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PMT16-03197 City of Menifee Permit No.: PMT16-03197 29714 HAUN RD. Type: Commercial Plumbing -�A—CCELA> MENIFEE,CA 92586 4.1 MENIFEE Date Issued: 09128/2016 P E R M I T Site Address: 27220 SUN CITY BLVD, MENIFEE, CA Parcel Number: 337-310-029 92586 Construction Cost: $4,000.00 Existing Use; Proposed Use: Description of REMOVE&REPLACE 3 COMMERCIAL SINKS SAME LOCATION, NO NEW PLUMBING Work: Owner Contractor VONS CO INC R C K SERVICES INC 1371 OAKLAND BLVD STE 200 3024 E LA PALMA AVE WALNUT CREEK, CA 94596 ANAHEIM, CA 92806 Applicant Phone 7146309805 JOSE ENRIQUEZ License Number:682918 R C K SERVICES INC 3024 E LA PALMA AVE ANAHEIM, CA 92806 Fee Description Qtv Amount($ Plumbing Fixtures and Vents, fixtures 3 116.00 Building Permit Issuance 1 2T00 GREEN FEE 1 1.00 General Plan Maintenance Fee-Plumbing 1 5.80 $149.80 The issuance of this permit shall not prevent the building official from thereafter requinng 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�Bldg_Perrnit 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). Chapter!)(commencing with section 7000)of Division 3 of the Business and c I am exempt from ficensure underthe ContractoesState License Law for Professions Code and my license is in full force and effect. the following reason: License Class US inse No. j�g By my signature below I acknowledge that,except for my personal residence Expires Inwhich I musthave resided for at least one year prior to completionof improvements covered by this permit.I cannot legally sell astructurethati WORKEWS COMPENSATION DEC�RA N 1�17 have builtasan owner-builderif ithasnotbeen constructedin its entiretyby 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 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 wwvv.IeRInfn.ca.gov/mIaw.htmL this permit is issued. Policy# UoQOOL11,352- 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 o By my signature below I certify to each of the following:I am the property 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 1'/'9 AjA with all applicable city and county ordinances and state laws relating to Carrier Expires P--16 1:2e91!7 building construction.I authorize representatives of this city or county to Policy# 9409D L2 _ / - enter the above identified property for inspection purposes. (This section need not to be completed is the permit Is/or one-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 employ any pers6ns in any manner so as to become subject to the CITY BUSINESS LICIENSE# i�94?6719 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 fin hwflh ompi with those provisions. Will the applicant or future building occupant handle hazardous material or a 0 s 3 0 "wt 0 p w' t os Prov'5m 5 mixture containing a hazardous material equal to or greater that the Applicant Date amounts specified on the Hazardous Materials Information Guide? PPI ca"t W W T P ARNIN ILURETOSECURE S COMPENSATION COVERAGE 15 ci Yes ci No I ILU 0 CU S COM U U WFUe LSU U Cr M T( Will the intended use of the building by the applicant or Future building W S NLA .AND SHALL SUE JECr AN EMPLOYER TO CRIMINAL PENALTIES 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(SCAQM D)?See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidellnes CONSTRUCTION LENDING AGENCY n Yes a No I hereb y 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) n 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 a in exem pt 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 repping. checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 N Business and Professions Code).Any city or county that requires a permit to �1&� )d4a2i- -kill—IV Date construct,alter,improve,demolish or repair any structure,prior to its PR ERrMWNER NT issuance,also requires the applicant for the permit to file a signed staterrient A AUTHO lZ that he or she is licensed pursuant to the provisions of the Contractor's S---- A RE Mt, 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 perm it subjects the applicant to a civil pena Ity of not more required practices.This includes rental propertV 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( 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 Contractoes State License Law does not apply to an owner of a 0 An EPA Lead-Safe Certified Renovator will be responsible for this project property who,through employeee or personal effort,builds or improves the property provided that the Inn proverments 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 not built or Improved for the purpose of sale. 0 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 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. — - — 0 BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION 4"."Men ifee DATE PERMIT/PLAN CHECK NUMBER TY/E: 4COMMERCIAIL O- RESIDENTIAL O- MULTI-FAMILY OMOBILEHOME OPOOLYSPA OSIGN SUBTYPE: CADDITION OALTERATION ODEMOLITION OELECTRICAL OMECHANICAL ONEW QPLUMBING 0 RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK ly6iN100�- -3 5AMz-- Aoc!,4i-;�n�J Afo Algr-llff 6//j A,,fl V? j / 50J "7- PROJECTADDRESS ASSESSOR'S PARCEL N MBER lC901 LOT' TRACT OWNER NAME 7blj�5 ADDRESS PHONE EMAIL APPLICANT NAME (Dne f�r-(Qj IT ADDRESS U PHONE EMAIL CONTRACTOR'S NAME DhzJ OWNER BUILDER? 0 YES NO BUSINESS NAME I , J,//9 ADDRESS 4�18 PHONE EMAIL CONTRACI-OR'S STATE LIC NUMBER [(�J)6 P-614-(,?3 5/1 LICENSE CLASSIFICATION 61"o VALUATION $ 4090 sOt FT Vf LSQFT APPLicAN-rs DATE CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION FIRE [GR- LltY U�MLNIFLL BUSIN�h LILENSE NUMBER EEJ log BUILDING PLANNING ENGINEERING N INVOICE I PAIDAMOUNT AMOUNT OCASH (iiCHECK# OCREDITCARD VI.SA/MC PLAN CHECK FEES PAID AMOUNT OCASH OCHECK# 0 CREDIT CARD VISAIMC OWNER BUILDER VERIFIED 0 YES 0 No DL NUMBER NOTARIZED LEITER 0 YES 0 NO City of Menifee Building&Sofety Department 29714 HOUn Rd. Menifee, CA 92586 951-672-6777 www.cityofmenifee.us Inspection Request Line 951-246-6213