PMT16-01157 City of Menifee Permit No.: PMT16-01157
29714 HAUN RD. Type: Residential Plumbing
<ACCELJ MENIFEE, CA92586
MENIFEE Date Issued: 0 4/1 512 01 6
PERMIT
Site Address: 28620 LEGACY WAY, MENIFEE, CA Parcel Number: 372-271-006
92584 Construction Cost: $1,500.00
Existing Use: Proposed Use:
Description of REPLACE 50 GAL.WATER HEATER, SAME SIZE/LOCATION GARAGE
Work:
Owner Contractor
EDWARD HURLEY AFFORDABLE WATER HEATERS AND PLUMBING
28620 LEGACY WAY 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 9!y Amount ISI
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_Pennit_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 D I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in ful o e and effect, the following reason:
License O s se No. By my signature below I acknowledge that,except for my personal residence
Expires Signatur 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 DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
❑I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that copy of the applicable law,Section
have and will maintain a certificate of consent of self-insure for worker's 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 sv ,y,leeinfo.ca.¢ov/calaw.html.
this permit is issued.
p icy
# Date
have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
ection 3700 of the Labor Code,for the performance of the work for which o By my signature below l certify to each of the following:I am the property
this permit is issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this
numbera,r(re: application and the information I have provided Is correct.I agree to comply
Lanier `S - Y t(j V"C� with all applicable city and county ordinances and state laws relating to
f,,� !-1 /��t building construction.I authorize representatives of this city or county to
Policy#tiV�(i �r-,6 LkR Lm Expires enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for o e-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT D I certify that in the performance of the work for which this permit is issued, O 3C3 1
I shall not employ any persons in any manner so as to became subject to the CITY BUSINESS LICENSE# r7
workers co ensation laws of Calif rnia,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to a orkers comya f nprovis' s of Section 3700 ofth Labor
Code,I shall hwith carrel i th p islow. Will the applicant or future building occupant handle hazardous material or
Applican ` / Date mixture containing a hazardous material equal to or greater that the
amauntr ecified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SE RE WORKER'S COMPENSATION VERAGE 15 ❑Yes No
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 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 forguid nes
CONSTRUCTION LENDING AGENCY D Yes No
1 hereby affirm that under the penalty of perjury there is a construction Will the roposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer boi dary of a school?
(Section 3097 Civil Code) ❑Yes o
OWNER BUILDER DECLARATIONS 1 have r ad the Hazardous Material Information Guide and the SCAQMD
permitting checklist.)understand my requirements under the State of
I hereby affirm under penalty of perjurythat I am exempt from the
Contractors License Law for the reason(s)indicated below 6y the Cal'rfoKNr.
ealth&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardmaterial reporting.
oyes
Business and Professions Cade).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWN ER 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 7032.5 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.ena.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-80G-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:
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.
*MenlTee
DATE L� �, PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL 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 ,PLUMBIN/G� {O RE-R1OOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER �(� '�t 1D� LOT TRACT p`
PROPERTY OWNER'S N/�AMtE /h
ADDRESS y IAA V �\ 1'�~ 7C -`1"cjs
PHONE 6\K, ' 11J 1 . " " EMAIL
APPLICANT NAME '\
ADDRESS �-/�•IL J r t 1 V
PHONE �'�-,',lkrj-o1O(A� EMAIL
CONTRACTOR'S NAME OWNER BUILDER? O YES ONO
- __.__—_ USINESS.NAME_
ADDRESS '(G Vy G lJA 0 �
PHONE yoLAq EMAIL 9& W As ,
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION $ , WYY SO L SO FT
I AUAPPLICANT'S SIGNATURE DATE
0
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I SMIP
INVOICE I
1rJ. J PAIDAMOUNT
AMOUNT �'J OCASH OCHECK# 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT OCASH OCHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
city o, Memfee Building&Scfety Department 29714 Houn Rd. Menifee, CAA 92586 951-672-6777
www.cityof-remfee.us Insuectian Request Line 951-240'-6213
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