PMT16-04306 City of Menifee Permit No.: PMT16-04306
29714 HAUN RD. Type: Residential Plumbing
<A-CCEL:A—> MENIFEE, CA 92586
MENIFEE Date Issued: 12/22/2016
P E R M I T
Site Address: 23931 CIRCLE DR, MENIFEE, CA 92587 Parcel Number: 350-082-043
Construction Cost: $500.00
Existing Use: Proposed Use:
Description of REPLACE 50 GAL WATER HEATER, SAME LOCATION
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 Ply. 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
$115.16
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 BIdgPerrnit-Ternplate.rpt Page I of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts forthe prcjects
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).
Chapterli(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 effect the following reason:
License Class 0 G 13 license No. t- By my signature below I acknowledge that,except for my personal residence
Expires Signature in which I must have resided for at least one year priorto 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
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 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.Ieginfo.ca.goy1calaw.html.
Policy# Date
Gh have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the La bar Code,for the performance of the work for which a By my signature below I certify to each of the following:I am the property
this 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
number are: application and the information I have provided is correct.I agree to comply
Carrier with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
policy# VJA Expires Q enter the above identified property for inspection purposes.
JThis section need not to be completed is the permit is for one-h undred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
u 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 compensation laws of California,and agree that if I should become 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_12- Date mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS a Yes o No
UNLAWFUL,AND SHALL SUBJECr 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 SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY aYes ciNo
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) o Yes a No
OWNER BUILDER DECLARA71ONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I herebyaffim under penalty of perjurythat I am exempt from the California Health&Safety Code,Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)inclicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applIca ble Item(s)(Section 7031.5 aYes o No
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair a ny 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(RRPJ
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 childcare facility to be RRP,certifiecl 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 or through their
o 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( )all of or( )portion of the work,and the structure is www.epa.gov/fead 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 employees'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. o No EPA Lead-Safe Certified Firm is required for th is project bemuse;
a 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 FIRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
-.'."Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL AESIDENTIAL OMULTI-FAMILY OMOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION OALTERATION ODEMOLITION OELECTRICAL OMECHANICAL
ONEW Q/PLUMBING 0 RE-ROOF-NUMBER OF SQUARES-
DESCRIPTION OF WORK RR-muVe (,LAd f4gliice 4 1/ V4
L 0 1!" o;i DEC 2 2 2616
PROJECTADDRESS ,--3 c, 0 A zl�
ASSESSOR'S PARCEL NUMBER
LOT TRAR(aceived
OWNER NAME Od- P 1 (4
ADDRESS
PHONE q EMAIL
APPLICANT NAME J �A-7) I CM,/
ADDRESS
PHONE (q-3 t 0 3 q1I EMAIL
CONTRAcroWS NAME R e p; OWNER BUILDER? 0 YES elkO
BUSINESSNAME �4j�-im 4,(-e BL4 iiI del 5 7`7 L
ADDRESS i q 3 2� G VC4 +Ur(i 0 1 41r-s-0 1 1-(�V 7-- 60 4 C 01
PHONE S 19 3 V S- -L- q-Z -7 EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION c- 3 6
I-00
VALUATION $ SO FT L SO FT
APPLICANTS SIGNATURE DATE 7-
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION SMIP CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN
INVOICE � Ir
_?.\4=..) PAIDAMOUNT - CASH OCHECK# OCREDITCARD VISA/MC
AMOUNT
PLAN CHECK FEES PAID AMOUNT OCASH OCHECK# 0CREDITCARO VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 No DL NUMBER NOTARIZED LETTER () YES 0 NO
City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92585 951-672-6777
www.cityofrnenifee.us Inspection Request Line 951-246-6213
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