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PMT17-01084
City of Menifee Permit No.: PMT17-01084 29714 HAUN RD. Type: Residential Plumbing '�A-CCELA? MENIFEE,CA 92586 r.—.9SA.— MENIFEE Date Issued: 0411212017 PERMIT Slte Address: 25587 MOUNTAIN GLEN CIR,MENIFEE, Parcel Number: 335-471-024 CA 92585 Construction Cost: $979.00 Existing Use: Proposed Use: Description of REPLACE WATER HEATER,SAME SIZE LOC,50 GAL IN GARAGE Work: Owner Contractor SAM AVALOS AFFORDABLE WATER HEATERS AND PLUMBING 25587 MOUNTAIN GLEN CIR INC MENIFEE,CA 92585 2835E 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 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 hereby affirm under penalty of perjury that I am under provisions of with a licensed contsactor(s)pursuant to the Contractors SOte License Law). Chapter9(commencing with section 7000)of Division 3 of the Business and o l 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 Clap U44") e No. C9 By my signature below l acknowledge that,except formy personal residence Expires _Signal,, in which I must have resided for at least one year prior to completion of 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 to its entirety by n I hereby affirm under penalty of perjury one ofthe 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 www.leeinfo.a.eov/alaw.html. this permit is issued. Policy# 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 forwhich o By my signature below l certify to each of the following:I am the property this permit is issued.My workers compensation insurance carrier and polity owner or authorized to act on the property owners behalf.I have read this number are: application and the information I have provided is corred.I agree to comply with all applicable city and county ordinances and stale laws relating to Carder , (s- --/J� �/R--s'/1 building construction.I authorize representatives of this city or county to Polity;"6N;(� q'4"t QExpfres_ enter the above identified property for Inspection purposes. (This section need not to be completed is the permit is for one-hundred Date dollars($300)or less PROPERTY OWNER OR AUTHORIZED AGENT o f 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 became subject to the COY BUSINESS LICENSE# workers compensation laws ofCalifarnia,a agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the wo}kers compe ion Isions ofSection 3700 aFthe bar Code,lshal rtbwith camp) epro -' ns. Will the applicant or future building occupant handle hazardous material or Applit .!�/ Date NO '-io ( mixture containing a hazardous material equal to or greater that the amounts specified on the Hazardous Materials Information Guide? WAR G:FAILURETO SECURE WORKER'S COMPENSATION COVERAGE IS O Yes ONO UNLAWFUL,AND SHALLSUBIECTAN 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)?See permitting checklist IN SECTION 3706 OF THE LIBOR CODE,INTEREST,AND ATTORNEYS FEES forguldelines CONSTRUCTION LENDINGAGENCY oyes 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 Cade) DYES 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)indicted 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 Dyes D 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 Contractors 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 contactors Business and Professions Cade)or that he or she is exempt from licensure and the basis for the alleged exemption.Any violation of Section 7031.5 by residence compensationfory to be Rrkthatified firms and ina ply With an Appifant for a permit subjects the applicant to a civil penalty of not more requiredeorchBdares Includes es he RRP-certified owners and property than($500). required practices.This Includes rental property ownersand property managers who do the paint-disturbing work themselves or through their Di,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Progam visit: compensation,will do( )all of or( )portion of the work,and the structure is www.eoa.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 Contractor's State License Law does not apply to an owner of a oAn EPA Lead-Safe Certified Renovator will he 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 Certirreo Firm Is required for this project because: 01,as owner of the property am exclusively contacting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contactors 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. y`F ram€ Sti 3G L s`'v - .* != %V k, ti �✓lenifee DATE PERMIT/PLAN CHECK NUMBERIA I I— O o vi TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA 0 SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW 14PLUMBING 0 RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK mq CJ r PROJECTADDRESS . l>r-o\PSkN ASSESSOR'S PARCEL NUMBER r✓ '7p LOT TRACT PROPERTY OWNER'S NAME �� f�T ADDRESS V'��`b�( �� t-+ — & PHONE EMAIL ((�' A APPLICANT NAME 'C� ADDRESS r MC lynn PHONE �`'�-_�l�yI��-y� EMAIL CONTRACTOR'S NAME '' OWNER BUILDER? O YES C NO BUSINESS NAME `k !� � ADDRESS jC V� 6 MACA 0\ PHONE �j�rj','S�5 ��n _ EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION VALUATION $ / SQ FT L SO FT APPLICANT'S SIGNATURE DATE Iff DEPARTMENT DISTRIBUTION M CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN V" SMIP AMOUN)ICT795 `�.I� PAID AMOUNT n CASH O CHECK# O CREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# 0 CREDIT CARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO City of lt,1enifee Building&Safety Department 29714 Noun Rd. Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-5213 n y m ff mO ;u I m n m a ,N, O p r JD- Y DA F D N -�^ h (0)m n 3D O T Ab n CL II m O m < mx IL J o ao m A m m •3° w m u d. n = K m N n 3 �I ` .� J J � d !! m w � y � '> T m' J d -c d o '� 0 D yC N w o s 3 3 3 0. m Z 0 m O N N m J Z co •� �. 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