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PMT16-02624 City of Menifee Permit No.: PMT16-02624 29714 HAUN RD. �/�►CCEL/� MENIFEE, CA 92586 Type: Residential Plumbing MENIFEE Date Issued: 08/11/2016 PERMIT Site Address: 29691 ROCK CANYON RD, MENIFEE, CA Parcel Number: 340461-023 92584 Construction Cost: $700.00 Existing Use: Proposed Use: Description of REPLACE 50 GALLON WATER HEATER-SAME LOCATION Work: Owner Contractor TUGBA HAWKINS INTER-CITY ENERGY SYSTEMS INC 29691 ROCK CANYON RD 1175 N DEL PLACE MENIFEE,CA 92584 ONTARIO,CA 91764 Applicant Phone:9097855075 TERESA DINTERMAN License Number.587709 INTER CITY ENERGY SYSTEMS INC 1175 n DEL RIO PLACE ONTARIO,CA 91764 Phone:9097585075 Fee Description g,yt Amount lsl 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 building operations being carded 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 perjury that 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 Contractors State License Law for Professions Code and myyllicense is in full force and effect. I the following reason: License Class. , a; V License N S 7�r�f By my signature below I acknowledge that,except for my personal residence Expires l/ ZX 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 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.leeinfo.ca.Rav/calaw.html. this permit is Issued. Policy# Date PROPERTY OWNER OR AUTHORIZED AGENT o 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 o 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.1 have read this number are: application and the information I have provided is correct.I agree to comply Carrier 4__ with all applicable city and county ordinances and state laws relating to ���' 1I,,.. building construction.I authorize representatives of this city or county to Policy#1bt0;'CdA y4�G/ Expires 77 / enter the above identified property for inspection (This section need not to be completed is the permit is for one-hundred o2 Date dollars($100)or less P I OPERTY OW NER OR AUTHORIZED AGENT o I certify that in the performance of the work for which this permit is issued, ,Lr-7 J I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# D �7 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 comply with those provisions. Will the applicant or future building occupant handle hazardous material or a Applicant Date 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 9011S UNLAWFUL,AND SHALL SUBJECT AN 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,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 o Yes 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 cuter boundary of a school? (Section 3097 Civil Code) o Yes,,�No OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD permitting checklist.I understand my requirements under the State of I hereby affirm under penalty of perjury that I am exempt from the California Health&Safety Code,Section 25505 and 25534 concerning Contractors License Law for the reason(s)indicated below by the zardous mat rial reporting. checkmark(s)I have placed next to the applicable item(s)(Section 7031.5es p Business and Professions Code).Any city or county that requires a permit to Date A construct,alter,improve,demolish or repair any structure,prior to its PROPER�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(RRPj 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 n 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.Rov/lead or contact the National Lead Information Center at not Intended or offered for sale.(Section 70",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. 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. CITY OF MENIFEF, i LCKNo: l 29714 Haun Road mt d uilt &safety DePt 1V— b (p2y Date:Menifee, CA 92586 � 1 2016 Dale: Phone: (951)672-6777 AUG MIOUnt ounC Fax:(951)679-38431 eceived Ck# Building Combination errnit Ck# Completed 6YApPlicant Legal Description: Planning Case; P operty,Addra As or" Parcel Number. ProjecVTanent Name — 62 unt#: Name: P ne No. �J Fax No. Property Add as (a F__ �X Owner Unit Numher .Tip Cod Email dress. �- N Phone No. 2✓ /� } ti o © : - - Sal Fax No. Applicant Add res �/ tO Unit Number Zrp Code mail Address: 7r, Name: Phone L No. ax No.em T y c_ ep —So7� Convaclor Addres o L ty r e Stale Zip Code ! 7( Contractors C Ile n s Licen COD ? se No. OpntraetoYs G rate of_Qel' mia License,NO. (f Classificatlorc. NumOsr of Squares: Square Footage Description of Work: `'l^ v I've r_ Cost of Wofk$ vQ OU Applicant's Signature --l Data_ Tn Be Completed By City Staff Only Indicate As R-Received or NIA-NotApplieabie 5 Completes sets of fully dimensioned,drawn to sale plans which include: t set of documents which include Q Title Sheet ❑ Elevations ❑ Meetdeal Plan � ❑ Geo Tech/Solis Report(on cd only) ❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan - ❑ TRIe 24 Energy(on 8%x 11) ❑ Foundation Plan ❑ Cress Section ❑ Plumbing Plan ❑ Structural Calculations ❑ Floor Plan f ❑ Single Line diagram for elec.services over 4ofl AMP ❑ Shwhaai Flaming Plan S Details ❑ Shoring Plan ❑ Sound Report-Residential Class Code: Indicate New Constmetion Alteration' Addltlon' Meansltvlethods Work Type: Repair - i Retrofit' Revision to l9dstlng PerWl Required? YES NO Proposed Building Use(s): Existing Building Use(s): rY Buildings: if Units: #Stories: Will the Building Have a Basement? Y of N Bldg.Code Occupancy Group indicate t�ice�if Indicate all [Elsted eo-tech.Haz Zane At Project Sprinpla ed YES or NO completion: Construction that apply. oastal Zone Type(s): C of O YES or NO oise Zone Required? on Historic Resources Inventory CITY PLANNING STAFF ONLY APPROVALS: Costal Commis Arch.Review Board Landmark Comm. Planning Comm.Zoning Administrator Fee Exempt City Project Elec.Vehicle Charger Landmark Seismic Retrofit spetlal cas::Img. Orfidnl tttavel Expedite Project(.): Chld Care City Pmject Green Building Landmark Altordahte Hvusfng For Staff Use Only BuildinplSal6ty Pemtit SPLciagst Cfty Planning Chat Engineering EPWM-Admin i TmnspOda110A MgmL Rent Control THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY Z d o O o' o u _ D 47 n iNi' D m m T o m m z 3 N m < ry G) m � 0m- w a m m = an d r� D N a mz p r Frr, cl m •• 3 w -i 'O o- Z 'O M A " O m A D Z _m i s m � Dz w v d N n ', n x w. vKi `m °� v N D Z m m r n c -I ry � m ZI It A D m `a y ,c ,e m 0 ° do = D 0 � .Zl d , O. y V m m °—' N f° = m D Z O m O 3 J M C CC ro _ N c j T rn O C C o n J O m < u+ _ 0 p v, c o Z < 3 3 c d Ocn m ^ i Q N '< C O G o u d � •G L � In � � N N .�i C. v 1 ao f n c m = s 3 O al O. O O N Q m O F j J 2.' d a d M. d v. 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N ] o •Z EF z . o. m 3 3. u a = c D p o, a F N o E 3 < a u c � a m �• � f. .o °: roi c w a a ro r. 1 u � 3 = � 00 o p1 ❑ m' O S _ _� •^i !D � C3A CD f9 3 a u_ v O v n to '^ -•• � — < u N a rD u 0 N p o0 3 p 0 o "' o T m N m N c ao n O O n oni E E l n Yo d u� o on � a o � " w N �• $ y� y , JV © 3 T N a N Cl? �. 1 3 a N o n N T <T � . 3 u ro Cl. D n. CD .�N. a u m D m'm i d C N m C N C FL \ N N T T N O p 1� TlcQ — 02 � 2�-� CITY OF MENIFEE MENIFEE. Department of Building and Safety Contractor Declaration '1_ 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: S 9 /0C /_ Exp.Date �0�� Contractor.2n'r,2✓'�t� �-y C{�p ko, 6 OWNER BUILDER DE—CLARTATIOON`: I 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 there from 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). ❑ I 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 "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: Carrier: ��y'j C� 141 117 YLeA111 ov'i-u� r-c7. Policy Number: f t7 C ('�,3 fl(o ell<tC> I (This section need not be completed if the permit is for one hundred dollars($100.00)or less. 1 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, shall forthwith comply with those provisions. Date: 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. f 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. Signature of ApplicantlAgent Print Applicant/Agent Name I Data( 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.