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PMT16-03696 City of Menifee Permit No.: PMT16-03696 29714 HAUN RD. Type: Residential Plumbing <A-CCIERUA? MENIFEE, CA 92586 MENIFEE Date Issued: 11/1612016 P E R M I T Site Address: 30914 YOUNG DOVE ST, MENIFEE, CA Parcel Number: 360-451-007 92584 Construction Cost: $1,600.00 Existing Use: Proposed Use: Description of REPLACE WATER HEATER.SAME SIZE/LOCATION 50 GALLON IN GARAGE. Work: Owner Contractor NANCY DA AFFORDABLE WATER HEATERS AND PLUMBING 30914 YOUNG DOVE ST INC MENIFEE, CA 92584 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(1) 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 forlelted. AA.BIdg_Pen-nit-Ternp1ate.rpt Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION propertywho builds or improves thereon,and whocantmcts forthe 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 ficensure under the Contractor's State License Law for Professions Code nd R an . . "11 and effect. the following reason: L' se Cl ss a mync 'e,12sin e U en I loan ��G By my signature below I acknowledge that,except for my personal residence r Expires 13 Signatur in which I must have resided for at least one year prior to completion of improvements covered by this permit.I cannot legallysell a structure that I R, CO WORKER! COMPENSATION DEC TION have built as an owner-builder if it has not been constructed In its entirety by ri 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 cement 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. www.leRinfo.ca.Rov/caIaw.html. P Icy Date I I l av�and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT [on 3700 of the Labor Code,for the performance of the work for which a By my signature below I certify to each of the fol lowing;I a in the property t his 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 num ber 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 Carrler"_em 0�---vkr' we'%'A building construction.I authorize representatives of this city orcountv to Policy;wskQsl M-1co —Expires i/1 !q — enter the above identified property for inspection purposes. (This section need not to be completed is the permit Is for one-hundred Date dollars($100)or less PROPERTY OWN ER OR AUTHORIZED AGENT ri I cert!"at in the performance of the work for which this permit is issued, I shall not employ any persons in any manner o as to become subject to the CITY BUSINESS LICENSE# worker's co n ation laws of Caliorel. alsid agree that If I should become HAZARDOUS MATERIAL DECLARATION subject to t e or ker's comp)*satp rev ns of Section 3700 of the Labor I'h I r. Code 1 0 ffivith cpmpf w" ';rVislons. Will the applicant or future building occupant handle hazardous material Or B nv ixture coetainirigia hazardous material equal to or greater that the ..,n _cified Applica el(& Date a`� n the Hazardous Materials Information Guide? WARNI .PFAILURE TO SE&RE WORKER'S COMPENSATION COVERAGE IS cr Yes No UNLAWFUL,AND SHALL SUBJECr AN EMPLOYER TO CRIMINAL PENALTIES Will the ted use of the building by the applicant or futu re building AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,00),IN occupant require a permit for the construction or modillcation 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 forguieefnes CONSTRUCTION LENDING AGEN Dyes Kolsed building or modified facility be within 1000 feet of the I hereby affirm that under the penalty of perjury there Is a construction Will the lending agency for the performance of the work which this permit is issued outerbopndary of a school? (Section 3097 Civil Code) a Yes No T_�' OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD permitting checklist.I understand 5py requirements under the State of I hereby affirm under penalty of perjury that I am exempt from the C�fiffornia Hpalth&Safety�AcleAcfion 25505 d 25534 Contractor's License Law for the reason(s)indicated below by the 10 ar ou a rial repo checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 s 0 Businessand Professions Code).Any city or county that requires a permit to Date PS-1 F'' construct,alter,Improve,demolish or repair any structure,priortoits P, OWNER OV0YH`0WZEIrAG1ENT issuance,also requires the applicant for the permittofilea signed statement that he or she is licensed pursuant to the provisions of the Contractor's State =RENOVATION,REPAIR AND PAINTING UIRP) 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 childmre facility to be RRP-certifted fimis 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 o 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.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 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 employeee or persona I 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. ri No EPA Lead-Safe Certifted Firm is required for this project because: to 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 ��"_'��`Menifee DATE PERMIT/PLAN CHECK NUMBER MT IV - 0-:�(z el O_ SIGN TYPE: 0 COMMERCIAL )(RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA SUBTYPE: 0 ADDITION 0 ALTERATION 0 DEMOLITION 0 ELECTRICAL 0 MECHANICAL ONEW )�PLUMBING 0 RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK \tJK1�� �,-) o 6vt�� ) (44t\ R A c-& PROJECTADDRESS A�kLk qj)U�� M\JC �A, � ASSESSOR'S PARCEL NUMBER LOT 4( TRACT q"(1— 2— PROPERTY OWNER'S NAME Nf\r1l C)A ADDRESS ��Aq JAUJ\�� �A - PHONE OV�711 ' '\(O,() - j/(R� EMAIL APPLICANT NAME �vktAa POIA ADDRESS '_,AtAC NC, COr-�JO-A-(,� PHONE EMAIL CONTRACTOR'S NAME OWNER BUILDER? 0 YES ONO BUSINESS NAME hg��Lk JW�OnS ADDRESS QALfei,4GiA PHONE EMAIL CONTRACTOR'S STATE LIC NUMBER /UCENSE LASSIFICATION VALUATION$ SQ FT L SO FT L&= DATE IA lwb�L�_ 77 aTY STAFF USE ONLY DEPARTMENT DISTRIBUTION CITY OF M MBLH BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE � PAID AMOUNT 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC AMOUNT I I PLAN CHECK FEES PAID AMOUNT I 1 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC OWNER BUILDER VERIFIED C)YES 0 No DLNUMBER NOTARIZED LETTER 0 YES 0 NO Cityof fV7--,iree Building& sofety Department 29714 Houn Rd. 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