PMT17-03538 City of Menifee Permit No.: PMT17-03538
29714 HAUN RD. Type: Residential Plumbing
�ACCEL/? MENIFEE,CA 92586
MENIFEE Date Issued: 1 010 4/2 01 7
PERMIT
Site Address: 29172 PERIDOT CIR, MENIFEE, CA Parcel Number: 340-181-041
92584 Construction Cost: $1,500.00
Existing Use: Proposed Use:
Description of REPLACE WATER SAME SIZE LOCATION 50 GAL, IN GARAGE
Work:
Owner Contractor
AHMAD ROYAN AFFORDABLE WATER HEATERS AND PLUMBING
29172 PERIDOT CIR 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 OQt Amount tE1
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
with a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjurythat 1 am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure underthe Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Cla s � � Signatur se No. By my signature below I acknowledge that,except for my personal residence
Expires / in which l must have resided for at least one year prior to completion of
Z4� 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 l 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.Iesdnfo.ca.gcsy/caIaw.btmI.
this permit is issued.
--"/"'c'q Date
`hl Is eancliv maintain workers compensation insurante,as required by PROPERTY OWNER OR AUTHORIZED AGENT
/section 3700 of the Labor Code,for the performance of the work far which ❑By my signature below I certify to each of the following:?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: rr r� application and the information 1 have provided is correct.I agree to comply
Carrier���.�_ YK� 1NP with all applicable city and county ordinances and state laws relating to
f�, �1' {/y-t building construction.I authorize representatives of this city or county to
Policy#V47Yt�f1q I OExpires 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,
I shall not emnlov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE fl
workers compensation laws of California,rd agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the wo kers compe ion DrAisions of Section 3700 of the L bor
Code,I shal with comEh a pro ' ' ns. 1 r Will the applicant or future building occupant handle hazardous material or a
`T� mixture containing a hazardous material equal to or greater that the
Appli Date �'�
amounts vsPecified on the Hazardous Materials Information Guide?
WAR G:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS o Yes I No
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 Coast Air Quality Management District(SCAQMD)7 See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY o Yes ANO
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 bonjtdary of a school?
(Section 3097 Civil Code) ❑Yes No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Inform on Guide and the SCAQMD
permitting checki t.lunderstand my rrementz under the State of
I hereby affirm under penalty of perjury that I am exempt from the California Health✓ afety Code,S t 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the ! /
checkmark(s)I have placed next to the applicable ttem(s)(Section 7031.5 ha2ardOrlS ma a reporting.i �-
oYes 'stNo
Business and Professions Cade).Any city or county that requires permit to r Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY ER 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(RRPI
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
r 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.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 not apply to an owner of a ❑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. o 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 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 & SAFETYPERMIT/PLAN CHECK APPLICATION
4
4
Menifee
DATEk5 L\ PERMIT/PLAN CHECK NUMBER �� O
TYPE: O COMMERCIAL RESIDENTIAL 0 MULTI-FAMILY O MOBILE HOME 0 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 (`
o i
PROJECTADDRESS Q�
ASSESSOR'S PARCEL NUMBER 340- I'M-O 41 LOT 5(0 TRACT
PROPERTY i OWNER'S NAME Psk� )tmo N 'I>'SSS 14
ADDRESS r O/y\\l 1J
PHONE ot�j � ' Cj�L'L'o1'SLJI ( EMAIL
APPLICANT NAME U/"\V`15-a n
ADDRESS 4cAoC 1 V
PHONE �ee�'�'.1, �04q( EMAIL
CONTRACTOR'S NAME OWNER BUILDER? 0 YES ONO
BUSINESSNAMEh�f�Lt "C
ADDRESS yy✓✓ II,,�/ G
PHONE �y`�'�M4� ' �",� EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ SQFT j LSQFT
APPLICANT'S SIGNATURE DATE lk
ln
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN ' ' SMIP
INVOICE I 'S t !�
AMOUNT J PAID AMOUNT OCASH OCHECKW OCREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER 0 YES O NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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