PMT16-03451 City of Menifee Permit No.: PMT1 6-03451
29714 HAUN RD. Type: Residential Plumbing
<A—CCF6� MENIFIfE, CA 92586
MENIFEE Date Issued: 1012012016
P E R M I T
Site Address: 29015 TURTLE ROCK CT, MENIFEE, CA Parcel Number: 351-210-001
92587 Construction Cost: $1,700.00
Existing Use: Proposed Use:
Descrlptlon of REPLACE EXISTING 50 GAL WATER HEATER IN GARAGE
Work;
Owner Contractor
GARRETTWHITE AFFORDABLE WATER HEATERS AND PLUMBING
29015 TURTLE ROCK COURT INC
MENIFEE, CA 92587 28358 CONSTELLATION ROAD#698
Applicant Phone: 8553459087
DANIEL MATA License Number:627368
AFFORDABLE WATER HEATERS AND PLUMBING INC
28358 CONSTELLATION ROAD#698
VALENCIA, CA 91355
Fee Description Qtv Amount($
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
$115.15
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of emors 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.Bldg_Peanit-Template.ript 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 Uicense 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:
License —_ I se No_,V2!t, By my signature below I acknowledge that,except for my personal residence
Expires Z4t.Sgnt.Ar 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 not been constructed in its entirety by
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 a ad will maintain a certificate of consent of self-insu re 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 welisite:
by Section 3700 of the Labor Code,for the performance of work for which www.leninfo.ca.gay/calaw.litoil.
this permit is issued.
Policy# Date
iI have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
ection 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 a m 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 15 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
enter the above identified property for inspection purposes.
Policy# _)Expire5'
1�14
(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 sha 11 not em ploy any persons in any in a nner so as to become subject to the CITY BUSINESS LICENSE#
workees compeppsation laws of Ca Iffornia,3od agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the wo ker's compen !on isions of Section 3700 of the bar
ct to t ewo r' in 'a of
I sh. th c.0 h ro nS Will the applicant or future building occupant handle hazardous material or a
0 mixture containing a hazardous material equal to or greater that the
an the Hazardous Materials Informatian Guide?
S COMP
G. LURE TO SECURE WORKER'!S COMPENSATION COVERAGE 15 Oyes ONO
ZG:FAILURE To SECURE WORKERP E
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(SCAQM D)?See permitting checklist
I N SECTION 3706 OF THE LABOR CODE,I NTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY o 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) oYes ONO
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQUID
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 o 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 IRRIPI
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
ci 1,as owner of the property,or my employee with wages as theirsole employees.Far more information about EPA!s Renovation Program visit;
compensation,will do I )all of or I I portion of the work,and the structure is www.eva.gov/lead or contact the Natilonal 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 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 far the purpose of sa le. o No EPA Lead-Safe Certified Firm is required for this project because:
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 rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
A
DATE PERM IT/PLAN CHECK NUMBER
oh"8
TYPE: OCOMMERCIAL )(RESIDENTIAL 0MULTI-FAMILY OMOBILEHOME 0 POOL/SPA 0 SIGN
SUBTYPE: OADDITION CALTERATION ODEMOLITION OELECTRICAL OMECHANICAL
ONEW )(PLUMBING 0 RE-ROOF-NUMBER OF SQUARES-
DESCRIPTION OF WORK
PROJECTADDRESS C-3rs-I
ASSESSOR'S PARCEL NUMBER LOT TRACT
PROPERTY OWNER'S NAME rity Ot MenI16 I
ADDRESS Building & bard,T�ePt.
PHONE EMAIL OCT 2 0 ZI 16
APPLICANT NAME tv�AA RE)(;o xu),,d
ADDRESS rn.,AtAC cot�JgAb-VL
PHONE EMAIL
CONTRACTOR'S NAME OWNERBUILDER? OYES �ONO
BUSINESS NAME bk��U6 \pJA'fa A)EA7K(jo�S
ADDRESS JZI�� Cor6dl�!&Mgr� �D,(A6#fACA QA(ktACiA 0\\AS8
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ N 'w SQ F�P? /// _44, L SO
� A
APPLICANT'S SIGNATURE Z DATE lor-Ln
Is F-0921m;9*104
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP I �e
INVOICE PAIDAMOUNT 0 CASH 0 CHECK If 0 CREDIT CARD VISA/MC
AMOUNT I
PLAN CHECK FEES I PAIDAMOUNT CASH 0 CHECK 9 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 No DLNUMBER NOTARIZED LE17ER 0 YES 0 NO
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