PMT17-01438 City of Menifee Permit No.: PMT17-01438
29714 HAUN RD.
�10.CCEL/? MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE Date Issued: 06/06/2017
PERMIT
Site Address: 26843 CHERRY HILLS BLVD, MENIFEE, Parcel Number: 337-341-018
CA 92586 Construction Cost: $16,775.12
Existing Use: Proposed Use:
Description of INSTALL 1 10'OF PERMA LINER IN 4"SEWER MAIN, INSTALL TWO 3"TWO WAY CLEAN OUTS
Work:
Owner Contractor
HAYDI JONES PEACH HOME SERVICES INC
26843 CHERRY HILLS BLVD 532 MALLOY COURT
MENIFEE,CA 92586 CORONA,CA 92880
Applicant Phone:7144628174
JANE RECKTENWALD License Number: 1018348
PEACH HOME SERVICES INC
532 MALLOY COURT
CORONA,CA 92880
Fee Description 01t rr Amount(S)
Piping/Repiping Single Family Residential 1 163.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 8.15
$199.15
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__Pernit_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 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 Contractors State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class C-QD rs(o License No.
By my signature below 1 acknowledge that,except for my personal residence
Expires Signatures 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
❑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 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 www.leginfo.ca.gov/calaw.litmi.permit is issued.
Policy# Date
eb 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 workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this
number are: 1 application and the information I have provided is correct.I agree to comply
1L)ES-F with all applicable city and county ordinances and state laws relating to
Carrier�lY%mo_a-1- M(G1
building construction.I authorize representatives of this city or county to
Policy#0�C471sm 450-Rq Expires ka enter the above identified pr. W for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date S ��
dollars($100)or less PROPERTY OWNER OR ED AGENT
ci I 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 become subjectto the CITY BUSINESS LICENSE It
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subjectto the workers compensay'eti tovisions of Section 3700 of the Labor
Code,I shall forthwith comply ifh t se prov' ions. WIII the applicant or future building occupant handle hazardous material or
mixture containing a hazardous material equal to or greater that the
Applicant Date57-5-0 amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes N0
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the ln/tended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)75ee permitting checklist
for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes ',;�No
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) ❑Yes `KNo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
1 hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item hazardous material reporting.$)(Section 7031:5 oyes �fJJo
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 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($500). managers who do the paint-disturbing work themselves or through their
❑I,as owner of the property,or my employee with wages as their sole 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.aov/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 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:
o 1,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 rule please fill out the RRP
Acknowledgement.
DATE -4-17 PERMIT/PLAN CHECK NUMBER FRI 1 D I
TYPE: COMMERCIAL V'RESIDENTIAL I, MULTI-FAMILY MOBILE HOME ' POOL/SPA SIGN
SUBTYPE: --- ADDITION ',ALTERATION :DEMOLITION - ELECTRICAL ✓MECHANICAL
NEW OPLUMBING RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK tall 110' of perma liner in 4" sewer main. Install two 3"
two way clean outs
PROJECTADDRESS 26843 Cherry Hill Blvd Sun City, CA 92586
ASSESSOR'S PARCEL NUMBER _�Z34J-018 LOT Lf Sl TRACT ��
OWNER NAME Haydi Jones
ADDRESS 26843 Cherry Hill Blvd Sun City, CA 92586
PHONE 951-218-1478 EMAIL
APPLICANT NAME ne Recktenwald
ADDRESS
PHONE 714-336-6159 EMAIL _janereck(@att.net i
CONTRACTOR'S NAME alto- 's Heating & Air OWNER BUILDER? :YES ENO
BUSINESS NAME
ADDRESSCorona, CA 92880
PHONE 951-737-4141 EMAIL
CONTRACTOR'S STATE LIC NUMBER 1018348 LICENSE CLASSIFICATION C20 C36
VALUATIONS 16,775.12 SO FT L SQ FT
I APPLICANT'S SIGNATURE DATE 5-4-17
DEPART%1EN'. DISTR;BUTIDN 0 CFY OF MENIFEE BUSV.35 LICENSE NUNIBEP
BUILDING PLANNING ENGINEERING FIRE GREEN j� SNIP
INVOICE PAID AMOUNT
AMOUNT CASH �CHECKY CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT CASH CHECK# CREDITCARD VISA/MC
OWNER BUILDER VERIFIED YES NO DL NUMBER NOTARIZED LETTER YES C NO
city of Menifee
Building & Safety Dept.
MAY 0 5 2017
CITY OF MENIFEE
BUILDING AND SAFETY DEPARTMENT
PLAN APPROVAL
REVIEWED B (--�O �1
. 5
DATE
'Approval of these plans shall not be construed to be a permit for,or an
approval of,any violation of any provisions of the federal, or city �-7
regulations and ordinances. This set of approved plans must b kept on
t
jobsite until completion.
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