PMT17-01729 City of Menifee Permit No.: PMT17-01729
29714 HAUN RD. Type: Residential Plumbing
<ACCEI- ? MENIFEE,CA 92586
`""'"-"""'""" MENIFEE Date Issued: 06/0112017
PERMIT
Site Address: 26837 CHERRY HILLS BLVD, MENIFEE, Parcel Number: 337-341-017
CA 92586 Construction Cost: $8,387.56
Existing Use: Proposed Use:
Description of INSTALL(1)3"TWO WAY CLEAN OUT
Work: REFERENCE PMT17-01438
Owner Contractor
BRYAN HOFFMAN PEACH HOME SERVICES INC
26837 CHERRY HILLS BLVD 532 MALLOY COURT
MENIFEE,CA 92586 CORONA,CA 92880
Applicant Phone:7144628174
JANE RECKTENWALD License Number: 1018348
PEACH HOME SERVICES INC
532 MALLOY COURT
CORONA,CA 92880
Fee Description Oft Amount($)
Building Permit Issuance 1 27.00
$27.00
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 pitied 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 Templale.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).
Chapter!)(commencing with section 7000)of Division 3 of the Business and a I am exempt from licensure under the Contractoes State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class C90 r3(0 License No. %01 Sb44 S By my signature below I acknowledge that,except for my personal residence
Expires e1-ZO'L`6 Signature Cam? in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.1 cannot legally sell a structure that I
have built as an owner-builder if it has not been constructed in its entirety by
a I hereby affirm under penalty of perjury one of the following declarations:) 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
this permit is issued. www.leeinfo.ca.eov/calmv.hhnl.
Policy 4 Date
as 1 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 a 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 owner's behalf.I have read this
numberarre: application and the Information I have provided is correct.I agree to comply
with all applicable city and ordinances and state laws relating to
Carrier .AYnnn 0.,�- M1dw�-7
building construction.I authorize representatives of this city or county to
Policy If Expires ka-1-11 enter the above identifiedpr eHjyfor inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less
PROPERTY OWNER OR Akt ED AGENT
D 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 N
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensa rovisions of Section 3700 of the Labor
Code,I shall forthwith comply hI use provisions. Will the applicant or future building occupant handle hazardous material or
Applicant Date5'5_0 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 'q�.40
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
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)?See permitting checklist
for guildeelines
CONSTRUCTION LENDING AGENCY oyes IfNo
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) o Yes YNO
OWNER BUILDER DECLARA71ONS 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 25SOS and 25534 concerning
hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5
Business and Professions Code).Any city or county that requires a permit to oyes �f4o
construct,after,improve,demolish or repair any structure,prior to its Date
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 IRRPI
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-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
al,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.eoa.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 Stale License Law dues not apply to an owner of a DAn 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. a No EPA Lead-Safe Certified Firm Is required for this project because:
o 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 RRP
Acknowledgement.
DATE PERMIT/PLAN CHECK NUMBER
I
j TYPE: - COMMERCIAL ✓RESIDENTIAL MULTI-FAMILY MOBILE HOME POOL/SPA SIGN i
SUBTYPE: ADDITION ALTERATION DEMOLITION ELECTRICAL ✓MECHANICAL i
NEW PLUMBING RE-ROOF-NUMBEROFSO.UARES
DESCRIPTION OFWORK Install 110' ofperma liner in 4" sewer main. Install two 3"
two way clean outs
PROJECT ADDRESS berry Hill Blvd Sun City�,//C�A�92586
ASSESSOR'S PARCEL NUMBER � _ LOT _E (,� TRACT
OWNERNAME -_T__.—..3..L" _
1 ADDRESS �CherryHill Blvd. Sun glty,_CA 92586
PHONE _ _ _ .— - .. _ EMAIL
APPLICANT NAMEp,���ktp�]_We�I
ADDRESS ._....._. _.... . . _.._ —._�
PHONE 714-336-6159--- --.-- EN'AIL _jaDeLeclstfS._..—__ .
_&CONTRACTQR'S NAME ' ltQ n'� Et�t, _. AIr A OWNER BDER? _ YES t/NO
i �UIL�...� �.._
BUSINESS NAN:e _
ADDRESS _5,V MauQ �r (tQjC?na, GA 92880
PHONE EMAIL _.._...___._.. i
f CONTRACTOR'S STA-1-E UC NUMBER 1 Q1 �8 _ LICENSE CLASSIFICATION CZQ,936
i
VAWATION S 16.775.12 SO FT % L SO FT
APPLICANT'S SIGNATURE DATE ',
1
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{ OWN9.&U4DER VERIFIED Y£5 NO OLNUMBER NQTA&ZEO;E TER Y.S NO
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PLAIN! APROVAL
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'Approval of thy:plans shall not 5e�nsNaad ip b°.@ �r k€3;pr ar, @I1
approval Of,an,viola as of any provisions of the Werdi, :r City
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