PMT16-01622 City of Menifee Permit No.: PMT16-01622
29714 HAUN RD. Type: Residential Plumbing
<A_CCELA? MENIFEE, CA 92586
MENIFEE Date Issued: 05/24/2016
PERMIT
Site Address: 26807 WILKES DR, MENIFEE, CA 92586 Parcel Number: 331-471-010
Construction Cost: $700.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING 40 GAL WATER HEATER IN GARAGE
Work:
Owner Contractor
KENNETH CENTER INTER-CITY ENERGY SYSTEMS INC
26807 WILKES DRIVE 1175 N DEL PLACE
MENIFEE, CA 92586 ONTARIO,CA 917fi4
Applicant Phone:9097855075
TERESA DINTERMAN - License Number: 587709
INTER-CITY ENERGY SYSTEMS INC
1175 N DEL PLACE
ONTARIO, CA 91764
Fee Description City 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
$115.16
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 carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise staled,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 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 ❑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 e ZA Ucep51.40. S U By my signature below I acknowledge that,except for my personal residence
Expires 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 constructed in its entirety by
n I 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 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.leeinfo.ca.eov/calaw.html.
this permit is issued.
Policy#
Date
,p -have and will maintain workers compensation Insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the tabor 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 on the property owners behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
Carrier rIY/f-"'l with all applicable city and county ordinances and state laws relating to
Cv3kl G��e 7 building construction.I authorize representatives of this city or county to
Policy# Expires enter the ab9A identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date Z
dollars($100)or less PR6FERTY OWNER OR AUTHORIZED AGENT
oIcertify that in the performance of the work for which this permit is issued, 2 .
I shall not employ any persons In any manner so as to become subject to the CITY BUSINESS LICENSE# V r]J ( 0/
0
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 co y with those pro ions. / Will the applicant or future building occupant handle hazardous material or a
Applicant �- Oate mixture containing a hazardous material equal to orgreater that the
amounts speofi on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVE G IS oyes a UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will themtended 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 forguidelines/
CONSTRUCTION LENDING AGENCY aYes of16
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 bounda>of a school?
(Section 3097 Civil Code) o Yes ❑yo'
OWNER BUILDER DECLARATIONS I have read the Haza us Material Information Guide and the SCAQMD
permitting chi 1 t.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the California th&Safety Code,Section 2SSOS and 25534 conceming
Contractors License Law for the reason(s)indicated below by the hazard s material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 DYes In No
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,prior to 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(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 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-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.eoa.eoy/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. D 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 RAP rule please fill out the RRP
Acknowledgement.
CITY OF MENI FEE
PLC NNo: P it o:
29714 Haun Road -0
Menifee, CA 92586 Data Date:
Phone: (951)672-6777 AmountAmount: el' Menifee
Fax:(951)679-3843 n9 atY Dept.
Iu
Ck#: Ck#
M
Building Combination Permit MAY 4 2016
Legal oasenpgon:
To Be Completed By Applicant rohlec
Plannin Case:
g R L: Rt: R:
Property gddre - Assessors Parcel Number.
ProjecUTenant Name: /A� /�- Unit ik - oFloor*
[Ad
ame: �i Ph a No. Fax No.
Property re s:Owner ` � Unit Number .Tip Codemail Address: /
Na
Phone No. - � Fax Na
� 7
Applicant A tlress:
S ee t� Unit Number Zip
Code n/7�
mail Address: 7
Name• Phone No. ax No.
S p -Sb7j
Contractor Atldre •ty Stet _Tip Code
d L ✓ ! �o
Contractors C Busrn s Ueense No. Contractors Cr late of¢al omia license No. Classificallon:
Number of Squares:
CJ
Square Footage
Description of Work: � raG r/
7 0 p,/,Z�-y.t- ✓ /.>!L //k Cl� Cost of Wodc$ OG
AppllcanCS Signature
Tq Be Compieted By:Citytitaff Only.;
Indicate As R-Recebred or NIA-Not Applicable
5 Compleles sets of fully dimensioned,dreym to sale plans which include: satofdocumentswhichinclude
❑ Title Sheet ❑ Elevations ❑ Bectrical Plan ❑ Geo Tech/Solis Report(on cd only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Machanioal Plan ❑ Title 24 Energy(on 8'b Y t1)
❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Struchual Calculations
❑ Floor Plan ❑ Structure]Framing Plan&Mile ❑ Shoring Plan ❑ Single Liner -Re for elec.services over 4g0 AMP
❑ Sound Report-Red de
Class Code: Indicate I lNew Construction Alteration' Addition' Means/Methods
Work-lypa. Repair Retrofit Revisio g n to Ewfin FiendRequired? YES NO
Proposed Building Use(s): Existing Building Use(s):
#Buildings: #Units: #Stories: Will the Building Have a Basement?
Y of N
Bldg.Code Occupancy Group Indicate indfCdle it YES or NO 1^1k:ate sit Geo-tech.Haz Zone
At Project Sprinklerad that a
Completion: Construction Pply: Coastal Zone
TYpe(s): C of O YES or NO Noise Zone
Requfred? I isled on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board Landmark Comm. I IPlanning Comm.Zoning Administrator
Fee Exempt: City Project I Elec.Vehicle Charger Landmark Seismic Rebofil spetlaf Gazin.mug.
tlPicnl Ao vat
Expedite Project(s): Child Care City Pmject Green Building Landmark AffeNahfe Ho�afng
For Staff-Use Only
6uildinplSalely Pemril Spet9afisl Cily Planning Ciml Engineering EPWM-Admin Trans portalion h Renl Control
THANK YOU FOR HELPING US CREATE ABETTER COMMUNITY
"i,op CITY OF MENIFEE City of Menifee
0' Building & Safety Dept.
pia1, Department of Building and Safety
MENIFEE`
\ � Contractor Declaration MAY 2 4 2016
F eceived
LICENSED CONTRACTORS DECLARATION: I hereby affirm under penalty of perjury that I am licensed under the provisions of Chapter 9
(connecting with Section 7000)of Division 3 of the Business and Professions code and my license is infull force and effect.
License Class: License No: y� 8�1 /7D�'"/� 1 Exp.Date i,(-/a—C 7S� 7-O/gl Contractor:�Y1 12✓'( ,�L/ C-Yfpy' i T-t'vl'a,�
❑ OWNER BUILDER DECLLAARRATION�:�II hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the
following reason: (Sec 7031.5 Business and Professions code. Any City or County which requires a permit to construct,alter,improve,
demolish or repair any structure prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she
is licensed pursuant to the provisions of the Contractors License Law(chapter 9[commencing with Section 7000]of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500.00]:
(] I,as the owner of the property,or my employees with wages as their sole compensation,will be the work,and the structure is not Intended
or offered for sale(Sec.7044, Business and Professions code: The Contractor License Law does not apply to the owner of property who
builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such
Improvements are not intended or offered for sale. If,however,the building or improvement is sold within one year of completion,the
owner-builder will have the burden of proving that he/she did not build or improve for the purpose of sale).
I,as owner of the property,am exclusively contracting with license contractors to construct the project(Sec.7044 Business and
Professions Code: The Contractor License Law does not apply to an owner of property who builds or improves thereon,and who
contracts for such projects with a contractor(s)license pursuant to the Contractors License Law).
❑ 1 am exempt under Sec. B S P.C.for the reason
Date: Owner:
WORKERS COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self-insure for worker compensation,as provided for by Section 370 of the Labor Code,
���... for the performance of the work for which this permit is issued
///
l� I have and will maintain workers compensation insurance,as required by Section 3700 of the Labor Code,for the performance of the work
for which this permit is issued. My Workers Compensation Insurance carrier and policy Number are: ,9
Carrier: �jzeicli llmt,J-k42 t Qol-i.o Policy Number: j,2 e- 02 fl6 yG 00
(This section need not be completed if the permit is for one hundred dollars($100.00)or less.
I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become
subject to the workers compensation laws of California,and agree that if I should become subject to the workers compensation provisions of
Sec.3700 of the Labor Code,I shall forthwith comply with those provisions.
Date: < .)- I Applicant:
WARNING: FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO
CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF
COMPENSATION,DAMAGES AS PROVIDED FOR IN SEC.3706 FOR THE LABOR CODE,INTERST,AND ATTORNEY FEES.
CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there is a construction-lending agency for the performance
of the work for which this permit is issued(Sec.3097,Civic C.).
Lender's Name:
Lender's Address:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify that I have read this application and state that the above
information is correct. I agree to comply with all City ordinances and state laws relating to building construction,and hereby authorize
representatives of the City to enter upon the above mentioned property for inspection purposes.
x
Signature of Applicant/Agent Print Applicant/Agent Name Date
INSPECTION INFORMATION:Work may proceed only at the direction of the field inspector- To request an inspection of work completed,call
the number(951)672.4777. Inspection request must be called in the day before to assure next day inspections.
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