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PMT17-04558 City of Menifee Permit No.: PMT17-04558 29714 HAUN RD. �/-�CCiii MENIFEE,CA 9258E Type: Residential Plumbing f1rt' 9fW''— MENIFEE Date Issued: 1 212 712 01 7 PERMIT Site Address: 28655 SHADY BROOK DR,MENIFEE, CA Parcel Number: 340-250-040 92584 Construction Cost: $2,848.00 Existing Use: Proposed Use: Description of REPLACE 50 GAL GAS WATER HEATER, SAME SIZE AND LOCATION IN GARAGE Work: Owner Contractor EVERETTE THOMPSON AFFORDABLE WATER HEATERS AND PLUMBING 28655 SHADYBROOK DR INC MENIFEE, CA 92584 28358 CONSTELLATION ROAD#698 Applicant Phone: 8553459087 GREGORY GUERRY License Number.627368 AFFORDABLE WATER HEATERS AND PLUMBING INC 28358 CONSTELLATION ROAD#698 VALENCIA, CA 91355 Fee Description ON Amount f51 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 $116.15 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_Permk_Template.rpt Page 1 of 1 CITY OF MENIFEE ICENSED 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 perjury that 1 am under provisions of Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contractors State License Law for Professions Code and my my is in full force and effect. the following reason: Ucense Class LAG CrJtnZJ.Nr�License No. Lz:�: By my signature below 1 acknowledge that,except for my personal residence Expires 61-30-I K Signature —� in which I must have resided for at least one year priorto completion of improvements covered by this permit.I cannot legally sell a structure that 1 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 forworkers 7044 of the Business and Professions Code,is available upon requestwhen 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.leeinfo.ca.eov/calaw.html. this permit is issued. Policy It Date )i(p 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 9 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 polity Pwner or authorized to act on the property owners behalf.I have read this number are: application and the information I have provided is correct.I agree to comply Carrier T,.,� c.o S- 4-r..,t (i-2cC F with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy# ryC&&So'iLUJ:Zc21 Expires g9 I. -r7 ( -L enter the above identified property for inspection purposes. (This section need not to be completed is the permit is for one-hundred Date i 7 dollars($100)or less ROPERTY 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 It _2�Z' 7 workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the workers compensation provjsions of Section 3700 of the Labor Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a mixture containing a hazardous material equal to or greater that the Applicant Date (�'Z-Z!gF- amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER' COMPENSATION COVERAGE IS Dyes jONo 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)?See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines CONSTRUCTION LENDING AGENCY oYes aglo 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) Dyes jLNo OWNER BUILDER DECLARATIONS 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 Contractors License Law for the reasons)indicated below by the California Health al Safety Code,Section 25505 and 25534 concerning hazardous material reporting. checkmark(s)I have placed next to the applicable items)(Section 7031.5 oYes polo 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 of the Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRP) 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 icensure 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 ❑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.epa.aov/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-BOD-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 r iPgL{¢rvM"Menifee property provided that the improvements are not intended or o r ft.1� Certified Firm Name: sale.If,however,the building or improvement is sold within one Wokg Dept. 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. DEC 2 7 201 7 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 GU f contractors to construct the project(Section 7044,Business and Professions Code:The Contractors State License Law does not apply to„'an v r 1 ve ur project does not comply with EPA RRP rule please fill out the RRP nowledgement. BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION A-- Nlerifee DATE 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 PLUMBIN/G�r OO RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK - . II S 41 o n r0i e PROJECTADDRESS 2 S \Q S S f) C ASSESSOR'S PARCEL NUMBER 5L40 'QG50 ' LOT _4 TRACT `J PROPERTY OWNER'S NAME S ADDRESS Z f p K 0r PHONE S 1 qS EMAIL APPLICANT NAME �! //�� ((�� ADDRESS MG a DI" PHONE `�'�-.�(�C. a►�p�,� EMAIL CONTRACTOR'S NAME -F OWNER BUILDER? O YES ONO BUSINESS NAMEhk��Lk ` ADDRESSqt3�SSG AA 0%, PHONE 45�-JLJs-QII,0LAq EMAIL C/ W c6 CONTRACTOR'S STATE LIC NUMBER !dL'�3kJ� LICENSE CLASSIFICATION VALUATION$ 2 I S -1 ff - SQ FT L SQ FT APPLICANT'S SIGNATURE - DATE % Z - Z. tZ' l OTY STAFF USE OJNLY DEPARTMENT DISTRIBUTION i CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNINGG� ENGINEERING FIRE GREEN SMIP II J.I�INVOICE PAID AMOUNT AMOUNT O CASH OCHECK# OCREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT 0CASH 0 CHECK# 0CREDIT 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 92585 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 � � w J- o � `� � n v'• y 9nm �� z a �. m 0 a » � .0. 3 .w. .D.� z 3� m `i `� w L� n -�I M. m f+ J- m .�. -w. m N C. Rl =• T_ 0 T .^e N IUD :' N S ^ m D O J IG S N W ...I 'o Q Z M (D� �a., m; G G C O y J m O 0. 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