PMT16-04501 C4 of Menifee Permit No.: PMT16-04501
29714 HAUN RD. Type: Residential Plumbing
<A—CCIEILA�> MENIFEE,CA 92586
MENIFEE Date Issued: 1212812016
P E R M I T
Site Address: 28088 PEBBLE BEACH DR. MENIFEE, Parcel Number: 337-162-005
CA 92586 Construction Cost: $1,500.00
Existing Use: Proposed Use:
Description of REPLACE 40 GAL WATER HEATER, SAME SIZE&LOCATION
Work:
Owner Contractor
JAMES SANTOS AFFORDABLE WATER HEATERS AND PLUMBING
28088 PEBBLE BEACH 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 9-ty 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
$116.15
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 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.ript Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION propertywho builds or improvesthereon,and who contracts forthe 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).
Chapter!)(commencing with section 7000)of Division 3 of the Business and m I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full fai n the following reason:
License C11 ss I (,A�1(6 U a i NO. BY my signature below I acknowledge that,except for my personal residence
ExpheMW A Signature in which I must have resided for at least one year prior to completion of
WORvFR'c COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I
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 websfte:
by Section 3700 of the Labor Code,for the performance of work for which
this permit is issued. www.IeRinfo.ca.gov/caIaw.htmI.
Policy# Date
� ave and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
ect�,on 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 th e 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
numberare: 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
Carrler6i.x_ 0), building construction.I authorize representatives of this city or county to
V —
Policy# 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 OWN ER 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# DR?,5051-6y
workees compe sat'on I f Caiifcmia!,,Ad agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the ..7rkaesc:`wsio�; ion visions of Section 3700 of the Lapo
Codelsha o' withcomp se prov, as. Will the applicant or future building occupant handle hazardous material or a
� Z - mixture containing a hazardous material equal to or greater that the
Appli Date I illle6 7t amounts 'R d n the Hazardous Materials Information Guide?
- I I U11 �srieci a a
WARE:2FAILU RE TEO SIERE WORKER'S COMPENSATION COVERAGE IS a Yes N
UNLAWFUL,AND SMALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ro
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN Will the intended use of the building by the applicant or future building
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 parimitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guicielu)(i s
CONSTRUCTION LENDING AGENCY Dyes No
Ir
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 b dary of a school?
(Section 3097 Civil Code) a Yes 0
OWNER BUILDER DECLARATIONS I have/e,d the Hazardous Material Infyination Guide and the SCAQMD
permitting checklist.I understand no quirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the C lif jlHe:ilth&Safe e, c9likin 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the h:,',O,,r' , %*/.Cd
checkmark(s)I have placed next to the applicable ftem(s)(Section 7031.5 0
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 (f,�Wffl ftKN—E R O0rH dfri K AGHE N T
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 ricensure receiving compensation for most work that disturbs paint in a pre-1978
a nd 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 or through their
ci 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.Roy/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 a 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. in 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 Contractoes 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.
A
...iX,I- Menifee
-4
DATE PERMIT/PLAN CHECK NUMBER VrMl
TYPE: CCOMMERCIAL )(RESIDENTIAL CMULTI-FAMILY 0MOBILEHOME 0 POOL/SPA SIGN
SUBTYPE: 0 ADDITION 0 ALTERATION 0 DEMOLITION 0 ELECTRICAL � MECHANICAL
ONEW 'fPLUMBING 0 RE-ROOF-NUMBER OF SQUARES_
DESCRIPTION OF WORK wmq 4NW�� -,�5!7k j=',
qzn&)�u tu�t:l — le7sstp
PROJECTADDRESS zeGLIC NL
ASSESSOR'S PARCEL NUMBER 12?? - 1(0,?� LOT TRACT 4ff 0
PROPERTY OWNEWS NAME �,AjLTn-S
ADDRESS Pe§gLt- MA&V\ O(L-
PHONE EMAIL
APPLICANT NAME
ADDRESS CAtA� AC,
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILDER? 0 YES ONO
BUSINESS NAME 6��(k
ADDRESSJ,ta(�� CLt:�(dV�gr�
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION $ SQ FT LSQFT I
APPLICANT'S SIG N I ATURE DATE 11,hc��tco
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PL4NNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT I OCASH QCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# 0 CREDIT CARD VISA/MC
LOWNER BUILDER VERIFIED 0 YES 0 NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
Cityof Menifoe Building& Safety Department 29714 Hour, Rd. lWenifee, CA. 92585 951-672-5777
v,,w,,v,cityof,,nenffee.us Inspection Request Line 951-246-6213
-0 r)
z
m om>
0 2� 6 (a i64
z
-4
? -g m
0 w 0 CL
3 >
CL z r) mo
I m
0 0 rn -C Z?�
Et -41
= ;a M —
o m 0
x 0
m
m . r-5;
0 rl >
CL
3 m m 0 0 m ct
z X a.
G) 10 — m
8, 7v >
CO
Z
M o
co Y"ll
am J� ffi
m z
1
co
:E
EP
C)
>
< W = :E
E 0 0 0
m
Ef
3 cl
It
C, 113 m
2m
at
E; 3 0 rri
o o
w :E 0 5r 9
o
0 D w
I
2� o
3
W . I
fz 2L w F
m
.n Q�0
:E CD
'w CD
w L-2
:E 00
(D
10
3
rl
L3� a W
aq
3
>
E3
r-
:E :E
r�n
00 z
5;
2.
3
m 0
5
0 5 0
@
�Aj 04601
I a
0 0
LLJ w
LU
a
Lu 411
LV 75
713 E
,13- .12 E
45 4%
0
AD
r a
jR 1 0 ,
Z
je
0 a
'a tL c
,w
-;; . 1p
0
u
Z5 F -d
12
EC
F®RD 'E -a
M M
0
E 12 E 'Ei D
42 w '.a - J� W w -W ;
M WC.
-0 47
r
01 Ol �c !E
u
jj
C 0 Or-
%,r w M > 0 u
5 E a X ,
z > 'L�� 2 6
cu
E- v� q E a
I 'u -E t 10
E z 0
1 0
w
E
w 0
C. cc A lu E V, 'a
C c W.
M E M 'a �u CL 0
M 0 = W
< c M IE c
LU 0 W. a 0 a
u
u
> w (k
WE w w 0 .� M
0
>
Ts
M M
c 0 CL
w M c c to > M
M w IM AD IT
M
E X� T -7
0 -z;i
w w
w 0
ZO w M 0 P� UW
w E X 0 u
u C; -i cli ni 4 ui
wd ui L6 P� Cd Oi a Li
E E
M
0
z u
u