PMT17-00251 City of Menifee Permit No.: PMT17-00251
29714 HAUN RD.
'ACCEL/> MENIFEE,CA 92586 Type: Residential Plumbing
MENIFEE Date Issued: UV27/2017
PERMIT
Site Address: 28296 PEBBLE BEACH DR, MENIFEE, Parcel Number: 337-183-012
CA 92586 Construction Cost: $1.296.00
Existing Use: Proposed Use:
Description of WATER HEATER REPLACEMENT 40 GAL,SAME LOCATION
Work:
Owner Contractor
APRIL R BENDER AMERICAN INSULATION INC
28296 PEBBLE BEACH DR 8305 MIRALANI DRIVE
MENIFEE,CA 92586 SAN DIEGO,CA 92126
Applicant Phone:8585270100
LIZETTE SOTO License Number: 855615
AMERICAN INSULATION INC
8305 MIRALANI DRIVE
SAN DIEGO, CA 92126
Fee Description Qtv Amount t5)
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_Pennit_Template.rpt Page 1 of 1
CITY OF MENIFEE
ICENSED 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 Iicensure under the Contractors State License Law for
Professions Code and my license is in full force and effe/c't.T� rr GG the following reason:
License Class C 12D License No. '65b �1,D By my signature below I acknowledge that,except for my personal residence
Expires 0 1 Signature 4 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 DECLA N have built as an owner-builder if It has not been constructed in its entirety by
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 wwwleginfo.ca.gov/calaw.html.
this permit is issued. Q )
Pal
# AMwC70 U`()6U Date
PROPERTY OWNER OR AUTHORIZED AGENT
dl have and will maintain workers compensation insurance,as required by
section 3700 of the Labor Cade,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
number are: / application and the information I have provided is correct I agree to comply
Carrier Cy�SPSS A1SV(GY\C� r r-sYY1 YlQ Y1\_/ with all applicable city and county ordinances and state laws relating to
�r building construction.I authorize representatives of this city or county to
Policy# Aut W�.708$6q Expire, VI I J I 1 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
Al
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 LA<BUSINESS LICENSE#
workers compensation laws of California,and agree that if I should become AZARDOUS MATERIAL DECLARATION
subject tp the workers compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comp),wi'h those provisions: Will the applicant or future building occupant handle hazardous material or a
A plicaat Date I' Z7 1 =ure containing a hazardous material equal to or greaterthatthe
amounts sp4i�afied on the Hazardous Materials Information Guide?
ARNIN • ALLURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes y'fl0
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
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)7 See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes d No
1 hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 3000 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 g-No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I 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
hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 ayes ,dN
Business and Professions Code).Any city or county that requires a permit to Date I—o 7-1-1
construct,alter,improve,demolish or repair any structure,prior to its ROPE O ER OR AU ORIZED 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 A 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 and Professions Code)orthat he or she is exempt from Iicensure 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($500). managers who do the paint-disturbing work themselves or through their
in 1,as owner ofthe 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 ofthe 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-BOD-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a o 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. ❑No EPA Lead-Safe Certified Firm is required for this project because:
❑I,as owner ofthe 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.
1
BUILDING ♦ SAFETY PERMIT/PLAN CHECK APPLICATION
...�
%Menifee
DATE - ` I PERMIT/PLAN CHECK NUMBER
TYPE: []COMMERCIAL RESIDENTIAL [-]MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA [-]SIGN
SUBTYPE: [-]ADDITION ❑ALTERATION []DEMOLITION ❑ELECTRICAL ❑MECHANICAL
❑NEW MPL�[UDMBING '❑RE-ROOrF--,NUMBER OF SQUARES ,^-n ..-�
DESCRIPTION OF WORK W G , \Y' r NL cYJ-c (a V ►` 4
PROJECTADDRESS �b (o (PdDUC C�c��(r/, as8to
ASSESSOR'S PARCEL NUMBER 3311- l�`�•� a LOT 1 TRACT L944- )
PROPERTY OWNER'S NAME
ADDRESS .9!o aC � 4.. J�C.. l`-'`QC.�f �• l^ `V `�-^�
PHONE �{ J� EMAIL S
C./ //
APPLICANT NAME f Ze#f Cf0� D
ADDRESS V�
r4 /l a a/✓1 /ll �er i e 9ds0 /
PHONE EMAIL
�519616ZZ-35;20Z
CONTRACTOR'S NAM
E �� C� OWNERBUILDER7 ❑YES❑NO
BUSINESS NAME"�'IWY-,�-e(Can
ADDRESS 4oA ` c_6,j i m
PHONE �g� — c��a--3S�-a EMAIL
p C
CONTRACTOR'S STATE LIC�NyUMMBER O "�L s LICENSE CLASSIFICATION
VALUATION$ SQ FT L SQ FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BU SINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE G PAIDAMOUNT
AMOUNT 6.1 O CASH O CHECK# 0 CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# OCREDIT 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, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-245-6213
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