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PMT16-04254 City of Menifee Permit No.: PMT16-04254 29714 HAUN RD. Type: Residential Plumbing <A-CCELA-> MENIFEE, CA 92586 MENIFEE Date Issued: 12120/2016 PERMIT Site Address: 23931 CIRCLE DR, MENIFEE,CA 92587 Parcel Number: 350-082-043 Construction Cost: $4,000.00 Existing Use: Proposed Use: Description of REPIPE HOUSE WITH PEX AND REPLACE 30'OF 1"COPPER WATER SERVICE LINE Work: Owner Contractor ROBERT PLATTE ULTIMATE BUILDERS INC 23931 CIRCLE DRIVE 19326 VENTURA BLVD STE 201 MENIFEE, CA 92587 TARZANA, CA 91356 Applicant Phone: 8667374731 JON KINGSLAND License Number.927892 ULTIMATE BUILDERS INC 19326 VENTURA BLVD STE 201 TARZANA,CA 91356 Fee Description ON Amount f$ Plumbing Fixtures and Vents, fixtures 7 136.00 Piping/Repiping Single Family Residential 1 163.00 Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 General Plan Maintenance Fee-Plumbing 1 14.95 $341.95 The issuance of this permit shall not prevent the building afficial from thereafter requiring the correction of errors in the plans and specifications or from preventing building 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. Ak131dg_Penit-Template.rpt Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION propertywho builds or improves thereon,and who contractsforthe projects I hereby affirm under penalty of perjury that I am under provisions of with a licensed contrauctor(s)pursuant to the Contractors State License Law). Chapter9(commencing with section 7000)of Division 3 of the Business and ci I am exempt from licensure under the Contractoes State Ulcense Law for Professions Code a rd my license is in full force and effect. the following reason: License Class— 111 6 0 License No. q 7�-7 By my signature below I acknowledge that,except for my personal residence Expires L-11 Signature 11__� in which I must have resided for at least one year prijarto 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 ci 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 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 La bar Code,for the performance of work for which this permit is issued. www.leginfo.ca.gov/calaw.htm]. Policy# Date Zhave and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT section 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 this permit is issued.My workees 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 is correct.I agree to comply Carrier W%p 14- with all applicable cityand county ordinances and state laws relatingto building construction.I authorize representatives of this city or county to Policy# 1/54 J-L7 I V 6 i;l —Expires q-11 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 ci 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# workees compensation laws of California,and agree that if I should became HAZARDOUS MATERIAL DECLARATION subject to the worker's compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a Applicant Date I mixture containing a hazardous material equal to or greater that the amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKEWS COMPENSATION COVERAGE IS ci Yes a No 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($200,000),IN occupant require a permit for the construction or madification 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 forguidelines CONSTRUCTION LENDING AGENCY o Yes D 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 boundbry of a school? (Section 3097 Civil Code) ciYes nNo OWNER BUILDER DECLARATIONS I have mad 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 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 ciYes cr No Business and Professions Code).Any city or county that requires a permit to Date construct,a Iter,Inn prove,demolish or repair my 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 JRRP) 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 pm-1978 and the basis for the alleged exemption.Any violation of Section 7031.5 by resid ence or childcare facility to be RRP-certified firms and comply with a n 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 a 1,as owner of the property,or my employee With wages as their sale 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 w%vw.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 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. u No EPA Lead-Safe Certified Firm is required for this project because; ci 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 "Menifee DATE PERMIT/PLAN CHECK NUMBER f7t!5jXf -nLAQ�4 TYPE: WCOMMERCIAL CRESIDENTIAL omuun-mmy OMOBILEHOME 0 POOL/SPA 0 SIGN SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRICAL CMECHANICAL ONEW R(PLUMBING 0 RE-ROOF-N UMBER OF SQUARES- DESCRIPTION OF WORK e Pe.* � e-.e C I I, �e 3 O� 0 F I L � pp L� (I +e� j 4?,V, L.ie PROJECTADDRESS -2-3 1 v C;,,c- D� oGesl ASSESSOR'S PARCEL NUMBER e�j;�Q -r"3 LOT TRACT OWNER NAME P, 4-.,,-e ADDRESS ri C Oil Menifen PHONE q 57 -7 '1 (, �l 2P4 EMAIL J- Ullam-gy Na" Dept. APPLICANT NAME I k,j DEC 2 0 2016 ADDRESS PHONE 3 tO 3 LII/ EMAIL CONTRACTOR'S NAME —Re oive� OWNER BUILDER? 0 YES 61<0 BUSINESS NAME q [ 4-i Je� L ADDRESS q 3 V-e, f-LA�r, ez 01 'rr,,-u M A C q�f 3 PHONE eIg3Lj-j__ 2- q-1-1 EMAIL CONTRACTOR'S STATE LIC NUMBER Rz, LICENSE CLASSIFICATION L I & 13 VALUATION$ L, 000 SO FT L SO FT APPLICANT'S SIGNATURE DATE-- MoErU�SE6�ff DEPARTMENT DISTRIBUTION ITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP I x INVOICE PAIDAMOUNT AMOUNT 94 1 3H I-cts OCASH OCHECK# 0 CREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT 1 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC OWNER BUILDER VERIFIED 0 YES 0 No CLNUMBER NOTARIZED LETTER 0 YES 0 NO City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777 www.cityofmenifee.us Inspection Request Line 951-246-6213 91OZ/61/6 **go-glaM=olp!uaod�xdsL,-Iluuodlu!jd/Luoisno/Ely3pi4o/Ojo-lz)n2nmun2u of4jo-jTpjj//:sdTTq u ul Lin cz, -rl C�� M3 % 10 ro --a m < a!- rn c z m 0 -0 M rn 0 Z z -TI m rn rn is rn L4 g F; rn go z (D rn 0 C-) goo CD rj I > Wc zrnc SD (D CD (D CL 00 (D 'o FFICE COPY 7 TO 7 O&M OtAl— Iva - 11111101T -