PMT16-03697 C4 of Menifee Permit No.: PMT16-03697
29714 HAUN RD. Type: Residential Plumbing
'�A—CCELA—> MENIFEE, CA 92586
MENIFEE Date Issued: 1111612016
P E R M I T
Site Address: 26385 FLAXLEAF DR, MENIFEE,CA Parcel Number: 360-630-008
92584 Construction Cost: $1,500.00
Existing Use: Proposed Use:
Description of REPLACE WATER HEATER.SAME LOCATION&SIZE.50 GALLON LOCATED IN GARAGE
Work,
Owner Contractor
ALEX JARAMILLO AFFORDABLE WATER HEATERS AND PLUMBING
26385 FLAXLEAF DR INC
MENIFEE, CA 92584 28358 CONSTELLATION ROAD#698
Applicant Phone:8553459087
DANIEL MATA License Number:627368
AFFORDABLE WATER HEATERS AND PLUMBING INC
28358 CONSTELLATION ROAD#696
VALENCIA,CA 91355
Fee Description 0tv Amount($
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
$116.16
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
forfeited.
AA.Bldg_Permit Template.rpt Page I of 1
CITY OF IVIENIFEE
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 o I am exempt from licensure under the Contractor's State License Law for
Professions Code and y lice se is in full e and effect the following reason:
License Cl Ss . en e No. IVA By my signature below I acknowledge that,except for my personal residence
Expires Signatur in which I must have resided for at least one year prior to completion of
WORKER' COM NS ON DEC DON improvements covered by this Perrin it.I can not legally sell a structu re that I
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 and will maintain a certificate of consent of self-insure for worker's 71344 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.leginfo.ca.gov/calaw.litml.
P icy# Date
PROPERTY OWNER OR AUTHORIZED AGENT
I have and will maintain worker's compensation insurance,as required by
ction 3700 of the Labor Code,for the performance of the work for which ci By my signature below I certify to each of the following:I am the property
;hlll's permit is issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property ownees behalf.I have read this
number 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
Carrier,"-en. nV--0k9 v46%'A building construction.I authorize representatives of this city or county to
Policy# Expires ILI 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 OWNER OR AUTHORIZED AGENT
o I certify that in the performance of the work for which this permit is issued,
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's corp"nsat'lon laws of Califor and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to me isions Or Section 5 700 of me LaUUF
Code,I shal o with c F m ose pr sfons. Will the applicant or future building occupant handle hazardous material or a
�a_ .-tu e to ta.n ing a hazardous material equal to or greater that the
rm
Applica Date 6 annourn' e,;fied on the Hazardous Materials Information Guide?
W NI nAILURETOSEC&REWORKER'SCOMPENSATIC)N COVERAGE IS 2tN o
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ded use of the building by the applicant or futu re build ing
AND CIVIL FIN ES UP TO ONE HU NDRED THOUSAND DOLLARS($10,000),1 N occupant req u ire a Perm it for the construction or mod ification from South
ADDITION TO TH E COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Qua lity Ma nagement District[SCAQM D)?See permitting checklist
I N SECTION 3706 OF THE LABOR CODE,I NTEREST,AND ATTORNEYS FEES for guleefn es
CONSTRUCTION LENDING AGENCY a Yes 0
Will th'�
I hereby affirm that under the penalty of perjury there is a construction e posed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outerkborndary of a school?
(Section 3097 Civil Code) o Yes No
r_1
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand Ty requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the orni-Health&Safety godeAction 1_1105 and 15134 writer n
cou 7
Contractor's License Law for the reason(s)Indicated below by the �a, aterial repo
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 TYZes
Business and Professions Code).Any city or county that requires a permit to ey 7�, ,
construct,alter,improve,demolish or repair any structure,prior to its rj //�d Date
issuance,also requires the applicant for the permit to file a signed statement PWPVF�OWNER O06T—HdRTZETAGENT
that he or she is licensed pursuant to the provisions of the Contractor's State WRENovATION.REPAIR AND PAINTING IRRP)
License Law(Chapter 9(commencingwith 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 pa int in a pre-1978
and the basis for the a leged exem ption.Any violation of Section 703 1.5 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 orthrough 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 1400-424-LEAD(5323).
Code,The Contractoes State License Law does not apply to an owner of a o 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 for the purpose of sale. 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.
g-
BUILDING & sAFETY PERMIT/PLAN CHECK APPLICATION
M e n 1 fe e
Ala-
DATE 01w, � vo PERMIT/PLAN CHECK NUMBER D3 0
TYPE: OCOMMERCIAL �(RESIDENTIAL CMULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION CELECTRICAL OMECHANICAL
ONEW XPLUMBING 0 RE-ROOF-NUMBER OF SQUARES-
DESCRIPTION OF WORK WL"
�9D (eA �Nl
PROJECTADDRESS NX�vCA� q�-
ASSESSOR'S PARCEL NUMBER INID - VV- DO& LOT TRACT
PROPERTY OWNER'S NAME
ADDRESS qV',7�b
PHONE EMAIL
APPLICANT NAME
ADDRESS 4AtAe
PHONE
EMAIL
CONTRACTOR'S NAME OWNER BUILDER? 0 YES ONO
BUSINESS NAME6��Lk yJA-f(a A)Lh�"
ADDRESS
PHONE EMAIL
CONTRACTOWS STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ SQF T LSQFT
N lho()�
APPLICANT'S SIGNATURE
CITYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION SMIPT LI1Y U�MLNIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GLEN
INVOICE
AMOUNT PAIDAMOUNT OCASH OCHECK# 0 CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DLNUMBER NOTARIZED LEITER 0 YES 0 NO
City of M-onij�-e Building& Departmeni -29714 Houn Rd. iWenifLe, CA 92585 951-672-6777
www.Ciry,-,,�.T,�,-ree.us lrso2mon Request Line 951-2405-6213
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