PMT17-00125 City of Menifee Permit No.: PMT17-00125
29714 HAUN RD. Type: Residential Plumbing
�1-�CCEL/-> MENIFEE,CA 92586
MENIFEE Date Issued: 0111 912 01 7
PERMIT
Site Address: 30098 PEBBLE BEACH DR, MENIFEE, Parcel Number: 336-144-013
CA 92586 Construction Cost: $1,689.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING 40 GAL WATER HEATER IN GARAGE
Work:
Owner Contractor
ROBERT PAGE AFFORDABLE WATER HEATERS AND PLUMBING
30098 PEBBLE BEACH DRIVE 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 Qlf 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
$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 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).
1 hereby affirm under penalty of perjury that I am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and in 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 Cla s se No. By my signature below I acknowledge that,except for my personal residence
Expires[ S(gnatur in which lmust have resided fora[least one year prior to completion of
�� cl_� 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
❑1 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 y,,,irw,leeinfo.ca.eav/calaw.html.
this permit is issued.
Policy# Date
ise
I have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
Rion 3700 of the Labor Code,for 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
numberare: 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
f�"'�.�.�t�!' {/y�-t�/� building construction.l authorize representatives of this city or county to
Pol icy#%N( tN'';DST�'4—I Y-i'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 employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
workers compensation laws of California,a rd agree that if I should become HAZARDOUS MATERIAL DECLARATION
subj?shal
wvo kerscompenn !on isions of5ection 3700 of the Lppbor
A With comp ifh epro ns. 1 Will the applicant or future building occupant handle hazardous material ora
!a' hate �� /( mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
LURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes D 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($100,11DD),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 3705 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguldelines
CONSTRUCTION LENDING AGENCY o Yes o No
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) in Yes o No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that l am exempt from the permitting checklist.I understand my requirements under the State of
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material reporting.
Business and Professions Code).Any city or county that requires a permit toconstruc oyes oNo
Date
issuance,also alter,improve, applicantsh for hepermiany t to file,prior toto 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(RAP)
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-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($SOO). _ managers who do the paint-disturbing work themselves or through their
D I,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/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 D 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. o No EPA Lead-Safe Certified Firm is required for this project because:
o I,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 role please fill out the RRP
Acknowledgement.
!� ..
Menifee
DATE ` �� PERMIT/PLAN CHECK NUMBER — S
TYPE: r' COMMERCIAL RESIDENTIAL C MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
ONEW PLUMBIN
G
O{{RE-R`OtOF-NUMMBEROF SQUARES
DESCRIPTION OF WORK
PROJECTADDRESS DtMlC p '
_ ASSESSOR'S PARCEL NUMBER — 1 y — LJ5 LOT TRACT
PROPERTY OWNER'S NAME MUM�7��- !nn 1 CA4 °,Sa4ekY UePt.
ADDRESS ram. 1� 1S 6 AUi \ IL DUI` ` 16
PHONE ��,T�� l��(A EEMMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILDER? O YES ONO
BUSINESS NAMECK
!' Lt �!
ADDRESS �11+'''0I/� Yr �/� /�. ��
PHONE ��-j'1j�� —govlq EMAIL S C/ V� {' , Cz
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION $ SOFT 12 L SQ FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT O CASH O CHECK H O CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Noun Rd. Menifee, C,4,92586 951-6 72-6 777
W'NY✓.CitVp f,,-rertifee.us Insoection Request Line 951-246-521
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