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PMT17-01006 City of Menifee Permit No.: PMT17-01006 29714 HAUN RD. Type: Residential Plumbing '5ACCELA? MENIFEE,CA 92586 MENIFEE Date Issued: 04/O5/2017 PERMIT Site Address: 28270 E WORCESTER RD,MENIFEE, CA Parcel Number: 337-090-035 92586 Construction Cost: $1,650.00 Existing Use: Proposed Use: Description of NEW 30 L FT GAS LINE TO KITCHEN THRU ATTIC Work: Owner Contractor MARY CHANCELLOR 24-HOUR EXPRESS SERVICES INC 28270 E WORCESTER RD 26047 JEFFERSON AVE STE D MENIFEE, CA 92586 MURRIETA, CA 92562 Applicant Phone: 9513025320 ROBERT COPELAND License Number:761778 24-HOUR EXPRESS SERVICES INC 26047 JEFFERSON AVE STE D MURRIETA, CA 92562 Fee Description Qtv Amount(El Plumbing Fixtures and Vents,fixtures 1 116.00 Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 General Plan Maintenance Fee-Plumbing 1 5.80 $149.80 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 carded 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_aldg_Pennil_Template.rpt Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION property who builds or improves thereon,and who contracts forthe 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 Contractor's State License Law for Professions Code and my license is in full force and effect. C� the following reason: License Class C- LO License No. (7 7 By my signature below I acknowledge that,except for my personal residence Expires 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 1 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 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,forthe performance of work forwhich ,Ns,s,,lezinfo.ca.¢ov/calaw.btml. this permit is issued. Policy# L,_�(21-U I� Sy I0q 3 Date ❑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 ❑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 Cartier 9 v"'PIn..PST sn SrlRo r-r L-P with all applicable city and county ordinances and state laws relating to l building construction.I authorize representatives of this city or county to Policy# 1M C'V�CV LCM' Expires 1-1—t 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 ❑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,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the worker's compensation provision of Section 3700 of the Labor Code,I shall forthwit co pl wit ose provi ons. Will the applicant or future building occupant handle hazardous material or a Applicant _ Date &7 q:5-4 7 mixture containing a hazardous material equal to or greater that the amounts s ecified on the Hazardous Materials Information Guide? 9 WARNING:FAILURE TO URE WORKER'S COMPENSATION COVERAGE IS ❑Yes 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 uidelines CONSTRUCTION LENDING AGENCY es o No I hereby affirm that underthe penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the lending agency forthe performance of the work which this permit is issued outer boundary of a school? (Section 3097 Civil Code) o Yes 1 Wp 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 reasons)indicated below by the California Health al Safety Code,Section 25505 and 25534 concerning h zardous material reporting. checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 s N ''JJ /' Business and Professions Code).Any city or county that requires a permit to Date rt�>—� construct,alter,improve,demolish or repair any structure,prior to its PROPERTY O ER OR THORIZEO 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 a pre-1978 and the basis forthe alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certlfiied 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 ❑I,as owner of the property,or my employee with wages as theirsole 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 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 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 ARP rule please fill out the RRP Acknowledgement. APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK Menifee DATE PERMIT/PLAN CHECK NUMBER pOIQ TYPE: COMMERCIAL XRESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA C SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL CNEW rPLUMBING ORE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK .e �� (.�g✓� PROJECTADDRESS g 70 e,4 1, Wo2ee �e �✓ �2Sb ASSESSOR'S PARCEL NUMBER 3� - 01c��35 LOT TRACT S OWNER NAME MaR e. ADDRESS ga v . PHONE CTS1) 7a7- IIIt EMAIL APPLICANT NAME gvkpeF ea vvice r ADDRESS ��p J2. 2So 74 ✓0✓R21,e CA PHONE EMAIL rI CONTRACTOR'S NAME j kj k4 eK vic, S OWNER BUILDER? O YES O<NO BUSINESS NAME ADDRESS _9u 07,�Ove_ PHONE (Z?5)) 20.E EMAIL CONTRACTOR'S STATE LIC NUMBER 7 6I 7 7 K LICENSE CLASSIFICATION G-36 VALUATION$ 16 50,E a` SQ FT L SO FT /� APPLICANT'S SIGNATURE V� DATE -7 DEPARTMENT DISTRIBUTION CITY OF MENIFLE BUS E NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP TVl(Lj�(Y� INVOICE r� PAID AMOUNT `� AMOUNT O CASH OCHECK# CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT OCASH OCHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO City of Menifee Building& Safety Deportment 29714 Houn Rd. Menifee, CA 92580'951-572-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 y ^/ �O 1 0 3 » z ƒk < / _ \ - > Er � 0 I � # _ 2 # � }2 Z� � * R �\ 151 G ,4 g '4 4 CD «! a \\ ƒ\ $ � . \ OCD ? � � 7 � a £ S) MM M O N S^ oI� �