PMT16-02836 City of Menifee Permit No.: PMT16-02836
29714 HAUN RD. Residential Plumbing
<ACCELA> MENIFEE, CA 92586 Type:
MENIFEE Date Issued: 08/29/2016
P E R M I T
Site Address: 25316 SHADY CREEK CIR, MENIFEE, CA Parcel Number: 339-393-023
92584 Construction Cost: $1,500.00
Existing Use: Proposed Use:
Description of REPLACE WATER HEATER,SAME SIZE/LOCATION 40 GAIJIN GARAGE
Work:
Owner Contractor
EUGENE CHEESMAN AFFORDABLE WATER HEATERS AND PLUMBING
25316 SHADY CREEK CIR 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 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
$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 bulliding 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 BidgPermit Ternplaterpt Page I of 1
CITY OF IVIENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts forthe 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 ci I am exempt from licensure under the Contractor's 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 nut been constructed in Its entirety by
a 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,forthe performance of work for which
this permit is issued. www.leginfo.ca.gov/calaw.htmi.
Policy# Date
o I have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which ci 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 ownees 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 HAZARDOUS 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 greaterthat 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) 0 Yes 0 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 oYes ci No
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 PROPERTY OWNER OR 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 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
a 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( )all of or( I portion of the work,and the structure is www.epa.9ov/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 Licentse 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. ci No EPA Lead-Safe Certified Firm is required for this project because:
in 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractoes 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 contractur(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I am u rider provisions of
Chapter!)(commencing with section 7000)of Division 3 of the Business and a I am exam pt from licensure under the Contractor's State License Law for
Professions Code and my license Is in full for e and effect. the following reason:
License C ass N'9 ;e No. I By my signature below I acknowledge that,except for my personal residence
in which I must have resided for at least one year prior to corn pletion of
Explre�LJ-IA I U Signatur
1 - improvements covered by this permit.I cannot legally sell a structure that I
KERS COMPENSATION DECLARATION have built as an owner-builder if it has nut been constructed in its entirety 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 seff-insure 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 webslte;
by Section 3700 of the Labor Code,for the performance of work for which www.Ieninfo.ca.gov/calaw.html.
this permit Is issued.
Date
Policy It PROPERTY OWNER OR AUTHORIZED AGENT
ci I have and will maintain worker's compensation insurance,as required by f the following:I am the property
section 3700 of the Labor Code,for the performance of the work for which ci By my signature below I certify to each o
this permit is Issued.My workees 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 Joe building construction.lauthorize representatives of this city orcountVto
Policy L10-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
cr I certify that in the performance of the work for which this permit is issued, 14
I shall not employ any persons inanymannersoasto become subject to the CITY BUSINESS LICENSE# to
W k r' tion laws of Callfo ia,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
m
Zee,rts.71')nsr:
so n U provi nsofSection3700ofth Lab
'06 or
Code,I sh o w Wt, thpe visions. Will the applicant or future building occupant handle hazardous material or a
"dure cop taining a hazardous material equal to or greater that the
A PP1;"h'+ ///,/j ;1'tgr1f_'fJ _Date Mo.' , -,!fled on the Hazardous Materials Information Guide?
WA FAILURE TO S&URE WORKER'S COMPENSATION 660VERAGE IS a Yes o
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Nr
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 guid Il
CONSTRUCTION LENDING AGENCY cr Yes FOS
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 bo?46dary of a school?
(Section 3097 Civil Code) cr Yes No
I
OWNER BUILDER DECLARATIONS I have Id the Hazardous Materivi nformation Guide and the SCAQMD
permitting checklist.I underptan#fty requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the Californla)lealth&Sa o Secti 5505 and 25534 concerni g
Contractor's License Law for the reason(s)indicated below by the hazer materiall I
checkmark(s)I have placed next to the applicable item(s)(Section 7032.5 0 No '
Business and Professions Code).Any city or county that requires a permit to D
construct,alter,improve,demolish or repair any structure,prior to its P E OWNE A T ]ZED 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(RRPI
Umnse Law(Chapter 9(commencing with Section 700)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 ficensure 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-certlfiled firms and comply With
a n Applica nt for a permit subjects the a pplicaint to a civil pena Ity 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 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( )all of or( )portion of the work,and the structure is www.epa.govilead 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 ci 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 orimprovement issold within one yearof Firm Cerfificattion No.:
completion,the Owner-Builder Will havethe burden of provingthat ftwas a No EPA Lead-Safe Certified Firm is required for this project because:
not built or improved for the purpose of sale.
a 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 70",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 RAP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
menifee
DATE Ik PERMIT/PLAN CHECK NUMBER F"-T((C� 00-MR2
TYPE: OCOMMERCIAL )(RESIDENTIAL 0MULTI-FAMILY OMOBILEHOME 0 POOL/SPA 0 SIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRICAL CIMECHANICAL
ONEW )(PLUMBING 0 RE-ROOF-N UMBER OF SQUARES_
DESCRIPTION OF WORK . C
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t4 OE M(4j
PROJECTADDRESS 1&�AW 92-rR4
ASSESSOR'S PARCEL NUMBER 1531001 LOT TRACT
PROPERTY OWNERS NAME L-Ah�
ADDRESS q&sk(o !�)MN URA;&
PHONE EMAIL
APPLICANT NAME
ADDRESS 4AtAeNC,
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILDER? 0 YES 0 NO
BUSINESS NAME h��Lk
ADDRESS jjjC(
CLt&j(dg�MgrJ �0-(A64fACA QAtkt4; A GNJ':4�
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER kItENSE CLASSIFICATION
VALUATION$ SO FT L SQ FT
DATE -sx
CITYST'iff USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN Uy SMIP
01
INV 2 PAIDAMOUNT
AMOUNT�(15'115 1 0 CASH 0 CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISAIMC
OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
Cit'l of Menifee Building&Safety Department 29714 Houn Rd. Menilfee, CA. 92585 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-2405-52-11 3
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