PMT16-01884 City of Menifee Permit No.: PMT16-01884
29714 HAUN RD.
<A-CCE6A' MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE Date Issued:
06/15I2016
PERMIT
Site Address: 25245 RIDGEMOOR RD, MENIFEE, CA Parcel Number: 339-440-005
92586 Construction Cost: $999.00
Existing Use: Proposed Use:
Description of REPLACE 50 GALLON WATER HEATER IN GARAGE
Work:
Owner Contractor
SALVADOR&MARIA VACA WATER HEATERS ONLY INC
25245 RIDGEMOOR RD 970 E MAIN STREET#200
MENIFEE, CA 92586 GRASS VALLEY, CA 95945
Applicant Phone:8008358345
STEVEN SCHNIERER License Number:374573
WATER HEATERS ONLY INC
970 E MAIN STREET#200
GRASS VALLEY, CA 95945
Fee Description PA Amount($)
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 Cade 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_Bldq_Permit_Templale.rpl 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 o I am exempt from licensure under the Contractors State License taw for
Professions Code and my license is in full force and effect. the following reason:
License Class C License No. 3-71ts-7-j By my signature below I acknowledge that,except for my personal residence
Expires 5131 17 Signature SvZ� L 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
o 1 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 ofthe Labor Code,for the performance of work for which www.leKinfo.ca.eov/calaw.html.
this permit is issued.
Policy# 45D3—D 4 Date
PROPERTY OWNER OR AUTHORIZED AGENT
❑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 / y 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 with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives ofthis city or county to
Policy# Expires enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Sv..�ry �2 Date 4CS I(.
dollars($300)or less PROPERTY OWNER OR AUTHORIZED AGENT
❑I certify that in the performance of the work for which this permit is issued, _
1 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 workers compensation provisions of Section 3700 ofthe Labor
Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant _ �rP Date for mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide.'
WARNING:FAILURETOSECURE WORKER'S COMPENSATION COVERAGE IS ❑YesAo
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use ofthe 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 for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes .)4,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) ❑Yes�o
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 under the State of
Contractors License Law for the reason(s)indicated below by the California Health al Safety Code,Section 25505 and 25534 concerning
h zardpus material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5
Business and Professions Code).Any city or county that requires a permit to IS Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED AGENT
issuance,also requires the applicantfor the permitto file a signed statement
that he or she is licensed pursuant to the provisions ofthe 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 ofthe 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.Rov/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:
a 1,as owner ofthe 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.
BUILDING & SAFETY PERMIT/PLAN CHECK AP •
Menifee
DATE Cc IS 1l, PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL XRESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA 0 SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
ONEW -9PLUMBING ORE-ROOF-NUMBIEROF SQUARES
DESCRIPTION OF WORK
PROJECTADDRESS ^p II
ASSESSOR'S PARCEL NUMBER —`T'7'`�_ � LOT TRACT aS ZSCO
OWNER NAME Ste, McLfkc V c, l,
ADDRESS ZSZ'fS CA 925810
PHONE qgl-332- 9333 EMAIL
APPLICANT NAME
ADDRESS 3iz2-S Lam. A * zip CA cl i31oz
PHONE $fig-73S--7B-7L„ EMAIL
CONTRACTOR'S NAME OWNER BUILDER? O YES NO
BUSINESS NAME c, Jers
ADDRESS 9 70 [ c;,r , 3rZco ,j GA cfi5q''f5
PHONE S3a- Z-)q- 3m) EMAIL
CONTRACTOR'S STATE LIC NUMBER 37L4S73 LICENSE CLASSIFICATION C3(,
VALUATION$ C?q O) 00 SO FT L SO FT
SIGNATURE - DATE (� i5 IL-
APPLICANT'S
Now—
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I SMIP
INVOICE PAID AMOUNT
AMOUNT I 5•IS OCASH 0CHECK4 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH 0CHECK# O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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