: 337-205-014 92586 Construction Cost: $700.00 Existing Use: Proposed Use: Description of REPLACE 40 GAL WATER HEATER, SAME LOCATION IN GARAGE Work: Owner Contractor JUDITH BOYD INTER-CITY ENERGY SYSTEMS INC 28761 DEL MONTE DR 12252 MC CANN DRIVE MENIFEE, CA 92586 SANTA FIE 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 QQtr Amount Rest i!S aft 'a er' e� 1 3.00 Building Permit Issuance 1 27.00 �EN.F,EEk $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 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 i i City Of Menifee I 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 j 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 �L Code:The Contractor's License Law does not apply to an owner of a property 1, License Class 6-9-0 License N / Sl 1 who builds or improves thereon, and who contracts for the projects with a Expires 51 1(o Signature ' licensed contractors)pursuant to the Contractors State License Law), WORKERS'COMPENSATION DECLARATION ❑ 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: have and will maintain a certificate of consent of self-insure for workers' gy 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 permit is issued. improvements covered by this permit, I cannot legally sell a structure that 1 have 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 j-7 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:hftp://www.leginfo.ca,gov/calaw.htmi, permit is issued.My workers'compensation insurance carrier and policy number are: Carrier 'ill �'ic. j,(h.��'t-/-z✓(.P ci">-�-- Property Owner or Aulorize Agent Date Expires ?'1/ Policy# 036: 7� � s 3 ❑ 8y 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- ❑ I certify that in the performance of the work for which this permit is issued,I identified propertyfor 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 subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith coomply with those provisions '.' Property Owner or Authorized Agent Date Date; / J / a'--- City Business License# �l / 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 f�NO EQUAL TO OR GREATER THAN THE AMOUNTS CONSTRUCTION LENDING AGENCY _1 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 Lender's Address FROM THE SOUTH COAST AIR QUALITY MANAGEMENT ❑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 reasons)indicated below by the checkmark(s)I have placed ❑YES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY next to the applicable items)(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, P 10 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 AYES 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($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING El I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERI F2EPORtING. compensation, will do ( )all of or( ) porting of the work, and the structure is PROPERTY OW R OR AUTHORJZ� A not intended intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's Slate License Law does not apply to an owner of a property who, through employees' or personal effort, builds or improves the property, / provided that the improvements are not intended or offered for sale. If,however, the building or improvement is sold within one year of completion, the Owner- Builder will have the burden of proving that it was not built or improved for the purpose of sale). (%("'AIT Oil ENIFEE PLCKNo: P it o: 29714 Haun Road �-� 5 Date: Date: / ' I Menifee, CA 92586 b Phone: (951)672-6777 Amount Amount Fax:(951)679-3843 ckn Ckk ' Building Combination Permit l To Be Come eted BY Annucanfi Legal Description: - r ^ Planning Case: F; L; Rt: R: Prape Address: 0 �� t�V I A VJ Assessor's Parcel Number. ,i�?� V J ✓ �� Projectffenant Name: � � Unit#. Floor#: Name: t t ! Pone No. Property -Yk'� Gl- ,� S� Fax No. Owner Add es : Unil Number Zip Code Email Address: D N';' •r, ; 1_ Pho©No. - �7 Fax No. Applicant Add res n '!��O D c I Unit Number Zi Coda (C.LC p -- mail Address: '-� _ _ Name: 1 Phone No. .7 ax No. Contractor Addrs / L ty s�State Zip Cade Contractor's Bu�ne s Lleense No. Contractor's Ci late of gal'omIn License No. Clase.I. lomC Number of Squares: !J Square Footage Des dpdo of Work: Cos[of Work-$ O Applf nl's Signs re Date: _ -To Be Completed ByCityBtar'f Onty Indicate As R-Recelved or NIA-Not Applicable 5 Completes sets of fully dimensioned,drawn to sale plans which include! t set of documents which include ❑ Tille Sheet ❑ Elevations ❑ Electrical Plan ;CO3 Soils Report(on cd only) ❑ Plot i Site Plan ❑ Roof Plan ® Mechanical Plan nergy(on 2 Y:x 11) QFoundation Plan Cross Section Calculations ❑ ❑ Plumbing Plan e diagram for elec.services over 400 AMP ® Floor Plan ❑ sWctural Framing Plan&Oaths ❑ Shoring Plan port-Residential Glass Code: Indicate New Const uction Alteration' Addition• Meanaf othods WorkType. Repair' - RetrofirReVlslon to Existing PagW Required9 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 tnd;cate Indicate if yES or NO Indicate ati Geo-tech.Haz.Zone Rt Project Construction SprinBlered that apply: Coastal Zone Completion: T e s YP C or O YES or NO Noise Zone Required? Listed on Historic Resources Inventory CITY PLANNING STAFF ONLY APPROVALS: Costal Commis Arch.Review Board Landmaric Comm. Planning Comm.Zoning Administrator Fee Exempt: City Project Elec.Vehicle Charger Landmark Seismic Rehord special case:amg- OlfidalAoomval Expedite Project(s): Child Care I City Project Green Building Landmadc Affordable Housing For Staff Use Only 6uildinglSalely .J. Permit Specialist City Planning I MI Engineering I EMP-Admin I Transp0'rta1z0nM-qmL_J Ram Control THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY CITY OF MENIFEE ' Department of Building and Safety ENIFE 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 in full force and effect. License Class: License No: 7� 770 si Exp.pate-Q/( Contractor: :Ti/l-kr Cy.-y n OWNER BUILDER DECLARATION: I hereby affirm under penalty of perjury that I am exempt from the Con ractors 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 70001 of Division 3 of the Business and Professions Code)or that he or she is exempt there from 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): 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 2rlI 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 dY permit its issued. My Workers Compensation Insurance carrier and policy Number are: Carrier 11a44 f"yt 0PI rr 'r-j L*-�-," Policy Number: 0 3G3 9 O�— (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 1 should become subject to the workers compensation provisions of Sec.3700 of the Labor Code,I shall rthwith comply with those provisions. / Date: (ei��Y�) Applicant: f.t� 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: 1 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 representa lives of the City to enter u on the above mentioned property for inspection purposes. / X �rrl-fin7n'ft/'rfncL/.� Signature o Applicant/Agent Print Applicant/Agent 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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