PMT17-03138 City of Menifee Permit No.: PMT17-03138
29714 HAUN RD.
";kCCELA— MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE Date Issued: 0 910 6/2 01 7
PERMIT
Site Address: 29073 PROMINENCE RD, MENIFEE, CA Parcel Number: 340-561-013
92584 Construction Cost: $1,300.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING 50 GAL WATER HEATER IN GARAGE
Work:
Owner Contractor
DENISE PONDS AFFORDABLE WATER HEATERS AND PLUMBING
29073 PROMINENCE ROAD INC
MENIFEE, CA 92584 28358 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 fEl
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
$116.16
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 forthe projects
I hereby affirm under penalty of perjurythat 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 o 1 am exempt from llcensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Clas Ise No. +�., By my signature below l acknowledge that,except for my personal residence
Expires Signatur In which l must have resided for at least one year priorto completion of
improvements covered by p cannot this permit.I legally sell a structure that I
WORKER'S COMPENSATION DECLARATION
have built as anowner-builder if it has not been constructed in its entirety by
o I hereby affirm under penalty of perjury one ofthe following declarations:I licensed contractors.I understand that a copy ofthe applicable law,Section
haveand will maintain a certificate of consent ofseif-Insure for workers 7044 ofthe Busmessand Professions Code,is availableupon requestwhen
compensation,issued bythe Director of Industrial Relations as provided for this application is submitted or at the following website:
by Section 3700 ofthe Labor Code,for the performance of work for which ,,w,�v_leeinfo.ca.¢ov/calaw.html.
this permit is issued.
.P/olicy Q Date
i`tt 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 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 policy owner or authorized to act on the property owners behalf.I have read this
numberare: application and the information I have provided is correct.I agree to comply
Carrier _�� with all applicable city and county ordinances and state laws relating to
i�"1�_r.�r�1' `/R-t��t buildingconstruction.I authorize representatives of this city crcountyto
Policy II ANCINI7�-� (A 1 0Expires 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
o I certify that in the performance of the work for which this permit is issued,
Ishallnotemoloy any persons in any manner so as to become subject to the CITY BUSINESS LICENSE If
workers compensation laws ofCallforrimyrd agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the L
mpen ation�apronf�.
5ection 3700 oftheL bor
Code,I shal p h Will the applicant or future building occupant handle hazardous material or a
A lic Date '7-� mixture containing a hazardous material equal to or greater that the
pp amounts specified on the Hazardous Materials Information Guide?
WAR G:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS D Yes O No
UNLAWFUL,AND SHALL SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES Will the intended use ofthe building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require 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 37060E THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY Dyes 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 ofthe
lending agency for the performance ofthe work which this permit is issued outer boundary ofa school?
(Section 3097 Civil Code) ❑Yes ❑No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjurythat 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
hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Oyes o 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 ofthe Contractors State EPA RENOVATION,REPAIR AND PAINTING fRRPJ
License Law(Chapter9(commencing with Section 7000)of Division 3 ofthe The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)orthat 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 he 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
o 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 ofthe 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 Contractors State License Law does notapply to an owner ofa ❑An EPA Lead-Safe Certified Renovatorwill he responsible forthis 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 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 RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN APPLICATION
q.11 �Menifee
DATE O� I PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW PLUMBINGG {{O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK PZC, C/
/ Yl )� U VV
i nn
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER �140-q q -0\?j LOT Oity OTIi+g Rifee
F',idltling & Safety eP
PROPERTY OWNER'S NAME � � �
ADDRESS
PHONE ` �'1'`-� ` V ,'�j��� EMAIL _
.,r u
APPLICANT NAME
i n
ADDRESS M C ,t� l y
PHONE &(]S-'b(k�-04LA45 EMAIL
CONTRACTOR'S NAME OWNER BUILDER? O YES ONO
BUSINESS NAME `k �C/
ADDRESS �6��V//y X� oI\
PHONErj'`�L�S QW��y EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
01
VALUATION$ ' SQ FT L SQ FT/�
APPLICANT'S SIGNATURE DATE 1
CITYSTAFFUSECINLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT O CASH O CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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