PMT17-00056 City of Menifee Permit No.: PMT17-00056
29714 HAUN RD. Type: Residential Plumbing
'c ►CCELA— MENIFEE, CA 92586
MENIFEE Date Issued: 01/10/2017
PERMIT
Site Address: 29142 CRESTLINE DR, MENIFEE, CA Parcel Number. 339-342-003
92584 Construction Cost: $13.600.00
Existing Use: Proposed Use:
Description of REPIPE ALL HOT &COLD WATER LINES,ALL COPPER LINES,49 OF 1",80'OF 3/4",200'OF 1/2",
Work: REPLACE EXISTING WATER HEATER WITH NEW TANKLESS WATER HEATER
Owner Contractor
JERRY VERA FAMILY PLUMBING HEATING&AIR INC
29142 CRESTLINE DRIVE 34629 FOX BERRY ROAD
MENIFEE, CA 92584 WINCHESTER, CA 92596
Applicant Phone: 9516994488
GREG JACKSON License Number:918182
FAMILY PLUMBING HEATING&AIR INC
34629 FOX BERRY ROAD
WINCHESTER, CA 92596
Fee Description aty. Amount M)
Piping/Repiping Single Family Residential 1 163.00
Residential Water Heater 1 83.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 12.30
$286.30
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.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the 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).
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class C36 License No. I S 2
By my signature below I acknowledge that,except for my personal residence
Expires f t!r 3 Signature_ in which I must have resided for at least one year prior to 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
❑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 workers 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 v www.le inf calaw.html.
this permit is issued. / r`
Policy# ��� Date /
❑I have and will maintain workers compensation insurance,as required by PROPRN OWNER OR AUTHORIZEDAGENT
section 3700 of the Labor Code,far the performance of the work for which ❑By my signature below I certify to each of the following:I am the property
this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf I have read this
number are: �1 application and the information I have provided is correct.I agree to comply
1 Carrier &,, NOV !< r'COCS with all applicable city and county ordinances and state laws relatingto
building construction.I authorize representatives of this city or county to
Policy# C1,7aZ TZV1 Expires // Z 6 enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred _ l Date / �G
dollars($100)or less PROPERTY WNER OR AUTHORIZED AGENT
❑I certify that in the performance of the work for which this permit is issued, r�
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# �3C 2 7j
workers compensation laws of California,and agree that if I should became HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shall forthwi om ly with those provisions. �J Will the applicant or future building occupant handle hazardous material or a
Applicant. Date mixture containinga 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 ❑Yes I(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
IN SECTIODITIONN
TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
N ELN 370fi OF THE LABOR[ODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes 9,vo
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) ❑Yes ❑No
OWNER BUILDER DECLARATIONS I have read 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
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
hazardous m rla porting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oyes J�
Business and Professions Code).Any city or county that requires a permit to -_ Date / lL/f/
construct,alter,improve,demolish or repair any structure,priorto its PROPER OWNER OR AUTHORIZED AGENT
issuance,also requires the applicant forthe permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRPJ
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 mostwork 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 applicantto 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
❑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 Contractors State License Law does not apply to an owner of 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 thatthe improvements are not intended or offered for Certified Finn 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. ❑No EPA Lead-Safe Certified Firm is required for this project because:
❑1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors 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.
CUILDING & SAFETY
I
.,; Menifee
DATE m ki PERMIT/PLAN CHECK NUMBER 1-]' 00051p
TYPE: O COMMERCIAL 4f RESIDENTIAL U MULTI-FAMILY G MOBILE HOME G POOL/SPA O SIGN
SUBTYPE: O ADDITION G ALTERATION O DEMOLITION O ELECTRICAL U MECHANICAL
O NEW O PLUMBING O RE-ROOF-NUMBER OF SQUARES City of Menif e
Dept.
DESCRIPTION OF WORK [41ht SJ
17
r� /ali (r. d Ce/e1
PROJECT ADDRESS Z y/y't C ,eW 4,'kc 1,14 Mee,rrr cF 92✓a-Receiv d
ASSESSOR'S PARCEL NUMBER 33j-?gA.Q • J50-';E-) LOT TRACT
OWNER NAME ;`Z`Z.y V Cy,
ADDRESS 2 f/yt CP67 4bic d4 chcb,'/"re' c'9 92rP
PHONE $/ 50/ 4 J'S'Z EMAIL
APPLICANT NAME C-,?re7 I, ti'asrm
ADDRESS 2 !o Dcf 6; !x, n /t a1 Gr7r.a FC L Y c/'zS�=�
PHONE 740 r601 L 2 1' 3 EMAIL
CONTRACTOR'S NAME OWNER BUILDER? O YES ANO
BUSINESS NAME
ADDRESS 3714G2,f -cl'b,•,,, ,� n � wiHCSrffrt c,' 9Z57C
PHONE %S'/ G7r 7177 EMAIL
CONTRACTOR'S STATE LIC NUMBER ��6�SJZ LICENSE CLASSIFICATION C Z e CA
VALUATION$ 13600 rlv SOFT LSO FT
APPLICANT'S SIGNATURE DATE
1 CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION 11 y CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE pplD AMOUNT
AMOUNT ' GCASH OCHECK# UCREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT ()CASH ()CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER U YES O NO
City of Menifee Building& Safety Depat tment 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.Lis Inspection Request Line 951-246-6213
Permit N
SITE PLAN 1'1'CbSI�
Firm Name Phone H
Last Name First Naine
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Site Address
APN _ _ /.-,� City of Menifee
C�J Building & Safety Dept.
Provide North Arrow REAR PROPERTY LINE JAN 10 2017
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L CITY OF MENIFEE L
I N BUILDING AND SAFETY DEPARTMI NT N
E PLAN APPROVAL E
REVIEWED BY 1
DATE
FRONT PROPERTY LINE
'Approval of these plans shall not be construed to be a permit for,or an
x
t D approval of,any violation of any provisions of the fedeol,state or city
v regulations and ordinances. This set of approved plans must be kept on the
H� jobsite until completion.
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