PMT17-04559 City of Menifee Permit No.: PMT17-04559
29714 HAUN RD. Type: Residential Plumbing
�L�CCEL/> MENIFEE, CA 92586
MENIFEE Date Issued 12/27/2017
PERMIT
Site Address: 28673 ACANTHUS CT, MENIFEE,CA Parcel Number: 333-500-014
92584 Construction Cost: $1,279.00
Existing Use: Proposed Use:
Description of REMOVE AND REPLACE WATER HEATER-SAME SIZE(50G),SAME LOCATION(GARAGE)
Work:
Owner Contractor
BRYAN OBAY AFFORDABLE WATER HEATERS AND PLUMBING
28673 ACANTHUS COURT INC
MENIFEE, CA 92584 28358 CONSTELLATION ROAD#698
Applicant Phone: 8553459087
AFFORDABLE WATER HEATERS AND PLUMBING INC License Number:627368
28358 CONSTELLATION ROAD#698
VALENCIA, CA 91355
Phone: 8553459087
Fee Description OQt Amount ISI
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
$115.16
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 an 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
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 I am under provisions of
Chapter!)(commencing with section 7000)of Division 3 of the Business and o 1 am exempt from licensure under the Contractors State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class li_3 6,2'r 'j,Nt License No. CZ-J=3Com, By my signature below I acknowledge that,except for my personal residence
'
Expires R-30-I'K Signature > in which I must have resided for at least one year prior to completion of
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
❑I hereby affirm under penalty of perjury one of the fallowing 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.leginfo.ca.gov/mlaw.htmi.
this permit Is issued.
Policy# Date
)iq 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 policy 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, with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# WC,,jF�oiZ4477o1 Expires r,7 I. L -r- enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred �� Date I?
dollars($100)or less ROPERTY OWNER OR AUTHORIZED AGENT
❑I certify that in the performance of the work for which this permit Is Issued,
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# -2�i�7� -;F-7—
worker's compensation laws of California,and agree that if 1 should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions 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
z Applicant Date -7Sak-/� amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER' COMPENSATION COVERAGE IS ❑Yes pfNo
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 ❑Yes o/slo
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 fLNo
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
California Health al Safety Cade,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the
hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5
oyes pg4o
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(RRP!
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 Cade)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-certlfied 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
D 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 I )all of or( )portion of the work,and the structure is www.eoa.¢ov/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 o An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or i f, 'i tenifee
property provided that the improvements are not Intended or o r`"(P1 Certified Firm Name:
sale.If,however,the building or improvement Is sold within one W Ing 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 17 9 7 2017
0 ❑No EPA Lead-Safe Certified Firm is required for this project because:
D I,as owner of the property am exclusively contracting with licensed L ll f
contractors to construct the project(Section 7044,Business and Professions -�I
Code:The Contractors State License Law does not apply to syogrgfaq� �� ur project does not comply with EPA RRP rule please fill out the RRP
��'"'�� ez,l nowledgement.
spa;;
11 et ee
DATE PERMIT/PLAN CHECK NUMBER PM"f-1-1 —0 I—ISS
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION XALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW PLUMBIN/G��-.((0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK r�4C� 1(j
.S 0 all �D Y-\ a y- e .
I
PROJECTADDRESS 2- G G) h +h J• �4-•
ASSESSOR'S PARCEL NUMBER 3J3' ' �� LOT Iq TRACT
PROPERTY OWNER'S NAME (/
ADDRESS 2 P
\ 1 c Q In--h Lt s Ch
PHONE �� ,S 1 ?i I(� S ,Q-7 2 EMAIL
APPLICANT NAME
ADDRESS 6 ,S n
'V
PHONE5,�1U�4S EMAIL
CONTRACTOR'S NAME OWNER BUILDER? O YES ONO
BUSINESS NAME !' Lt
ADDRESS (d !!^� JA
PHONE glj -jtAS-9�01,�q EMAIL A
CONTRACTOR'S STATE LIC NUMBER '��j�J� LICENSE CLASSIFICATION
VALUATION$ I l Z 7 _ SQ FT L SO FT
APPLICANT'S SIGNATURE DATE i.2.- Z -1-�
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE-BUUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP ;73 1 •o
INVOICE ,yam
AMOUNT I1' 'i4S PAIDAMOUNT OCASH OCHECK# OCREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# OCREDITCARD VIWMC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES 0 NO
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City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92S86 951-6 72-ROding DePt
www.cityofinenifee.us Inspection Request Line 951-246-6213 DEC 2 1 20i.1
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