PMT16-01503 City of Menifee Permit No.: PMT16-01503
_ 29714 HAUN RD.
41-'C L/-> MENIFEE, CA92586 Type: Residential Plumbing
MENIFEE Date Issued:
05/1312016
PERMIT
Site Address: 28882 LOIRE VALLEY LN, MENIFEE, CA Parcel Number: 364-122-010
92584 Construction Cost: $1,500.00
Existing Use: Proposed Use:
Description of REPLACING EXISTING 50 GAL WATER HEATER SAME LOCATION
Work:
Owner Contractor
AMALITSA ANASTASIOU TRUTEAM OF CALIFORNIA INC
28882 LOIRE VALLEY LN 260 JIMMY ANN DRIVE
MENIFEE, CA 92584 DAYTONA BEACH, FL 32114
Applicant Phone:3863042222
EDWARD PONCE License Number: 221517
TRUTEAM OF CALIFORNIA INC
260 JIMMY ANN DRIVE
DAYTONA BEACH, CA 32114
Fee Description P!t 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
$115.16
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 carded 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_Pemiit_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 ❑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 6 License No. 7/57 By my signature below l acknowledge that,except for my personal residence
Expires 9150117 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 DECLARATION have built as an owner-builder if it has not been constmcted in its entirety by
O I hereby affirm under penalty of perjury one of the fallowing 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 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 www.legjnfo.ca.gov/calaw.htmL permit is issued.
Policy# Date
/ have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 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 owner's behalf.I have read this
number are: // application and the information 1 have provided is correct.I agree to comply
Cartier lrs` /T.f PH-r r // with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# WLIEC yf-/S/$ 53 Expires 41301201(, 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#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of section 3700 of the Labor
Code,I shall forth w' /comply with ttloose provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant /Y_ Dale S�/3��G mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS oYes )kNo
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
IN SECTION 3706 OF TH
ADDITION TO THE OF COS
OFCOMPENSATION,DAMAGESASPROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
E LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines ,
CONSTRUCTION LENDING AGENCY DYes rEYN,
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 Cade) D Yes DW
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements underthe State of
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material reporting.
oYes Oslo
Business and Professions Code).Any city or county that requires a permit to
i_ro- /k--. Date G 1514
construct,alter,improve, applicantsh for hepermiany t toile a signets its 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 IRRPI
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 than($500). required practices.This includes rental property owners and property
managers who do the paint-disturbing work themselves or through their
❑1,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.epa.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. D No EPA Lead-Safe Certified Fin is required for this project bemuse:
O 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 05/13/2016 PERMIT/PLAN CHECK NUMBER r l ((D—o KD
TYPE: El COMMERCIAL ❑✓ RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION []ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑MECHANICAL
❑NEW ❑PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Replacing Existing 50 Gallon water heater same location
PROJECTADDRESS 28882 Loire Valley Lane
ASSESSOR'S PARCEL NUMBER LOT C5 TRACT aaI `1
PROPERTY OWNER'S NAME Amalitsa Anastasioq
ADDRESS 28882 Loire Valley Lane
PHONE (626)215-2491 EMAIL
APPLICANT NAME Edward Ponce
ADDRESS 475 Rivera St.#D Riverside CA 92501
PHONE (951)683-4429 EMAIL
CONTRACTOR'S NAME OWNERBUILDER? ❑YES❑✓NO
BUSINESS NAME Truteam of Califomia
ADDRESS 475 Rivera St.#D Riverside CA 92501
PHONE (951)683-4429 EMAIL
CONTRACTOR'S STATE LIC NUMBER 221517 LICENSE CLASSIFICATION B
VALUATION$ $1,500.00 SO FT 2581 L SO FT
APPLICANT'SSIGNATURE ��-�` DATE 05/13/2016
C17Y STAFF USE ONLY
DEPARTMENT DISTRIBUTION �NO CI Y BU EOFy UCENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP vINVOICE I
L�
AMOUNT • 1:J PAIDAMOUNT O CASH O CHECK q O CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 HDun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee,us Inspection Request Line 951-246-6213
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