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PMT16-02835 City of Menifee Permit No.: PMT16-02835 29714 HAUN RD. Type: Residential Plumbing <A-CCELA-> MENIFEE,CA 92586 el—I MENIFEE Date Issued: 08/2912016 P E R M I T Site Address: 29680 W]LLIAMETTE WAY, MENIFEE, Parcel Number: 33"21-036 CA 92586 Construction Cost: $2,000.00 Existing Use: Proposed Use: Description of REPLACE WATER SAME SIZEILOCATION 50 GAL IN GARAGE Work: Owner Contractor JUSTINE ZAWICKI AFFORDABLE WATER HEATERS AND PLUMBING 29680 WILLIAMETTE WAY 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 QtV 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 oflhis permitshall notpreveritthe building official from thereafter requiring the correction ofenors in the plans and specifications or from preventing builiding operations being carded on thereunder when in violation of the Building Code or of any other ordinance of City of Menifee.Except as othenAdse 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 BidgPermit-Template.rpt Page 1 of I CITY OF IVIENIFEE 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)pursuaritto the Contractors State License Law). Chapterg(commencing with section 7000)of Division 3 of the Business and ci 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 License No. 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 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 workees 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 this permit is issued. www.Ieginfo.ca.gav/caIaw.htmI. Policy# Date PROPERTY OWNER OR AUTHORIZED AGENT ci I have and will maintain worker's compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which a By my signature below I certify to each of the following:I am the property this permit is issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this number are: application and the information I have provided is correct.I agree to comply with all applicable city and county ordinances and state laws relating to Carrier building construction.I authorize representatives of this 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 Date dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT ci I certify that in the performance of the work for which this permit is issued, I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# worker's compensation laws of California,and agree that if I should become HA7ARDOLI5 MATERIAL DECLARATION subject to the worker's 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 mixture containing a hazardous material equal to or greater that the Applicant Date amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ci Yes o No 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 o 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) ci Yes ci 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 Contractor's License Law for the reason(s)Indicated below by the hazardous material reporting. checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 ciYes o No Business and Professions Code).Any city or county that requires a permitto Date construct,after,improve,demolish or repair any structure,priorto its PROPERTY OWNER OR AUTHORIZEDAGENT issuance,also requires the applicantforthe permitto file a signed statement that he or she is licensed pursuannto the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING IRRPI 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 ci 1,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 I I all of or I I 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 Contractor's 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 1,as owner of the property am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractor's 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 MENIFEE LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects with a licensed contmctor(s)pursuant to the Contractors State License Law). I hereby affirm u rider penalty of perju ry that I am under provisions of Chapter9(commencing with section 7000)of Division 3 of the Business and a I am exempt from licensu re under the Contractor's State License Law for Professions Code and my license i.s in full for and effect. the following reason: License C ass '9,0 No. By my signature below I acknowledge that,except for my personal residence Explre&LIALI Signatur in which I in ust have resided for at least one year prior to completion of I - I improvements covered by this permit.I cannot legally sell a structure that I WORKEWS COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirely by in 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 selMnsure for worker's 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 wyw.Ieginfo.iui.gciv/calaw.htmI. this permit is issued. Date Policy# PROPERTY OWNER OR AUTHORIZED AGENT a I have and will maintain worker's 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 worker's compensation insurance carrier and policy owner or authorized to act on the property owner's behaff.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 of this city or county to V Expires enter the above identified property for inspection purposes. Po I icy#V241�� /17 (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 employ any persons in any mann er so as to become subject to the CITY BUSINESS UCENSE# 0 13954511 worker's comp risation laws of Califo ia,and agree that If I should become HAZARDOUS MATERIAL DECLARATION 't to ih, 'k subje r n ti 1 prov nsafSection3700 fth Lab r I Q Y, - Code,I sh ci hwi Wit th se visions. Will the applicant or future building occupant handle hazardous material or a nor, ure corl mn �7;0 am., Annfirz"flayJ Date xt ta' ' a hazardous material equal to or greater that the s -c;fledg,n the Hazardous Materials Information Guide? WA 4Ng7 N�o .FAILURE TO S&6IRE WORKEWS COMPENSATION COVERAGE IS ci Yes UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building AND CIVIL FIN ES UP TO ONE H UNDRED 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 guld I CONSTRUCTION LENDING AGENCY a Yes 5; 1 hereby affirm that under the pena Ity 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 boodary of a school? (Section 3097 Civil Code) o Yes No OWNER BUILDER DECLARATIONS I have r Sd he Hazardous terial f ation Guide and the SCAQMD yn orm .r permitting checklist.I uncle an Y requirements under the State of filorma,Uesdith 11, a 0 SecU 5505 and 25534concemi g I hereby affirm under penalty of perjury that I am exempt from the �'a� CiiI f Contractor's License Law for the reason(s)indicated below by the hazar ;material I checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 0Y No Business and Professions Code).Any city or county that requires a permit to ), T Ad" D--- construct,alter,improve,demolish or repair any structure,prior to its P E OWN ER(pf(AVTkNIZED AGENT issuance,also requires the applicant for the permit to file a signed statement A that he or she is licensed pursuant to the provisions of the Contractor's 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 FRP)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 he RRP-certlfied firms and comply with an Applicant for a permit subjects the applicant to a civil penalty of not mom required practices.This Includes rental property owners and property than($500). managers who do the paint-disturbing work themselves or through their a 1,as owner of the property,or my employee with wages as their sole employees.For more information about EPXs Renovation Program visit: compensation,will do( )all of or( )portion of the work,and the structure is www.epa.goyllead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions I-SOM24-LEAD(5323). Code;The Contractor's State License Law does not apply to an owner of a in An EPA Lead-Safe Certified Renovator will be responsible for this project property who,tb rough em ployees'or personal effort,builds or im proves 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 yea r of Firm Certification No.: completion,the Owner-Builder will have the burden of proving that it was ci No EPA Lead-Safe Certified Firm is required for this project because: not built or improved for the purpose of sale. ct 1,as owner of the property a in exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractor's 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. BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION Me n ifee DATE IA jAa PERMIT/PLAN CHECK NUMBER TYPE: OCOMMERCIAL )(RESIDENTIAL OMULTI-FAMILY OMOBILEHOME 0 POOL/SPA 0 SIGN SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRICAL OMECHANICAL CNEW )(PLUMBING 0 RE-ROOF-NUMBER OF SQUARES— DESCRIPTION OF WORK \fJK% AW Q.-C A, tf 2 0 k/ / PROJECTADDRESS jja( ASSESSOR'S PARCEL NUMBER TRACT -TA PROPERTY OWNER'S NAME ADDRESS P H 0 N E EMAIL APPLICANT NAME ADDRESS 4AOC PHONE qj�E-_jqt;104tAl� EMAIL CONTRACTOR'S NAME OWNERBUILDER? OYESONO BUSINESS NAME Pg&X&Lk ADDRESSpjA3t!SS Car&-�I�gH 90.(46#fAS JAL& !KA 0\\jLC tK� PHONE %LA,5— EMAIL CONTRACTOR'S STATE LIC NUMBER /JCENSE CLASSIFICATION VALUATION$ S-Q F'T L SQ FT ATE .CITYSTAFFUSE.ONLY ----- -- --- DEPARTMENT DISTRIBUTION lrj CITY OF PERIFEE B-0019S LICIRSE RUMbLK BUILDING PLANNING ENGINEERING FIRE GREEN SMIP � INVOICE 1 PAIDAMOUNT 0 CASH 0 0 CREDIT CARD ViSA/MC ' T I AMOUN CHECK# PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISAINIC OWNER BUILDER VERIFIED 0 YES 0 NO DLNUMBER NOTARIZED LEITER 0 YES 0 NO Ci�-j of iWenifee Building & Scfe(v Deoartment29714 HOU17 Rd. Men�fee, CA 92586 951-672-6777 wwt,v.cityoi�-nenifee.tisitis!)ectionReqt.iestLit7e951-240'-62-13 C) G) c! > Z M M2� 0 -�o G) cam n Ci M w > EL A = o- CL Z M 0 n -1 " rn a u rn ID -C tt z ;o M 0 CL w n M n o M :E 35 0 G) — M -n i jF —7r ID 12 'o M 7� X :E Cl) ir W ID co ca cp 0 ct zi LI M cn ur M ct M 0 0 Fi- 0 0 = , M 2 - — 0 " ac) p cl c :E s- 0 C, CI) CD ID CD CD CA c w EL P- ga) EL MW Co Mc 0 M z OQ zw ZF I w PJ 2 c Fr @ Val (pe n-3 g L/47% LU Xr a m LU m 4, wo LLS 3: m M-x 0 w w Isi cn ro- 0 -C a O -E c 4 v 'o i- i!: n -M U m iz M, f! Ro, :io 4 F2 0 E f�- , .0 c 0 w 2. &L m 0-0 t5 kL W to 'o LA 0 -ii E �5 Z Z 1- .2 10 --w E u a M a Oc m Ti Br Ci -E -E 0 E w OR , 0 E �E' v -2 0 W7- E Ju JI 9 LU 0 am-,—Mw -P- 15- Ir .6 V ,,- u 0 e, \I) 9 - = v 0 -U in !� z w La V > w a 1� E 01 - IF - w 0 49 m: Y) 0 v 0 [013 CL a c m w m 0 1 IN CL CL M JT -E -5 a -9 E S z Jt 4. 17 w E m m IM ui cc 1 w 0 Z E cc x w u .2 u z AV -st 'A w r-: C6 6 -1 EL- Im m Au E E o 1! . a u a 4 z Q 4c