PMT17-00122 City of Menifee Permit No.: PMT17-00122
29714 HAUN RD.
�CCELA> MENIFEE,CA 92586 Type: Residential Plumbing
MENIFEE Date Issued: 01/19/2017
PERMIT
Site Address: 30956 LAJOE ST, MENIFEE, CA 92584 Parcel Number: 360-463-031
Construction Cost: $1,479.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING 50 GAL WATER HEATER IN GARAGE
Work:
Owner Contractor
ELLEN GOV AFFORDABLE WATER HEATERS AND PLUMBING
30956 LAJOE STREET INC
MENIFEE,CA 92584 28358 CONSTELLATION ROAD#698
Applicant Phone: B553459087
DANIEL MATA License Number:627368
AFFORDABLE WATER HEATERS AND PLUMBING INC
28358 CONSTELLATION ROAD#698
VALENCIA,CA 91355
Fee Description QtV Amount IS1
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_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
With a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and O 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 C-lla*�__s --&I",�� 4 e No. By my signature below 1 acknowledge that,except for my personal residence
Expires�r�r _Signatur 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
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:) licensed contractors.)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 fallowing website:
by Section 3700 of the Labor Code,for the performance of work for which www.leRInfio.ca.Rov/caIaw.htmL permit is issued.
policy If Date
i`fr I have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
/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 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
numberare: fr application and the information 1 have provided is correct.I agree to comply
Carrier ,-0 Y with all applicable city and county ordinances and state laws relating to
A"1��r.r1 mil, {/y-��/� building construction.l authorize representatives of this city or county to
Policy q N�1N1;p- q'Q Y-�'JExpires 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 emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE If
workers compensation laws of California,yd agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the wo}'kers compen aanton isions of Section 3700 of the L bor
Code,I shal with coI K e pro .. ns. Will the applicant orfuture building occupant handle hazardous material Ora
Date '7-� ( mixture containing a hazardous material equal to or greater that the
Appir l, amounts specified on the Hazardous Materials Information Guide?
ell
WAR G:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes ❑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($100,0DO),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 Distdct(SCAQMD)7 See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ayes ONO
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 ❑NO
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the 5fAQMD
permitting checklist.)understand my requirements under the State of
hereby affirm under penalty of perjury that lam exempt from the
California
Contractor hazardous s License Law for the reason(s)indicated below by the Health al Safety Code,Section 25505 and 25534 concerning
rdo
hus material reporting.
checkmark(s)I have placed next to the applicable Item(s)(Section 7031.5 OYes O No
Business and Professions Code).Any city or countythat requires a permitto Date
construct alter,Improve,demolish or repair any structure,priorto 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 Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRP)
License Law(Chapter9(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 703LS 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
O I,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.ena.eov/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 oAn 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. o No EPA Lead-Safe Certified Firm is required for this project bemuse:
O 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.
APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK
w -
M e n i f e e
DATE ` 1 PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY C' MOBILE HOME C POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION C DEMOLITION O ELECTRICAL O MECHANICAL
ONEW )(PLUMBING
�� {0RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
PROJECT ADDRESS
ASSESSOR'S PARCEL NUMBER 3�p[JY•� -�' 1 LOT TRACT
1
PROPERTY OWNER'S NAME VLC/
/ - City of Menifee
ADDRESS �W iA Safety Dept.
PHONE CVC�` - 1� EE/M�AIL
APPLICANT NAME �J�/"\ Received
ADDRESS 1L
PHONE ��-.'SI�S���� EMAIL
CONTRACTOR'S NAME OWNER BUILDER? O YES O NO
BUSINESS NAME !� �j JNEg(jo�S
ADDRESS �Ci V 6 o
PHONE �r-JLAs -Q\aN ^� EMAIL 9&/ VJ f' . C�
CONTRACTOR'S STATE LIC NUMBER wjnjb-D LICENSE CLASSIFICATION
VALUATION$ / SO FT 42 , z L SO FT
APPLICANT'S SIGNATURE4=1eZZ1_ze_.z'z'zzeLDATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT OCASH OCHECK# 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH 0CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building & Safety Department 29714 Houn Rd. A4enifee, CA 92585 951-672-6777
www.cityof,,nenifee.us Inspection Request Line 951-246-6213
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