PMT16-04500 City of Menifee Permit No.: PMT16-04500
29714 HAUN RD. Type: Residential Plumbing
5ACCELA> MENIFEE, CA 92586
MENIFEE Date Issued: 12/2812016
P E R M I T
Site Address: 26146 BALDY PEAK DR, MENIFEE, CA Parcel Number. 338-251-020
92586 Construction Cost: $1,500.00
Existing Use: Proposed Use:
Description of REPLACE 40 GAL WATER HEATER, SAME SIZE&LOCATION
Work:
Owner Contractor
STEVEN LEACH AFFORDABLE WATER HEATERS AND PLUMBING
26146 BALDY PEAK DR INC
MENIFEE, CA 92586 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
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 carfied 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_Perrnt-TeMplate.rpt Page 1 of I
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).
Cha pter9(com mencing with section 7GOO)of Division 3 of the Business and a I am exempt from licensure under the Contractoes State License Law for
Professions Code an d my license is in full forcai and effect. the following reason:
1 4 No. By my signature below I acknowledge that,except for my personal residence
Licari Cl�� 2==
E.pir:��4% Slgnature� J in which I must have resided for at least one year priarto completion of
(�� 1// improvements covered by this permit.I cannot legallysell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
cs 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 workees 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.legfnfo.ca.gay/calaw.html.
Policy# Date
iI have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
el,tion 3700 of the Labor 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 ownees behalf.I have read this
number are: application and the information I have provided Is correct.I agree to comply
rk'K, C with all applicable city and county ordinances and state laws relating to
Carrier V — /), building construction.I authorize representatives of this city or county to
Poficy#VIY�WSILMQQ _Expires I 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 emoloy any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# 05051-a'
workeescomp sation laws of California d agree that if I should become HAZARDOUS MATERIAL DECLARATION
subjecttothew rker'scompens ion visions of Section 3700 of the Lapis
Code,isha o with comp se prov ns. Will the applicant or future building occupant handle hazardous material or a
Appill Date mixture containing a hazardous material equal to or greater that the
annountt�s s9pe ified on the Hazardous Materials Information Guide?
WAR a:FAILURE TO ESERE WEORKER'SCOMPENSATION COVERAGE IS cs Yes 0
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES
AND CIVI L FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000 Will the intended use of the building by the applicant or future building
),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Qua lity Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guicielif��(
CONSTRUCTION LENDING AGENCY oyes 0
1 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 b dary of a school?
(Section 3097 Civil Code) o Yes 0
OWNER BUILDER DECLARATIONS I have/eadthe Hazardous Material InVirriation Guide and the SCAQMD
permitting checklist.I understand mXrequirements undertheState of
I herebyaffirm under penaltVof perjurythat I am exemptfrom the C I`f " HaaIth&SafeTVLQae, ction25505an 25534concerning
contraictoes License Law for the reason(s)indicated below by the h:,',Or' 'm:
checkmark(s)I have placed next to the applica ble Item(s)(Section 7031.5 Eo
Business and Professions Code).Any city or county that requires a permit to 7,
construct,alter,improve,demolish or repair any structure,prior to its �41'71/Z rg,/; Date
issuance,also requires the applicant for the permit to file a signed statement (�WfflftV_NER O�,91MCTAIE-DAGENT
that he or she is licensed pursuant to the provisions of the Contractoes State EPA RENOVATION,REPAIR AND PAINTING IRRPI
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business a rid 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-certified firms and comply with
a n Applica nt for a permit subjects the applicant to a civil pena Ity of not more required ismalces.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
cs 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 ci An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,th rough am ployees'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. rs No EPA Lead-Safe Certified Firm is required for this pmject because:
o 1,as owner of the property a m 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 role please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
�,,,&V
Wenifee
PERMIT/PLAN CHECK NUMBER
DATE /\u
TYPE: O- COMMERCIAL )(RESIDENTIAL OMULTI-FAMILY " MOBILEHOME OPOOL/SPA OSIGN
SUBTYPE: OADDITION CALTERATION 0DEMOUTION CELECTRICAL OMECHANICAL
ONEW %,PLUMBING 0 RE-ROOF-NUMBER OF SQUARES—
DESCRIPTION OF WORK
PROJECTAIDDRESS
ASSESSOR'S PARCEL NUMBER 06t'OLOT —UY2-� TRACT
PROPERTY OWNER'S NAME
ADDRESS -q,(0�0(0 C�A
PHONE kijl�, EMAIL
APPLICANT NAME oAp-4�, Ii., w,\A-%
ADDRESS tAtAC PJIC,
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILDER? 0 YES ONO
BUSINESS NAME
ADDRESS
PHONE
%(A,5 - 00 EMAIL
CONTRACTOR'S STATE LIC NUMBER LMSIA LICENSE CLASSIFICATION
VALUATION $ SQF9 LSQ FT
APPLI NrS SIGNATURE4Z— ----------WkTE N�—A�
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION Lily 01-mENIF=EEBU INESS LICENSE NUMBER
PLANNING ENGINEERING -REEN SMIP
BUILDING FIRE G
INVOICE PAIDAMOUNT
0 CASH 0
AMOUNT IF)- 1 '5 1 CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES I PAIDAMOUNT 0 CASH 0 CHECK If 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 NO DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City0f fV7-11f9e SUdding&Scfety Depertment29714,�Oun Rd. Menifee, CA 92586951-672-6777
www.dtyofmenifee.us Inspection Request Line 951-246-6213
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