PMT17-00719 City of Menifee Permit No.: PMT17-00719
29714 HAUN RD.
�ACCELA? MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE Date Issued: 03/09/2017
PERMIT
Site Address: 31690 BRENTWORTH ST, MENIFEE, CA Parcel Number: 372-440-003
92584 Construction Cost: $3,700.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING WATER HEATER,WITH TANKLESS WATER HEATER
Work:
Owner Contractor
JEFF SMITH LENOX CUSTOM PLUMBING INC
31690 BRENTWORTH STREET 1654 ILLINOIS AVENUE UNIT#16
MENIFEE, CA 92584 PERRIS, CA 92571
Applicant Phone: 9512323153
CHRIS ALLEN License Number. 880544
LENOX CUSTOM PLUMBING INC
1654 ILLINOIS AVENUE UNIT#16
PERRIS, CA 92571
Fee Description QtV Amount ISI
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
I hereby affirm under penalty of perjurythat 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 ❑1 am exempt from licensure under the Contractor's State License Law for
Professions Code and en
my
license is in full force and effect.i the fallowing reason:
License Class 1°'f CAr License No. c' 054�
By my signature below I acknowledge that,except for my personal residence
Expires I2 3( ( Signature n6;?2 — 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
A,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 website:
by Section 3700 of the Labor Code,for the performance of work for which ,z„,vw vvv.IeRinfo.ca.Rov/caIaw.html.permit is issued.
Policy# Date
have and will maintain worker's 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 worker's compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
number are: 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
building construction.I authorize representatives of this city or county to
Policy q =490 y 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 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 q
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,lshall forthw' y those provisions. / Will the applicant or future building occupant handle hazardous material or
Applicant Date '3 gL`7 mixture containing a 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 o Yes o 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 SECTIONON
3 06 OF T T LABOR CODE,INTERTION,DAMAGESDATTORNEYS
PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 370fi OF THE LABOR[ODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY ❑Yes ❑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) ❑Yes ❑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
Contractor's 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 oyes ❑No
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 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 Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRP)
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 apre-7978
and the basis for the alleged exemption.Any violation of Section 7D31.5 by residence or childcare facility to he 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 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 Contractor's 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 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
completion,the Owner-Builder will have the burden of proving that it was Firm Certification No.:
not built or Improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
❑I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's 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 ARP
Acknowledgement.
BUILDING & T/PLAN CHECK APPLICATION
SAFETY PERMI
`Menifee
DATE 3 !17 PERMIT/PLAN CHECK NUMBER PW Il-
TYPE: O COMMERCIAL 64ESIDENTIAL O MULTI-FAMILY 0 MOBILE HOME O POOL/SPA 0 SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
ONEW (YfLUMBING ORE-ROOF-NUMBER OF SQUARES
ty of Menifee
DESCRIPTION OF WORK � �rf Building & Safety Dept.
MAR
PROJECTADDRESS 3/&f0 125by
ASSESSOR'S PARCEL NUMBER 'j uu LOT TRACT Received
�- (Zt�3
OWNER NAME jerrrH l'i1
ADDRESS 3 lip?D
PHONE 267546Ag5- EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME j A) OWNER BUILDER? O YES t"10
BUSINESS NAME p 4
ADDRESS (&Sri( IwAwlr 4w. fr-tx -'4 2Linj
PHONES 3Y9�y/p5D EMAIL 1G
CONTRACTOR'S STATE LIC NUMBER 8&54Cy LICENSE CLASSIFICATION
VALUATION$ 37W' SQ FT L SQ FT
APPLICANT'S SIGNATURE DATE k2la
I
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN ' SMIP x
INVOICE /� PAID AMOUNT O
AMOUNT `5. 15• OCASH IJ L.HEL.Kp CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT 0CASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Ib'lenijee 9uildina '� Safety Department 29714 Houn Rct. Menifee, CA 92586 951-672-0'777
,vww.cic:vofrnenifee.Iis Inspection Request Line 951-246-6z13
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