PMT15-03523 City of Menifee Permit No.: PMT15-03523
_ 29714 HAUN RD. Type: Residential Plumbing
�/-�CCEL/ MEN]FEE,CA92586
MENIFEE Date Issued:
11/10/2015
PERMIT
Site Address: 29113 CRESTLINE DR, MENIFEE,CA Parcel Number: 339-341-023
92584 Construction Cost: $1,989.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING 40 GAL WATER HEATER, SAME SIZE AND LOCATION
Work:
Owner Contractor
FRED LELAND AFFORDABLE WATER HEATERS AND PLUMBING
29113 CRESTLINE DRIVE INC
MENIFEE,CA 92584 28358 CONSTELLATION ROAD#698
Applicant Phone:8553459087
DANIEL MATA License Number:627368
AFFORDABLE WATER HEATERS AND PLUMBING INC
28358 CONSTELLATION ROAD#698
VALENCIA, CA 91355
Fee Description Qtv Amount I51
Residential Water Heater 1 83.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 4.15
$115.15
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 Terrplate.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ 1 am exempt from licensure under the Contractors'State License Law for the
I hereby affirm under penalty or perjury that I am licensed under provisions of following reason:
Chapter 9(commencing with section 7000)of Division 3 of the Business and By my signature below I acknowledge that,except for my personal residence in
Professions Code and my license is in full force and effect. which I must have resided for at least one year prior to completion of
License Cl ss L3 L. a No. Improvements covered by this permit, I cannot legally sell a structure that I have
Expires >7 Signatur 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
WORKERS'COMPENSATION D RATION Business and Professions Code,is available upon request when this application is
submitted or at the following Web site:
❑ 1 hereby affirm under penalty of perjury one of the following declarations: htto:l/www.leainfo.ca.aov/calaw.html.
I have and will maintain a certificate of consent of self-insure for workers'
compensation,Issued by the Director of Industrial Relations as provided for by Date
Section 3700 of the Labor Code, for the performance of work for which this
permit is issued. Property Owner orAuthodzed Agent
Policy# ❑ By my Signature below, I certify to each of the following: I am the property
I have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owners behalf. I have read this
ction 3700 of the Labor Code, for the performance of the work for which this application and the information I have provided is correct. I agree to comply
permit is issued.Myworkers'compensation insurance cerierand policy number are: 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-
Carrier�1 )�`S_ identified property for the inspection purposes.
Policy# .7i\�.li� Expires Date
Property Owner or Authorized Agent
(This section need not be completed if the permit is for
one-hundred dollars($100)or less) City Business License#
HAZARDOUS MATERIAL DECLARATION
❑ 1 certify that in the performance of the work for which this permit is Issued.I
shall not employ any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or a
workers'compensation laws of California, and agree that if I should become mixture containing a hazardous material equal to or greater that the
subject to the workers'compylsation provisions of Section 3700 of the Labor amounts ecified on the Hazardous Materials Information Guide?
Code,I shal orthwith with hose provisio S. DYES
1N0
Applica ate; ) Will the intended use of the building by the applicant or future building
occupant require a permit for the construction or modification from South
WAR G: FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guideli s
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND OYES NO
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the p ggqposed building or modified facility be within 1000 feet of the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary fa school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES ❑YES .`!a�]/`NO
CONSTRUCTION LENDING AGENCY I have re d the Hazardous Material Information Guide and the SCAOMD
I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist.I understand my requirements under the State of
agency for the performance of the work which this permit is issued (Section California Health&Safety Code,Se ' n 25505 and 25534 concerning
3097 Civil Code) hazard material reporfin
OWNER BUILDER DECLARATIONS OYES
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date
License Law for the reason(s)indicated below by the checkmark(s)I have placed PRO ER OWNER OR AOTHORIZED AGENT
next to the applicable item(s)(Section 7031.5. Business and Professions Code:
Any city or county that requires a permit to construct, alter, improve, demolish, EPA RENOVATION,REPAIR AND PAINTING(RRP1
or repair any structure, prior to its issuance, also requires the applicant for the
permit to rile a signed statement that he or she is licensed pursuant to the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
provisions of the Contractor's State License Law(Chapter 9 (commencing with receiving compensation for most work that disturbs paint in a pre-1978
Section 7000)of Division 3 of the Business and Professions Code)or that he or residence or childcare facility to be RRP-certified firms and comply with
she is exempt from licensure and the basis for the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than($500).) employees.For more information about EPA's Renovation Program visit:
❑ www.epa.govfiead or contact the National Lead Information Center at
I, as owner of the property; or my employees with wages as their sole 1-800-424-LEAD(5323).
compensation,will do( )all of or( )porting of the work, and the structure is
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 ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however, Certified Firm Name:
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 Fro Certification No.:
purpose of sale).
❑ I, as owner of the property an exclusively contracting with licensed No EPA Lead-Safe Certified Firm is required for this project because:
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's License Law does not apply to an owner of a property
who builds or improves thereon, and who contracts for the projects with a
licensed contractor(s)pursuant to the Contractors State License Law). If your project does not comply with EPA RRP rule please fill out the RRP
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
a
Menifee
DATE PERMIT/PLAN CHECK NUMBER Q�j6a'7j
TYPE: :: COMMERCIAL I RESIDENTIAL O MULTI-FAMILY O MOBILE HOME :; POOL/SPA O SIGN
SUBTYPE: O ADDITION 0 ALTERATION O DEMOLITION O ELECTRICAL 0 MECHANICAL
O NEW PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK 1N
PROJECTADDRESS 2� e,,�, Vf
ASSESSOR'S PARCEL NUMBER ;_J,J � -��?j LOT TRACT
City of Menifee
OWNER NAME Building & Sa
ADDRESS iANG
PHONE OQ'306>' (01/0 EMAIL
APPLICANT NAME e c e A ve d
ADDRESS S40C
PHONE EMAIL
CONTRACTOR'S NAME ,,(( OWNER BUILDER? O YES p,NO
BUSINESS NAME ut
ADDRESS IG1tA R.S /y
PHONE '�LAA EMAIL ��, czm
CONTRACTOR'S STATE LIC NUMBER Q4 (A LICENSE CLASSIFICATION ?j
VALUATION $ I SO FT L SQ FT
APPLICANT'S SIGNATURE DATE l Q
L, I
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN 1 SMIP
INVOICE PAID AMOUNT 1 C� `� .`
AMOUNT 1 I5 1',5• 1 ✓ C CASH CHECK It CREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT C: CASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER :i YES O NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.Lls Inspection Request Line 951-246-6213
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