PMT16-04257 Cfty of Menifee Permit No.: PMT16-04257
29714 HAUN RD. Type: Residential Plumbing
IrXccr=U� MENIFEE, CA 92586
MENIFEE Date Issued: 12120/2016
P E R M I T
Site Address: 28860 HOPE DR, MENIFEE, CA 92586 Parcel Number: 337-366-010
Construction Cost: $1,000.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING 40 GAL WATER HEATER,SAME LOCATION
Work:
Owner Contractor
JOSEFA ESPINOSA QUALITY CONSERVATION SERVICES INC
28860 HOPE DRIVE 4751 ARROW HIGHWAY
MENIFEE, CA 92586 MONTCLAIR, CA 91763
Applicant Phone:9094450450
DIANA OLIVAS License Number:757471
QUALITY CONSERVATION SERVICES INC
4751 ARROW HIGHWAY
MONTCLAIR,CA 91763
Fee Description pty 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 requi(ing the correction of enors 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.Bidg_Permit-Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who buildsor improves thereon,and who contracts forthe projects
I hereby affirm under penaltyof perjury that I am under provisions of with a licensed contractor(s)pursuarittothe Contractors State Uicense Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and a I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effecL the following reason:
License Class is rise No. By my signature below I acknowledge that,except for my personal residence
Expires .20 A Signature oa in wh ich I in ust have resided for at least one year prior to completion of
Improvements covered by this permit.I can not lega Ily 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
a 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 Labor Code,for the performance of work for which
this permit is issued. www.leginfo�ca.gov/calaw.litml.
Policy# Date
PROPERTY OWNER OR AUTHORIZED AGENT
6X.�e and will maintain workees compensation Insurance,as required by
section 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 in the property
this pernu issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
numb application and the information I have provided is correct.I agree to comply
C. with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# ::7 Expires. 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
a 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 It
worker's cgrl3pensation laws of California,and agree thatif I should become HAZARDOUS MATERIAL DECLARATION
subject cdl'lhe orkere's ciornpen�satioropvlrsiva�nsof Section 3700 of the Labor
�h " 0 " sc phy w,ata r 0 'L of
de sh 11 hwith comply with provisions. Will the applicant or future building occupant handle hazardous material or a
th s
mixture containing a hazardous material equal to or greater that the
at Date amounts specified on the Hazardous Materials Information Guide?
6.F ILU RE To SECU E R'S COMP
IVRNG:FAILURE TO SECURE WORKEWS COMPENSATION COVERAGE IS o Yes ci 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($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(SCAQMD)?See permitting checklist
IN SECrION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguldelines
CONSTRUCTION LENDING AGENCY a 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) ci Yes oNo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCACMD
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 items)(Section 7031.5 ciYes ci 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[RRP)
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&arn 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 orthrough their
0 1,as owner of the property,or my employee with wages as theirsole 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.aov/Iead or contact the National Lead Information Center at
not Intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LFAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a ci 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-Buifder will have the burden of proving that it was
not built or improved for the purpose of sale. a No EPA Lead I-Safe Certified Firm is required for this project because:
0 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 NUMBEReww-ouavi
TYPE: OCOMMERCIAL ORESIDENTIAL 0MULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: �ADDITION OALTERATION 0DEMOUTION 0ELECTRICAL OMECHANICAL
ONEW & PLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK /9Z ) /j)19 J(f�7t(-'
h a-d
C"' O'=Q
PROJEcTADDRESS BUIlding a apt.
ASSESSOR'S PARCEL NUMBER LOT TRACT DEC 2 0 2016
OWNER NAME nc-, L a Received
ADDRESS �� b f), A-g JQAL,
PHONE J51-733 - � <n 9 EMAIL
APPLICANT NAME I Pvo /1 6111-) a
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME 0
(O/)M", SJ400�ANERBUILDER7 OYES^O
BUSINESS NAME
ADDRESS t6 6C) A �76
PHONE Vl
��30 EMAIL
CONTRACTOWS STATE LIC NUMBER 75�7(,/ '7 1 LICENSE CLASSIFICATION
VALUATION$ 1)6 � SQ FT L SO FT
_j "Q Z'�
APPLICANVSSIGNATURE,�� 14'A'711110 Al� ; /,'�> DATE—2�2
jrivj,A"-Mog li�
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP I )c
ZDAMOUNT IV5.VS
= � I 1 0 CASH CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PA D AMOUNT 0 CASH 0 CHECK# �CREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 No DLNUMBER NOTARIZEDLETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-5213
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