PMT16-03041 City of Menifee Permit No.: PMT16-03041
29714 HAUN RD. Type: Residential Plumbing
'K;kCCF-LA? MENIFEE, CA 92586
MENIFEE Date Issued: 09/1312016
P E R M I T
Site Address: 25856 BOULDER ROCK PL, MENIFEE, Parcel Number: 335-480-025
CA 92585 Construction Cost: $2,134.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING 50 GAL WATER HEATER, SAME LOCATION
Work:
Owner Contractor
CANDY PLUMBER AFFORDABLE WATER HEATERS AND PLUMBING
25856 BOULDER ROCK PLACE INC
MENIFEE,CA 92585 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 gtl 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 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 BidgPermit-Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION propertywho 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).
Chapter!3(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
Professilons Code and my license is in e and effect. the following reason:
s
Licens:Class &4�6 ate e e No. 13&1� By my signature below I acknowledge that,except for my persona I residence
Expire ign-.. in which I must have resided for at least one year prior to completion of
,n-,--,-,- ---,1PENSAT1ONDECLA TION Improvements covered by this permit.I cannot legally sell a structure that I
have built as an owner-builder if it has not been constructed in Its entirety by
u 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
this permit is issued. wwvv.Iegmfo.m.Roy/caIavv.htmI.
P p icy N Date
PROPERTY OWNER OR AUTHORIZED AGENT
I have and Will maintain worker's compensation insurance,as required by
Ition 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 beha If.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
Candea C6 k9a building construction.I authorize representatives of this city or county to
itt, enter the above identified property for inspection purpos�.
Pollcyl�. Expires ' I,I 1� 11-1
(This section need not to be completed is the permit is for an hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
u I certify that in the performance of the work for which this permit is issued,
I shall not enrol any persons in an manr 0 b:,co e subject to the CITY BUSINESS LICENSE#
worke 01U,. -n-sgars'e0th iifT HAZARDOUS MATERIAL DECLARATION
s be
de Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
APPI, amounts specified on the Hazardous Materials Information Guide?
WAR o 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 modificatlion 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 forguidelines
CONSTRUCTION LENDING AGENCY ciYes riNo
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) ciYes oNo
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 o No
Business and Professions Code).Any city or county that requires a permit to Date
construct,after,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED AGENT
issuance,also tecluires 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(RRP)
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.Anyviolation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with
an Applicant for a permit subjects the applim nt to a clivil Pena ItV of not more required practices.This includes renta I property owners a nd property
than($500). managers who do the paint-disturbing work themselves or through their
u 1,as omer of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do I )all of or( )portion of the work and the structure is www.epa.gov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Profession$ 1-800-424-LEAD(5323)4
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. a No EPA Lead-Safe Certified Firm is required for this project bemuse:
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
P
�'."-' Menifee
DATE / IU PERMIT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL )(RESIDENTIAL 0MULTI-FAMILY C) MOBILEHOME OPOOL/SPA CSIGN
SUBTYPE: CADDITION CALTERATION ODEMOLITION O- ELECTRICAL OMECHANICAL
ONEW )(PLUMBING ORE-ROOT-NUMBEROFSQUARES-
DESCRIPTION OF WORK WfPL&f6 6;
PROJEcTADDRESS �2 (�J)U U01��
ASSESSOR'S PARCEL NUMBER LOT TRACT -CUy otlAantfee-
PROPERTY OWN ER'S NAME Building 8,Safety Dept
ADDRESS /L44k�� (�0\3UCC� ou. SEP 13 2016
PHONE EMAIL Reeeived
APPLICANTNAIME
ADDRESS ZAOC Pic, Co��MbTOR
PHONE fg��I�-044(9 EMAIL
CONTRACTOR'S NAME OWNERBUILDER.? CYES)ONO
BUSINESSNAME h9gQXJKLt \NAjaVk9"
ADDRESS jAal�� C,3r&j(d
PHONE EMAIL
C
CONTRACTOR'S STATE LIC NUMBER ICENSE CLASSIFICATION
0,/VALUATION$ SQ FT L SC,FT
APPLI IGNATURE DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAIDAMOUNT
AMOUNT 11%5-V5 I I \k'�-5,VS OCASH OCHECK# 0 CREDIT CARD VISA/MC
PLAN CHECK FEES I PAIDAMOUNT 1 0 CASH 0 CHECK# 0 CREDIT CARD VISAIMC
OWNER BUILDER VERIFIED 0 YES 0 No DLNUMBER NOTARIZED LE17ER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA. 92586 951-672-6777
www.cityofmenifee.us inspection Request Line 951-2405-5213
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