PMT16-01545 City of Menifee Permit No.: PMT16-01545
MENIFEE,
EE, C 92 Type: Residential Plumbing
�CCEiL/� MENIFEE, CA 92586
MENIFEE Date Issued: 05117/2016
PERMIT
Site Address: 29504 BASTE CIR, MENIFEE,CA 92586 Parcel Number: 336-351-026
Construction Cost: $15,566.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING 40 GAL WATER HEATER, REPIPE ENTIRE HOUSE
Work:
Owner Contractor
MADELINE DUGAY W C HEATING&AIR CONDITIONING INC
29504 BASIE CIRCLE 41085 GOLDEN GATE CIR
MENIFEE, CA 92586 MURRIETA, CA 92562
Applicant Phone: 9516000700
JAMES MCKEE License Number:779604
W C HEATING&AIR CONDITIONING INC
41085 GOLDEN GATE CIR
MURRIETA, CA 92562
Fee Description city Amount fSl
Receptacle,Switch, Outlet&Fixture 12 171.00
PipinglRepiping Single Family Residential 1 163.00
Residential Water Heater 1 83.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 12.30
$457.30
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_eldg_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 D I am exempt from licensure under the Contractor's State License Law for
Professions Code and
my license is in full force and effect. the following reason:
License Class e3 to Licens T Jq 0 O� By my signature below I acknowledge that,except for my personal residence
Expires &. 30-�to Signature vl� in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I
have built as an owner-builder if it has not been constructed in its entirety by
1-10, ereby 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 workers 71344 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
this permit is issued. www.ieeinfo.ca.aov/calaw.html.
Policy# \rj&H"r L 7j 1 -'+9 Date
D I have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 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: application and the information I have provided is correct.I agree to comply
Carrier g-w 4--'� with all applicable city and county ordinances and slate laws relating to
9 building construction.I authorize representatives of this city or county to
Policy#W Cvv C 7-O 3 1 Expires^-1777� enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred
dollars($100)or less Date
NO
PROPERTY OWNER OR AUTHORIZED AGENT
certify that in the performance of the work far 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 worker's-6prnpensation provisions of Section 3700 of the Labor
Code,I shall forthi6ith c mply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant - _ Date Imo' b mixture containing a hazardous material equal to or greater thatthe
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes o No
UNLAWFUL,AND SHALL SUBIECTAN 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, M PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTERESTT,AND
ND ATTORNEYS FEES , forguldellnes
CONSTRUCTION LENDING AGENCY o Yes o No
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) D Yes ❑No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that 1 am exempt from the permitting checklist I understand my requirements under the 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 items)(Section 7031.5 hazardous material reporting.
Business and Professions Code).Any city or county that requires a permit to ciYes allo
construct,alter,improve,demolish or repair any structure,prior to its Date
issuance,also requires the applicant for the permit to file a signed statement PROPERTY OWNER OR AUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRP)
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 that receiving compensation for most work t disturbs paint in apre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to he work
thartifled firms and comply with
than($500).Applicant for a permit subjects the applicant to o civil penalty of not more required practices.This includes rental property owners and property
than
managers who do the paint-disturbing work themselves or through their
o 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 property who,through employeesor personal effort,builds or improves the ❑An EPA Lead-Safe Certified Renovator will he responsible forthis project
'
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-Bullder 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:
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.
• 1i IVA Imlaw-AU111111
Menifee
DATE PERMIT/PLAN CHECK NUMBER -C>IS LIE—
TYPE: O COMMERCIAL 'I 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 )d PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Pe x N&W yAA k r 9 ru,Le-
"1D l a1\D,r. � yus✓1rr
PROJECTADDRESS 295-vLl e ',` Svr, I. Jq q
ASSESSOR'S PARCEL NUMBER �-351-�l_O LOT TRACT Cily ot Menlfee
OWNER NAME
Q 6� tA Building&5a Pt'
ADDRESS MAY 1
7 -lull
PHONE '3 1 T ` 3S-:H EMAIL ,, d
APPLICANT NAME TAWA M(A&Wl
ADDRESS
PHONE EMAIL
JerNA
CONTRACTOR'S NAME -(„oy U,M � r. OWNER BUILDER? OYES ENO
BUSINESSNAME \f4Z nnj \�CrIF1 Y
ADDRESS _ 1 (Ors ; J ��•-,ram ...�-c a.-- ri Ot-e,
PHONE fo OU • 6 : -0 o EMAIL
n2C�� � ���°Dt/
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION C 3
VALUATION$ ,5 f S b ID SQ FT L SO FT
APPLICANT'S SIGNATURE DATE
,fir' • _._
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSACARDVISA/MC
R
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP X
INVOICE PAID AMOUNT 2
AMOUNT t-{S7• rj •aj O CASH O CHECK# O CC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# vCOWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZED LETTER
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
295t)y has- Gir•
City &Safety Dept.
MaMOG
Sinn G`�`'I
Ok- g25(oZ Building
MAY 17 2016
Received
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