PMT16-00960 City of Menifee Permit No.: PMT16-00960
29714 HAUN RD.
�ACCEL/-> MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE Date Issued:
04/05/2016
PERMIT
Site Address: 27204 HOWARD ST, MENIFEE, CA 92586 Parcel Number: 335-312-010
Construction Cost $6,000.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING 50 GAL WATER HEATER, SAME LOCATION
Work:
Owner Contractor
JERRY BURGESS W C HEATING&AIR CONDITIONING INC
27204 HOWARD STREET 41085 GOLDEN GATE CIR
MENIFEE,CA 92586 MURRIETA, CA 92562
Applicant Phone: 9516000700
JILL WESTON License Number 779604
W C HEATING&AIR CONDITIONING INC
41085 GOLDEN GATE CIR
MURRIETA, CA 92562
Fee Description QtV Amount IE)
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_Permil_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 1 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 ❑I am exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full force and effect the following reason:
License Class /y An License No.Ti4 L69 By mysignature below l acknowledge that,except for my personal residence
Expires Signature in which l 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 DECLARATIO have built as an owner-builder if it has not been constructed in its entirety by
❑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 bythe 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 w%w.Ieginfo.m.gov/calaw.htmI.permit is issued.
Policy# Date
Y,t have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
'section 37DO of the Labor Code,for the performance of the work for which ❑By my signature below l 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 on the property owners behalf.I have read this
number are: t 1 ,e —•.,_ - application and the information I have provided is correct I agree to comply
Carrierbery-shim !JC 1�r7GJwY with all applimble city and county ordinances and state laws relating to
Q building construction.i authorize representatives of this city or county to
Policy# bk.WIZA01M141 Expires�/ IT�� enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
❑I certify that in the performance of the work for which this permit is issued,
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those provisions. 1 Will the applicant or future building occupant handle hazardous material or
Applicant W Date r'�-'1$' (L mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide.
WARNING:FA URE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑yes
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TOTHE 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 forguidellnes
CONSTRUCTION LENDING AGENCY ❑Yes 1}Mo
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 boundary of a school?
(Section 3097 Civil Code) O Yes !?"No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements underthe State of
I hereby affirm under penalty of perjury that lam exempt from the
California Health al Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the
checkmark(s)I have placed next to the applicable item(s)(Section 70315 hazardous material reporting.
Business and Professions Code).Any city or county that requires a permit to DVes ¢1qo
construct,alter,improve,demolish or repair any structure,prior to its Date J
issuance,also requires the applicant for the permit to file a signed statement PROPE !OWNER OR AUTHORIZED AGENT
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 exemptfrom licensure receiving compensation for most work that dsturbs 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-dsturbing work themselves or through their
O1,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 O 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. O No EPA Lead-Safe Certified Firm Is required for this project because:
D I,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
APPLICATION& SAFETY PERMIT/PLAN CHECK
y`f�•
�`Menifee
DATE 03/31/2016 PERMIT/PLAN CHECK NUMBER 9WIt b a
TYPE: [-]COMMERCIAL 0 RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION []ELECTRICAL ❑MECHANICAL
❑NEW ❑PLUMBING [I RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK REPLACING EXISTING 50 GALLON WATER HEATER WITH 50 GAL TANK WAER HEATER
(GARAGE) City of Meni
e
PROJECTADDRESS 27204 HOWARD ST Gt
G
ASSESSOR'S PARCEL NUMBER S'b j • -619 -ONO LOT TRACT
PROPERTY OWNER'S NAME JERRY BURGESS
ADDRESS 27204 HOWARD ST..MENIFEE, CA 92586
PHONE EMAIL
APPLICANTNAME JILLWESTON
ADDRESS 3645 RUFFIN RD 330-335 SAN DIEGO,CA 92123
PHONE (619)384-6622 EMAIL J
CONTRACTOR'S NAME RUSSELL COCHRAN OWNER BUILDER? ❑YES❑✓NO
BUSINESS NAME WC PLUMBING, HEATING&AIR
ADDRESS 41085 GOLDEN GATE CIR MURRIETA, CA 92562
PHONE (951)600-0700 EMAIL
CONTRACTOR'S STATE LIC NUMBER 779604 LICENSE CLASSIFICATION C20
VALUATION $ $6,000.00 SO FT 1784 L SO FT
APPLICANT'S SIGNATURE DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION �[ CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT 0CASH G CHECK# GCREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT G CASH GCHECK# G CREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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