PMT16-02937 City of Menifee Permit No.: PMT16-02937
29714 HAUN RD. Type: Residential Plumbing
'(;�CCIELA.' MENIFEE, CA 92686
MENIFEE Date Issued: 09102J2016
P E R M I T
Site Address: 27109 EL RANCHO DR, MENIFEE, CA Parcel Number: 336-112-007
92586 Construction Cost: $1,200.00
Existing Use: Proposed Use;
Description of REPLACE EXISTING WATER HEATER WITH NEW TANKLESS WATER HEATER
Work:
Owner Contractor
DAWN WILDER PAYLESS 4 PLUMBING INC
27109 EL RANCHO DRIVE 985 KENDALL DR SUITE A323
MENIFEE, CA 92586 SAN BERNARDINO, CA 92407
Applicant Phone:8002200209
FABIAN BELTRAN License Number:817084
PAYLESS 4 PLUMBING INC
985 KENDALL DR SUITE A323
SAN BERNARDINO,CA 92407
Fee Description Qtv Amount(S)
Residential Water Heater 83.00
Building Permit Issuance 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 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.
APLBldg_Permit—Template.rpt Page 1 of 1
CITY OF MENIFEE
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)pursuant to the Contractors State License Law).
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. the following reason:
UcenseClass License No. 5;w7o-6-4 By my signature below I acknowledge that,except for my personal residence
7— 1 —
Expires 44:�2 4 k Signature
in which I must have resided for at least one year priorto completion of
improvements covered by this permit.I cannot legallysell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
ci 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 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 www.Ie;dnfo.ca.Roy/caIaw.htmI.
this permit is issued.
Policy# Wwcs\-I \GAS PROPERTY OWNER OR AUTHORIZED AGENT Date
o 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
Carrier with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy k-) kL-A-� Expires enter the above Identified property for inspection purposes.
_n 61
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZEDAGENT
a I certify that in the performance of the work for which this permit is issued,
I she 11 n ot em play 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 sha 11 forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material eq ual to or greater that the
Applicant,io� Date amounts specified onthe Hazardous Materials Information Guide?
WARNING:FAILURETO SECUREWORKER'S COMPENSATION COVERAGE IS u Yes ci 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 Qua lity Management District(SCAQM D)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ciYes allo
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) u Yes a 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 uYes oNa
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 OWN ER 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(RRPI
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 Rcensure receiving compensation for most work that disturbs paint in a pria-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($500). managers who do the paint-disturbing work themselves or through their
ci 1,as owner of the property,or my employee with wages as their sole employees.For more Information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure Is www.eria.goy/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-80D-424-LEAD(5323).
Code,The Contractor's State License Law does not apply to an owner of a a An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that It was
not built or Improved for the purpose of sale. in No EPA Lead-Safe Certified Firm is required for this project because:
a 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
0,1111k, Men[fee
DATE 12)hv PERMIT/PLAN CHECK NUMBER
TYPE: ',� COMMERCIAL ORESIDENTIAL 0MULTI-FAMILY OMOBILEHOME 0 POOL/SPA 0 SIGN
SUBTYPE: OADDITION C)ALTERATION ODEMOLITION OELECTRICAL OMECHANICAL
ONEW O— PLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER LOT TRACrG e 'I e,,))
Bulldl%QiAa� upt.
OWNER NAME
ADDRESS orl SEF
PHONE EMAIL Recehied
APPLICANTNAME
ADDRESS �'6S4cS
PHONE EMAIL
CONTRACTOR'S NAME OWNERBUILDER? OYESj.-NO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION C--�&g A;L /v
VALUATION$ aco SO FT L SO FT
APPLICANT'S SIGNATURE DATE
AMIL,
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE I PAIDAMOUNT
AMOUNT IV5-\4�n) 1 111,5. OCASH OCHECK# —0 CREDIT CARD VISAIMC
PLAN CHECK FEES I PAIDAMOUNT 1 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DLNUMBER NOTARIZED LETTER 0 YES Ow NO
City of Menifee Building&Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
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