PMT17-01460 City of Menifee Permit No.: PMT17-01460
29714 HAUN RD.
�!-�CCEL/-> MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE Date Issued: 05/08/2017
PERMIT
Site Address: 29851 MOONDANCE WAY, MENIFEE, CA Parcel Number: 338-111-006
92586 Construction Cost: $4,500.00
Existing Use: Proposed Use:
Description of REROUTING ALL PLUMBING LINES(HOT/COLD)OUT OF EXISTING SLAB REROUTING ABOVE
Work: SLAB
Owner Contractor
RAYMOND BILYEU ACCURATE LEAK LOCATORS INC
29851 MOONDANCE WAY 26025 NEWPORT ROAD#A 413
MENIFEE, CA 92586 MENIFEE, CA 92584
Applicant Phone: 8883335325
TONY FALCO License Number:850152
ACCURATE LEAK LOCATORS INC
26025 NEWPORT ROAD#A 413
MENIFEE, CA 92584
Fee Description O_yt Amount W
PipinglRepiping Single Family Residential 1 163.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maigtenance 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 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_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 perjury that I am under provisions of with a licensed contractors)pursuant to the Contractors State License Law),
Chapter!)(commencing with section 7000)of Division 3 of the Business and a I am exempt from licensure under the Contractor's State License Law for
Professions Cade and my license is in full force and effect. the following reason:
License Class_CZ(' License No. ��SL) �Sa By my signature below l 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 I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed In its entirety by
o 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 Cade,is available upon request when
compensation,Issued by the Director of Industrial Relations as provided for this application is submitted or at the following webshe:
by Section 3700 of the Labor Code,for the performance of work for which
this permit is issued. www.leeinfo.ca.eav/calaw.htmL
Policy# s/'=-a Date
D I have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Cade,for the performance of the work for which a By my signature below I certify to each of the following:I am the property
this permit is issued.My workers wmpensation insurance carrier and policy owner or authorized to act on the property owners behalf.)have read this
number are:: application and the information 1 have provided is correct.1 agree to comply
Carrier_ phC1 i�r "'t; with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy#L D'-zt vekr/ Expires /.2 Z30117 enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is far ane-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZEDA ENT
o I certify that in the performance of the work for which this permit is issued, 'n�
I shall notemolov any persons in any manner so as to became subject to the CITY BUSINESS LICENSE I$ v�
workers compensation laws of California,and agree that if]should became HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Cade,I shall forthwith comply tb.tt ose provisions. Will the applicant or future building occupant handle hazardous material or
Applicant /mil Date mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAI T CURE WORKER'S COMPENSATION COVERAGE IS o Yes a No
UNLAWFUL,AND PIAL SUIUECT AN EMPLOYER TO CRIMINAL PENALTIES Will the in/tended 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(SCtionor odi permitting from
checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES fo Coast
Airllnes
Qua
CONSTRUCTION LENDING AGENCY ❑Yes jo'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) a Yes /G No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
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 Cade,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable Item(s)(Section 7031.5 hazardous material reporting. __.._.._.
Business and Professions Code).Any city or county that requires a permit to DYes -crNo
Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY - NE R 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 IRRP)
License Law(Chapter 9(commencing with Section 70001 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-1979
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
a 1,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( I portion of the work,and the structure is www.eoa.RovAead 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
property who,through employees'or personal effort,builds or improves the D An EPA Lead-Safe Certified Renovator will be responsible for this project
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:
a 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 RRP rule please fill out the RRP
Acknowledgement
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
® Menifee
DATE J — PERMIT/PLAN CHECK NUMBER I-7; ,(P
TYPE: O COMMERCIAL ibrRESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEEWnW ANPPLUMBING 0 RE-ROOF-NUMBER/OF SQUARES—
DESCRIPTION DESCRIPTION OF WORK llCe PCIah /Lt b•• P.S /T COf
s
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER ��/ �� LOT jy' TRACT r
OWNER NAME
ADDRESS i.LJ
PHONE Cj.S'/ (p� �tT 1,5 EMAIL
APPLICANT NAME J ['
ADDRESS S geloj
PHONE EMAIL
CONTRACTOR'S NAME pq OWnNER BUILDER? O YES 0 NO
BUSINESS NAME k Z0 _ /
ADDRESS (,U 027-- j "4
PHONE 3 33 s3as EMAIL //(� - c, p , 6nA
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ fZse0, oD SQFT LSQFT /Oa L - Ai E
APPLICANT'S SIGNATURE DATE - 7
CITY STAFF USE ONLY 40
DEPARTMENT DISTRIBUTION ow
CITY OF ME�NIIFF'E�E BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN I SMIP
INVOICE Af/�j PAIDAMOUNT
AMOUNT { 1-1 1 1 1 OCASH OCHECKN 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK k O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building& Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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