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PMT15-03940 City of Menifee Permit No.: PMT15-03940 29714 HAUN RD. Type: Residential Plumbing <ACCEC? MENIFEE, CA 92586 MENIFEE Date Issued: 12/21/2015 PERMIT Site Address: 28727 MILKY WAY, MENIFEE,CA 92586 Parcel Number: 339-211-002 Construction Cost $500.00 Existing Use: Proposed Use: Description of REPLACE SHOWER VALVE AND ALIGN DRAIN TO ACCOMODATE NEW 36"x 66"SHOWER PAN, Work: CAP OFF PLUMBING FOR EXISTING TUB Owner Contractor LUCILLE MORA C L I DEVELOPERS INC 28727 MILKY WAY 21581 ORANGE AVE MENIFEE,CA 92586 PERRIS, CA 92570 Applicant Phone:9517226515 ISAAC LOPEZ License Number: 1005862 C L I DEVELOPERS INC 21581 ORANGE AVE PERRIS, CA 92570 Fee Description OQt Amount i$) Plumbing Fixtures and Vents,fixtures 2 116.00 Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 General Plan Maintenance Fee-Plumbing 1 5.80 $149.80 The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and specifications or from preventing builiding operations being carried on thereunder when in violation of the Building Code or of any other ordinance of City of Menifee.Except as otherwise stated,a permit for construction under which no work is commenced within six months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be forfeited. AA_Bldg_Pernit_Template.rpt Page 1 of 1 City Of Menifee LICENSED DECLARATION ❑ ]am exempt from Iicensure under the Contractors'State License Law for the following reason: I hereby affirm under penalty or perjury that I am licensed under provisions of Chapter 9(commencing with section 7000)of Division 3 of the Business and By my signature below I acknowledge that, except for my personal residence it Professions Code and my license is in full force and effect. which I must have resided for at least one year prior to completion or License Class 13 Lice N 100G"$G,2 Improvements covered by this permit, I cannot legally sell a structure that I have Expires Signature built as an owner-building if it has not been constructed in its entirety by licensec contractors. I understand that a copy of the applicable law,Section 7044 of the WORKERS'COMPENSATION DECLARATION Business and Professions Code,is available upon request when this application ie submitted or at the following Web site: ❑ I hereby affirm under penalty of perjury one of the following declarations: htto.,//www.leoinfb.m.aov/calaw.htmi. 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 or Authorized Agent Policy# ❑ By my Signature below, I certify to each of the following: 1 am the properll ❑ 1 have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property owner's behalf. I have read thie section 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 carrier and policy number are: with all applicable city and county ordinances and state laws relating to buildinc construction.I authorize representatives of this city or county to enter the above. Carrier SfOLX ra3 .p TfA-r-,'gKee identified property for the inspection purposes. Policy# R(c(3Zt I . 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,1 shall not emolov 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 B i should become mixture containing a hazardous material equal to or greater that the subject to the workers'compensation provisions of Secdon.3700 of the Labor amounts specified on the Hazardous Materials Information Guide? Code,I shall forjb�,viitth/co ly with those provisions. DYES ❑NO Applicant;i %doDate; /�— �— Will the intended use of the building by the applicant or future building ��i-""— occupant require a permit for the construction or modification from South WARNIN FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DYES ❑NO CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the outer DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of a school? LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES ❑NO CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAQMD 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 8 Safety Code,Section 25505 and 25534 concerning 3097 Civil Code) hazardous material reporting. OWNER BUILDER DECLARATIONS DYES ❑NO 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 PROPERTY OWNER OR AUTHORIZED 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(RRP) 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 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 firths 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.gov/lead 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( )parting of the work,and the structure is not intended or offered for sale.(Section 7044,Business and Professions Code; The Contractor's Stale 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 Finn 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 Firm Certification No.: purpose of sale). ❑ 1, as owner of the property an exclusively contracting with licensed No EPA Lead-Safe Certified Finn 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 Acknowledgement. BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION Men;fee DATE ?. 'L I- I PERMIT/PLAN CHECK NUMBER P TYPE: O COMMERCIAL K RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW r PLUMBING O RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK SjAo rr URI1,4 01hcl ca I' J ci . m L.O ct-kc n PROIECTADDRESS 'a-72 y IIlL I M2^S� "t54 �1 _ ,iiding i£ Safety Dept. ASSESSOR'S PARCEL NUMBER 037 A -Pik- � LOT TRACT OWNERNAME C.v%i I2. o DEC 21 2015 ADDRESS ,-t Z -61 Tiee vN ceeived PHONE (c,>s)�:n ► -^ GO-A EMAIL APPLICANT NAME ADDRESS PHONE EMAIL CONTRACTOR'S NAME OWNER BUILDER? O YES NO BUSINESS NAME c^ LX Devepergv..G.. ADDRESS (r 2-C S$ l Q e 'Ave e'.t t- 3 C_ P, ,`.f76 PHONE 1`7 J�(� 7 Z-ti- Co 751 EMAIL 1ppB7-jt C,I 1 -C->Vi51tf-U't1 \0Ar1. .6OKn. CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION$ p0 SO FT L SQ FT APPLICANT'S SIGNATURE DATE l-LI- 1 S OTYSTAFFUSEONLY DEPARTMENT DISTRIBUTION CITY OFp�tl-F(E�EBUQSINESS LI ENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP l! ✓V INVOICE PAIDAMOUNT //�� AMOUNT q1 • OCASH 0CHECK# OCREDITCARD VISA/MC PLAN CHECK FEES PAID AMOUNT O CASH O CHECK M O CREDIT CARD VISA/MC OWNER BUILDERVERIFIED OYES O NO DLNUMBER NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-5777 www.cityofTIenifee.us Inspection Request Line 951-246-6213 i I i 2�l d SfiOs Mcts+�r 13a+G� City of Menifee Building & Safety Dept. i,6 DEC 21 2015 CL 2 capa� f'lo�t6irJ O [Received 0 LU O <.J `pyse I PJlr ^ ora'K +o u1 ,- 16)( Coco LL Gt052r i REcf Ebt CITY OF MENIFEE BUILDING AND SAFETY DEPARTMENT PLAN APPROVAL, 2 REVIEWED BY Oj& \ ,� DATE V 'Approval of these plans shall not be construed to be a permit for,or an approval of,any violation of any provisions of the federal,state or city regulations and ordinances. This set of approved plans must be kept on the jobsite until completion. 2672-7 M;ir-y jC/oLY 04, ,Tee GP qZS -6� r%