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PMT16-01425 City of Menifee Permit No.: PMT16-01425 29714 HAUN RD. �A—CCEL/-> MENIFEE, CA 92586 Type: Residential Plumbing MENIFEE Date Issued: 06105/2016 PERMIT Site Address: 28228 VIA BANDITA, MENIFEE, CA Parcel Number: 336-317-017 92585 Construction Cost; $515.00 Existing Use: Proposed Use: Description of WATER HEATER CHANGE OUT,40 GAL Work: Owner Contractor WENDY JONES AMERIPAN INC 28228 VIA BANDITA 77564 COUNTRY CLUB DR#368 B MENIFEE, CA 92585 PALM DESERT, CA 92211 Applicant Phone:7609728068 JIMMY CARTER License Number:896899 AMERIPAN INC 77564 COUNTRY CLUB DR#368 B PALM DESERT, CA 92211 Fee Description gty Amount($) 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 propertywho builds or improves thereon,and who contracts for the projects with a licensed contractor(s)pursuant to the Contactors State License Law). I hereby affirm under penalty of perjury that I am under provisions of Chapter9(commencing with section 7000)of Division 3 of the Business and o 1 am exempt from licensure under the Contractor's State License Law for Professions Cc and my license is in full force and effect. the following reason: License Class_License No.AT6 CT.9 By my signature below I acknowledge that,except for my personal residence Fires Signature in which I 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 DECIA ON have built as an owner-builder if it has not been constructed in its entirety by o 1 hereby affirm under penalty of perjury one of the following declarations:I licensed contactors.I understand that a 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 tabor Code,for the performance of work for which , ww.leeinfo.ca.¢ov/calaw.htmL Policy phis mitlk issue CC �l 1 .�} (� 1l1 1-( V —!� Date _ 1-9 / PROPERTY OWNER OR AUTHORIZED AGENT ❑I have and will maintain worker's compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which o 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 polity owner or authorized to act on the property owner's behalf.I have read this number are: application and the information I have provided is correct.I agree to comply with all applicable city and county ordinances and state laws relating to Carrier building construction.I authorize representatives of this city or county to Policy Lf Expires 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 o 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 theLAZA Y BUSINESS LICENSE If workers compensation laws of California,and agree that if I should becomeZARDOUS MATERIAL DECLARATION subject to the workers compensation provisions of Section 3700 of the Labor de,Is forthwith comply wit those pro ions. l the applicant or future building occupant handle hazardous material or pplicant ture containing a hazardous material equal to or greater that the ounts spe�cif '°n the Hazardous Materials Information Guide? WARNI G FAILURE T SE RE WORKER'S COMPENSATION COVERAGE ISes & a UNLAW L,AND SHALL BJEC7AN EMPLOYER TO CRIMINAL PENALTIESl the intended use of the building by the applicant or future building AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),INupant require a permit for the construction or modification from South ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FORst Air Quality Management District(SCAQMD)?See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEESguidelines CONSTRUCTION LENDING AGENCY es p I hereby affirm that under the penalty of perjury there is a constructionll the proposed building or modified facility be within 1000 feet of the lending agency for the performance of the work which this permit is issueder hounda school?(Section 3097 Civil Code) es oOWNER BUILDER DECLARATIONS ve read the Hazardous Material Information Guide and the SCAQMD mitting checklist I understand my requirements underthe State of I hereby affirm under penalty of perjury that I am exempt from the ifornia Health&Safety Code,Section 25505 and 25S34 concerning Contractors License Law for theieason(s)indicated below by the ous material reportincheckmark(s)I have placed next to the applicable items)(Section 7031.5s oWo ./�^Business and Professions Code).Any city or county that requires a permit toDatec./ ~construct,alter,improve,demolish or repair any structure,prior to itsERN OWNE 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 Iicensure 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). managerswho do the paint-disturbing work themselves or through their ❑1,as owner of the property,or my employee with wages as their sale 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.epa.gov/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: in 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. APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK "Menifee DATE 04/27/2016 PERMIT/PLAN CHECK NUMBER (u'- ' TYPE: ❑COMMERCIAL ❑✓ RESIDENTIAL [—]MULTI-FAMILY ❑MOBILEHOME OPOOLISPA [-]SIGN SUBTYPE: ❑ADDmON ❑ALTERATION []DEMOLITION ❑ELECTRICAL [—]MECHANICAL ❑NEW [Z]PLUMBING ❑RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK Water heater change out. PROJECT ADDRESS 28228 Via Bandits,Romolaannd,CA 92585 s,� ASSESSOR'S PARCEL NUMBER 'J LP- LOT TRACT I� PROPERTY OWNER'S NAME Wendy Jones ADDRESS 28228 Via Bandita,Romaland,CA 92585 PHONE (760)213-4299 EMAIL APPUCANTNAME Anabelle Rodriguez ADDRESS 77564-B Country Club Dr#368,Palm Desert,CA 92211 PHONE (760)972-8068 EMAIL dispatch@completemechanicalservice.com CONTRACTOR'S NAME Complete Mechanical Service OWNER BUILDER? ❑YES©NO BUSINESS NAME Complete Mechanical Service ADDRESS 77564E Country Club Dr#368, Palm Desert,CA 92211 PHONE (760)972-8068 EMAIL dispatch@completemechanicaiservice.com CONTRACTOR'S STATE LIC NUMBER 896899 LICENSE CLASSIFICATION C VALUATION$ $515.00 SQ FT L SQ FT APPLICANT'S SIGNATURE DATE 04/27/2016 CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS UCENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE I 'C5. � PAID AMOUNT AMOUNT 0CASH 0 CHECK If 0CREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT OCASH O CHECK R OCREDITCARD 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. 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