PMT16-02409 City of Menifee Permit No.: PMT16-02409
29714 HAUN RD.
�/�C.CEL/1� MENIFEE, CA 9258E Type: Residential Plumbing
MENIFEE Date Issued: 0 7/2 712 01 6
PERMIT
Site Address: 27873 BLUFF VISTA WAY, MENIFEE, CA Parcel Number: 340-430-024
92584 Construction Cost: $1,700.00
Existing Use: Proposed Use:
Description of REPLACE WATER HEATER SAME SIZE AND LOCATION-50 GALLON
Work:
Owner Contractor
DAVID HALSTEAD AFFORDABLE WATER HEATERS AND PLUMBING
27873 BLUFF VISTA WAY INC
MENIFEE, CA 92584 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 QQt Amount MI
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 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_Pennit_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 ❑I am exempt from Iicensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. the
the following reason:
License Cie s U �e No. L By my signature below I acknowledge that,except for my personal residence
Expires 3 Signature in which l 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 DECLA ION have built as an owner-builder if it has not been constructed in its entirety by
o 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.Ieeinfo.ca.eov/calaw.html.
this permit is issued.
jicyDate
have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTFIORRED AGENT
ction 3700 ofthe Labor Code,for the performance of the work forwhith o By my signature below I certify to each of the following:I am the property
s permit is issued.My workers compensation insurance carrier and polity 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
nn with all applicable city and county ordinances and state laws relating to
Carrier�1 , 'm ' )+' Vie building construction.l authorize representatives of this city or county to
kO'�,'IS-MOD Expires \ 1 enter the above identified property for inspection purposes.
Policy#WS>
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
D I certify that in the performance of the work for which this permit is issued,
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
workers compensation laws of California nd agree that if I should became HAZARDOUS MATERIAL DECLARATION
subject to thew rkers compel anon avision ofSection 3700 ofth La bar
Code,I she with c imp it se P ions. Will the applicant or future building occupant handle hazardous material or a
Appli nt Datev1 lb mixture containing a hazardous material equal to or greater that the
amounts,,,,,,������'PPP ecified on the Hazardous Materials Information Guide?
WA :FAILURE TO SEC E WORKER'S COMPENSATION COVERAGE IS DYes hl No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will thei ttended 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���}}}uality Management District(SCAQMD)7 See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for gui[�e'Ines
CONSTRUCTION LENDING AGENCY 0Yes Na
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 koijndaryofa school?
(Section 3097 Civil Code) ❑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
Califori9r,
ealth Jk Safety Code, ttion 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the hazeraterial re
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 DY s
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 p ER OWNER gfFrAUTH&CIZED 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 AN O PAINTING 1RRP1
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 Iicensure 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
D 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.aov{lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a D 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:
n 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.
ME
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
�I I-
nlw� received
DATE 1 ✓1 q0 PERMIT/PLAN CHECK NUMBER VAT VQ — (D2`'I6
TYPE: O COMMERCIAL 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 PLUMBING 0A�RE-R'O`OF-NUMBER OF SQUARES
DESCRIPTION OFF WORK �Ci � � � ••��
PROJECTADDRESS 1�I
ASSESSOR'S PARCEL NUMBER '�{h JD O•L�{ �LO,(T� _�_ TRACT ft 3(J
PROPERTY OWNER'S NAME(� r�'C \.�� CAO y, f (�
ADDRESS . /j(q��^,�' �Q,� �_'Y� S C S Ci (-A
PHONE "\�lt"J' pIJ�'7/��'.,.,7'�-1�w EMAIL
APPLICANT NAME h y J n
ADDRESS MG I V
PHONE ["-,jQ( -04(A( EMAIL
CONTRACTOR'S NAME OWNER BUILDER? O YES O NO
LISINESSSIAME_ _ L _ _ 'C
ADDRESS f,,6[[VJ�L Y, A�( 'l�
PHONE 91j-_&�s - yotAq EMAIL JZ/ W +C.D
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ , j SOFT L SQ FT
APPLICANT'S SIGNATURE DATE �I
OTYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GLEN SMIP
INVOICE „� ` PAID AMOUNT
AMOUNT I
O CASH O CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT I OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City Of Menifee Building&Safety Department 29714 Houn Rd. Nlenifee, CA 92585 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-245-6213
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