PMT16-00388 City of Menifee Permit No.: PMT16-00388
29714 HAUN RD.
Type: Residential Plumbing
"'�KCCEUR> MENIFEE,CA 92586
MENIFEE Date Issued: 02/16/2016
PERMIT
Site Address: 29592 SQUAW VALLEY DR, MENIFEE, Parcel Number: 338-253-034
CA 92586 Construction Cost: $999.00
Existing Use: Proposed Use:
Description of REPLACE 50 GAL WATER HEATER IN GARAGE
Work:
Owner Contractor
JUSTIN&JESSICA BAILEY WATER HEATERS ONLY INC
29592 SQUAW VALLEY DR 970 E MAIN STREET#200
MENIFEE, CA 92586 GRASS VALLEY, CA 95945
Applicant Phone: 8008358345
STEVEN SCHNIERER License Number.374573
WATER HEATERS ONLY INC
970 E MAIN STREET#200
GRASS VALLEY, CA 95945
Fee Description Oft Amount 181
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 slated,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_Btdg_Permd Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION
I hereby affirm under penalty or perjury that l 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 contactors to construct the project(Section 7044,Business and Pmfessions
Professions Code and my license is in full tome and effect. Code:The Contractors Ucense Law does not apply to an owner of a property
Ucense Class C3(o .License No.37•4S7-5 who builds or Improves thereon,and who contracts for the projects with a
res5 3 1 . Sig
nature gnatureS.�wrz_�"2 � licensed contractor(s)pursuant to the Contractors Stele License Law).
WORKERS'COMPENSATION DECLARATION
�[ ' ❑ lam exempt from Ilcensure under the Contractors'State License Law for the
•Ti.l 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
permit is Issued. improvements covered by this permit,I cannot legally sell a structure that I have
Policy# 145D3-o'F 9 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
'I have and will maintain warners'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 pedormance of the work for which this submitted or at the following Web site:htto,lhwvw leoinfo.o.goyLgim.html,
permit is Issued.My workers compensation Insurance carder and policy number are:
Cartier ropertY Owner orAuthorized Agent Date
Expires Policy#
Name ofAgem Phone# my Signature below, I certify to each of the following:I am the property
owner or authorized to act on the property, owners behalf. I have read this
(This section need not be completed if the permit Is for application and the Information I have provided Is coned I agree to comply
one-hundred dollars($100)or less) with all applicable city and county ordinances and state laws relating to building
construction.I authorize representatives of this city or county to enter the above-
0 1 certify that in the performance of the work for which this permit is issued,I identified property for the Inspection purposes. ---
shall not employ any persons In any manner so as to become subject to the ,
Workers'compensation laws of California,and agree that if I should become —C� ��)bll(e'
subject to the workers compensation provisions of Section 3700 of the Labor Property OwnerorAuthorzed Agent Date
Code,I shall forthwith comply with those provisions.
Date; ( Ike, Applicant;
L s City Business Ucense# 035$ur3'
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 HAZARDOUS MATERIAL ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE,INTEREST,AND ATTORNEYS FEES 4110 EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY VV SPECIFIED ON THE HAZARDOUS MATERIALS
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) APPUCANT OR FUTURE BUILDING OCCUPANT REQUIRE
Lender's Name DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
Lender's Address O FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR
OWNER BUILDER DECLARATIONS GUIDE LINES
I hereby affirm under penalty of perjury that I am exempt from the Contractors PRINT NAME Ste>vcvv ��.v.r�rer
License Law for the reason(s)indicated below by the chedonwk(s)I have placed OYES 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, zp& 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 Ucense Law(Chapter9(commencing with I HAVE READ THE HAZARDOUS MATERIAL
Section 7000)of DhAsion 3 of the Business and Professions Code)or that he or ORAW INFORMATION GUIDE AND THE SCAQMD PERMITTING
she Is exempt from licensum 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($500).) CODE,SECTION 25505 25533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL f'(EPOWYING.
compensation,will do( )all of or( )porting of the work,and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code; A
The Contractor's State License Law does not apply to an owner of a property X-
who, through employees'or personal effort. builds or improves the property,
provided that the Improvements are not intended or offered for sale.If,however,
the building or Improvement Is sold within one year of completion,the Owner-
Builder will have the burden of proving that it was not built or Improved for the
purpose of sale).
A.�
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Meniiee
DATE 02/1 612 0 1 6 PERMIT/PLAN CHECK NUMBER "P`Mk - COS
TYPE: ❑COMMERCIAL ❑✓ RESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑f6EC ol eALifee
[]NEW ❑✓ PLUMBING ❑RE-ROOF-NUMBER OF SQUARES Buildinng & Safety
DESCRIPTION OF WORK Replace 50 Galion Water Heater In Garage
PROJECTADDRESS 29592 Squaw Valley Drive Received
ASSESSOR'S PARCEL NUMBER 338- P53-031 LOT o10 TRACT ,2
OWNER NAME Justin&Jessica Bailey
ADDRESS 29592 Squaw Valley Drive Sun City, CA 92586
PHONE (760)550-7602 EMAIL
APPLICANT NAME Steven Schnierer
ADDRESS 31225 La Baya Drive Suite 112 Westlake Village, CA 91362
PHONE (818)735-7876 EMAIL
CONTRACTOR'S NAME Water Heaters Only Inc. OWNER BUILDER? ❑YES❑✓NO
BUSINESS NAME Water Heaters Only Inc.
ADDRESS 970 E Main Street#200 Grass Valley,CA 95945
PHONE (530)274-3001 EMAIL -
CONTRACTOR'S STATE LIC NUMBER 374573 LICENSE CLASSIFICATION C36
VALUATION$ $999.00 SO FT L SO FT
APPLICANT'S SIGNATURE DATE 02/16/2016
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION W CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE
AMOUNT •� PAID AMOUNT OCASH OCHECK# 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES 0 NO DL NUMBER NOTARIZED LETTER 0 YES O NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-572-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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