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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. 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