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. Menifee, CA 9.2586 951-672-6777
www.cityof,,menifee.us Inoection Request Line 951-246-5213
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