PMT16-02408 City of Menifee Permit No.: PMT16-02408
29714 HAUN RD.
�CCELA�. MENIFEE, CA 92586 Type: Residential Plumbing
`"'""""Wt - MENIFEE Date Issued:
07/27/2016
PERMIT
Site Address: 26207 POTOMAC DR, MENIFEE, CA Parcel Number: 338-201-008
92586 Construction Cost: $2,237.00
Existing Use: Proposed Use:
Description of REPLACE WATER HEATER SAME SIZE/LOCATION,40 GAL IN GARAGE
Work:
Owner Contractor
ORAN UNDERHILL AFFORDABLE WATER HEATERS AND PLUMBING
26207 POTOMAC DR INC
MENIFEE,CA 92586 28358 CONSTELLATION ROAD#698
Applicant Phone:8553459087
DANIEL MATA License Number.627368
AFFORDABLE WATER HEATERS AND PLUMBING INC
28358 CONSTELLATION ROAD#698
VALENCIA,CA 91355
Fee Description QQtt( Amount 151
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
$116.15
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 Permit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
with a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjurythat I am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. r the following reason:
License Cla s �J PON
e No. _ 1� By my signature below I acknowledge that,except for my personal residence
Expires O Signature in which I must have resided for at least one year prior to completion of
I improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECIA have built as an owner-builder if it has not been constructed in its entirety by
D 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.lezinfo.ca.eov/calaw.html.
this permit is issued.
P icy f! Date
PROPERTY OWNER OR AUTHORIZED AGENT
I have and will maintain workers compensatian insurance,as required by
' coon 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 on the property owners behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
n a-
with all applicable city and county ordinances and state laws relating to
Carrier,�Y, building construction.I authorize representatives of this city or county to
Poliryff WSKri�2i2yd11O.� Expires \ 1 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 emPlay any persons in any manner so as to become subject to the CITY BUSINESS LICENSE g
workers compensation laws of California iend agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to thew rkerscompe�JJJ Lion avoion mbection3700ofth Labor
Code,I sha hwith co'P it se p?o7 ions. 7 Will the applicant or future building occupant handle hazardous material or a
/ 4-11
L� mixture containing a hazardous material equal to or greater that the
li nt Dateamounts ecified on the Hazardous Materials Information Guide?
WA .FAILURE TO SEC E WORKER'S COMPENSATION COVERAGE IS 0 YesNo
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the i tended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($300,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air QuaKty Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for gui nes
CONSTRUCNON LENDING AGENCY 0Yes pl No
1 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 kog ddary ofaschool?
(Section 3097 Civil Code) o Yes No
OWNER BUILDER DECLARATIONS I have rea 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 m equirements under the State of
California ealth's Safety Code, ction 25505 and 25534 concerning
Contractors License Law for the reason(s)Indicated below by the bazar material re
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 0Y ❑ o
Business and Professions Code).Any city or county that requires a permit to / Date 1 7i
construct,alter,improve,demolish or repair any structure,prior to its lo ERMRN_EReFrAUTH&WiZED 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 perm it 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
u 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.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 o An EPA Lead-Safe Certified Renovator will be responsible for this project
propertywho,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. o No EPA Lead-Safe Certified Firm is required for this project because:
❑I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Cade: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
• l APPLICATION
c
_ Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION C ELECTRICAL O MECHANICAL
ONEW PLUMBING {{ORE-R,O`OF-NUMMBEROF SQUARES
DESCRIPTION OF WORK WCf6r`�ICr CJ C
PROJECTADDRESS qJA I,U - Oo(' AC,C� OI D
ASSESSOR'S PARCEL NUMBER ✓ OS V I'�'�� ✓ LOT _I TRACT �O� ✓�
PROPERTY OWNER'S NAME � /� U Jer auk, y /� nr
ADDRESS .� ^ tOyI�V' C �_ � G � �iC. Ct\ y`-J%(o
PHONE b. - -A✓ - %�LG EMAIL
APPLICANT NAME
ADDRESS 4AOeNC, I V
PHONE �'�-�l�s� �� EMAIL
CONTRACTOR'S NAME OWNER BUILDER? O YES ONO
ADDRESS
PHONE %LI,5 40LA EMAIL
CONTRACTOR'S STATE LIC NUMBER ICENSE CLASSIFICATION
VALUATION$ SO FT L SO FT /
APPLICANT'S SIGNATURE DATE I
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINE55 UCENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE G. , PAIDAMOUNT
AMOUNT li J OCASH OCHECK# OCREDITCARD VISAiMC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZED LETTER C YES C NO
City of Menifee Building&Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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