PMT16-03450 City of Menifee Permit No.: PMT1 6-03460
29714 HAUN RD. Type: Residential Plumbing
<A--CCEL:^--" MENIFEE, CA 92586
MENIFEE Date Issued: 1012012016
P E R M I T
Site Address: 29257 LIDO BAY DR, MENIFEE, CA Parcel Number: 333-451-024
92585 Construction Cost; $1,438.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING 50 GAL WATER HEATER IN GARAGE
Work:
Owner Contractor
BENJAMIN ROCACUBA AFFORDABLE WATER HEATERS AND PLUMBING
29257 LIDO BAY DRIVE INC
MENIFEE,CA 92585 28358 CONSTELLATION ROAD#698
Applicant Phone: 8553459087
DANIEL MATA License Number:627368
AFFORDABLE WATER HEATERS AND PLUMBING INC
28358 CONSTELLATION ROAD#698
VALENCIA, CA 91355
Fee Description Qtv Amount($
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 buillding 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 construcUon 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 Ternplate.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 a I am exempt from licensure under the Contractor's State Uicense Law for
Professions Code and my license is In full force and effect. the following reason:
License se No. By mysignature below I acknowledge that,except for my personal residence
Expires Z*tTignatu4r a4a 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
WORKERS 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 contnictors.I understand that a copy of the applicable law,Section
have and Will maintain a certificate of consent of self-Insure for worker's 70"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 wwwJeRinfo.ca.Rov/calaw.htmL
this permit is issued.
Policy# Date
iI have and will maintain worker's camp.ensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
ction 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 carner and policy owner or authorized to act on the property owner's behe If.I have read this
number are: application and the information I have provided is correct.I agree to comply
Carrier�AS-m-OLM6, with all applicable city and county ordinances and state laws relating to
bul ding construction.I authorize representatives of this city or county to
W s enter th e above identified property for inspection purposes.
Policy# -)Expire
(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,
lshalinatempi any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's compensation laws of California,yd agree that if I should become
HAZARDOUS MATERIAL DECLARATION
subject to ibe wo ker's corn;en 0ion Isiom of Section 3700 of the L bar
ct er's com 'a no of
P e P -s Will the applicant or future building occupant handle hazardous material or a
rt wl c. P
0 mixture containing a hazardous material equal to or greater that the
t'
LL atwu_specified on the Hazardous Materials Information Guide?
'a I w
I�sh.
,c
G G. S COM
U U RKER'S COMPENSATION COVERAGE IS o Yes a No
FAILURE TO SECURE WORKER PE
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or futu re building
AN D CIVIL FINES 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 guidelines
CONSTRUCTION LENDING AGENCY ci Yes a 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) n 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 2S534 concerning
Contractor's License Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed nextito the applicable Item(s)(Section 7031.5 ciYes; a No
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair a nV 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 Contmctoes State EPA RENOVATION,REPAIR AND PAINTING IRRP)
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 70315 by residence or childca re facility to be RRP-cert'ified firms and comply with
a n Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes renta I property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
ci 1,as owner of the propeft 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.Roy/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 u 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 yea r of Firm Certification No.:
cam pletion,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 bemuse:
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 mle please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: -- COMMERCIAL )(RESIDENTIAL ' MULTI-FAMILY OMOBILEHOME 0 POOL/SPA SIGN
SUBTYPE: 0 ADDITION ALTERATION 0 DEMOLITION �� ELECTRICAL 0 MECHANICAL
ONEW YPLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
PROJECTAIDDRESS IML71 JA00 ISM O� - CjQ59 --; guil(I'Ly Of Menifg.
ASSESSOR'S PARCEL NUMBER �'Fety Dept
, ip5j LOT TRACT V2_016
PROPERTY OWNER'S NAME
ADDRESS
PHONE EMAIL
APPLICANT NAME
ADDRESS rA06Airn
PHONE l 04LA(g EMAIL
CONTRACTOR'S NAME OWNERBUIUDER? 0YESWO
BUSINESS NAME 6��Lt
ADDRESS JZ(��
PHONE EMAIL Ojtq�g'�)PCV-4kAAP
CONTRACTOR'S STATE LIC NUMBER wi,-%b'6 LICENSE CLASSIFICATION
VALUATION$ SQ FT/,/ L SQ FT
Z11Z
APPLICANT'S SIGNATURE DATE lr\
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP x
INVOICE 1 1\5, \�5 1 PAIDAMOUNT C'CREDIT CARD VISA/MC
AMOUNT � I OCASH CHECK 9 1
PLAN CHECK FEES PAIDAMOUNT CASH CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED rQYES C NO CIL NUMBER NOTARIZED LETTER 0 YES 0 NO
-:7 1 7
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