PMT16-00410 City of Menifee Permit No.: PMT16-00410
29714 HAUN RD.
�CCEUA MENIFEE,CA 9258E Type: Residential Plumbing
MENIFEE Date Issued: 0 212 312 01 6
PERMIT
Site Address: 29130 PEPPERGRASS AVE, MENIFEE, Parcel Number: 339-493-013
CA 92584 Construction Cost: $850.00
Existing Use: Proposed Use:
Description of REPLACE 50 GAL GAS WATER HEATER
Work:
Owner Contractor
WELLY CAD SANFORD&SON PLUMBING
29130 PEPPERGRASS AVE 33173 SHORELINE DR
MENIFEE,CA 92584 LAKE ELSINORE, CA 92530
Applicant Phone:9516787299
ERIKA VILLASENOR License Number.742415
SANFORD&SON PLUMBING
33173 SHORELINE DR
LAKE ELSINORE,CA 92530
Fee Descrlption 01tr 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_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and o 1 am exempt from licensure under the Contractors State License Law for
Professions Code Tmay lic/ensse is in full force and effect. /� the following reason:
License Class, l.IJ Liven��roN�/��—l'CX� 1 , By mysignature below l acknowledge that,except for my personal residence
Expires DSignatum / %� � in which 1 must have resided for at least one year prior to completion of
improvements covered by this permit I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
D 1 hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section
have and will maintain a certificate of consent of self-insure for workers 7044 of the Business and Professions Code,is available upon request when
compensation,issued by the Director of Industrial Relations as provided for this application is submitted or at the following website:
by Section 3700 of the Labor Code,for the performance of work for which wvnv.leeinfo.ca.eov/calaw.html.
this permit is issued.
Policy#
Date
ectI have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
ion 3700 of the Labor Code,for the performance of the work for which ❑By my signature below I certify to each of the following:I am the property
this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act an the property owners behalf.I have read this
number are: qI� /,,t� application and the information I have provided is correcL I agree to comply
Carrier I W Lll l T�.0 Y �. with all applicable city and county ordinances and state laws relating to
/�
` � �3-g�0/( entente oust .)authorize representatives p rpohis s s.or county to
Policy# ) pes p, enter the abo en� d prop for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY R OR UTHORIZED AGENT
o I certify that in the performance of the work forwhich this permit is issued,
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the woyke(""compensation provisions of Section 3700 of the Labor
Code,Ishall fo witq/u+mply with s rovisions. Will the applicant or future building occupant handle hazardous material or
�p � cl _ mixture containing a hazardous material equal to or greater that the
Applicant Date L Y� amounts specifiedon the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes Ica ryo
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER 70 CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($300,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidlB�lin'es
CONSTRUCTION LENDING AGENCY ❑Yes p rvo
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer bopndary of a school?
(Section 3097 Civil Code) o Yes r�`'o
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the
Contractors License Law for the reason(s)indicated below by the hazaCalifomia Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oYes o�y{s_m�aterial reporting.
Business and Professions Code).Any city or county that requires a permit to oyes o);frj
construct,alter,improve,demolish or repair any structure,prior to its T6��`�"`"'"' Date
PROPERTY OWNER OR AUTHORIZED AGENT
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 Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRP)
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions code)or that he or she is exempt from licensure receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with
an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
❑I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.eoa.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code,The Contractors State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
❑1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
�,B;UILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
y-Menifee
M
DATE 20 PERMIT/PLAN CHECK NUMBER '���410
TYPE: ❑COMMERCIAL ❑✓ RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ❑SIGN
SUBTYPE: []ADDITION ❑ALTERATION []DEMOLITION []ELECTRICAL [-]MECHANICAL
❑NEW ❑✓ PLUMBING ❑RE-ROOF-NUMBER OF SQUARES City of Menil ae
P lding & Safet Dept.
DESCRIPTION OF WORK 1 I.1'�ttit (�-�- Q CQ�;wi
FEB 2 3 1 16
PROJECTADDRESS GL9I30- �e!- „p
ASSESSOR'S PARCEL NUMBER �j���-12 - OV3 LOT �j� TRACT ?j 4JJ
PROPERTY OWNER'S NAME Clu On
ADDRESS �ag130 ��� ' c Hale. Men,'Pev 014 92S C(
G,
PHONE ( /A.r1 aaa -%S ) EMAIL
APPLICANT NAME a n foyd 0. - e f/[,,� p p
ADDRESS (3 �, 3 �'t6Y� I ! L Q �C1 LE 1e `j t Y7we 01-� 92 3
PHONE ( � � - (pub - _7 2-q -1 EMAIL vet,Lw5 :"vy)
CONTRACTOR'S NAME Sanford O.Lieberg OWNER BUILDER? ❑YESR NO
BUSINESS NAME Sanford&Son Plumbing
ADDRESS 33173 Shoreline Dr. Lake Elsinore,CA.92530
PHONE (951)678-7299 EMAIL ',sanfordsonplumbingl@gmail.com
CONTRACTOR'S STATE LIC NUMBER 742415 LICENSE CLASSIFICATION C36
VALUATION$ S,V' 1.SO FT L SO FT APPLICANT'S SIGNATURE DATE - -]"2D
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION I CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN ` SMIP
INVOICE '
AMOUNT I I 5. PAID AMOUNT �v
CASH 0 CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT
O CASH 'v CHECK A O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cititofinenifee.us Inspection Request Line 951-246-6213
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