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PMT18-00904 City of Menifee Permit No.: PMT18-00904 29714 HAUN RD. Type: Residential Plumbing <;i�CCFL/ MENIFEE, CA 92586 ea..voa saaR. MENIFEE Date Issued: 0 310112 01 8 PERMIT Site Address: 27694 ADAMS AVE,MENIFEE, CA 92585 Parcel Number: 329-202-014 Construction Cost: $700.00 Existing Use: Proposed Use: Description of REMOVE AND REPLACE40 GALLON WATER HEATER WITH SAME SIZE(40 GALLON) &SAME Work: LOCATION(OUTSIDE CLOSET-WH NOT LOCATED IN MH) Owner Contractor GLORIA GUERRERO INTER-CITY ENERGY SYSTEMS INC 27694 ADAMS AVE 1175 N DEL PLACE ONTARIO, CA 91764 Applicant Phone:9097855075 INTER-CITY ENERGY SYSTEMS INC License Number: 587709 1175 N DEL PLACE ONTARIO, CA 91764 Phone:9097855075 Fee Description (3yt Amount 1$t Water Heater 1 83.00 Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 SMIP RESIDENTIAL 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 81dg_Permit Template.rpt Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects I hereby affirm under penalty of perjury that I am under provisions of with a licensed contmaor(s)pursuant to the Contractors State License Law). Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from licensure under the Contractors State License Law for Professions Code a--nxxdd�my license is in full force and effect. p the following reason: License Class l�a��'7i�i License a. S �7 7(' % By my signature below I acknowledge that,except for my personal residence Expires h 0 Signature e-L,!7, 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 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 worker's 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 ww .leeinfo.ca.eov/calaw.html. this permit is Issued. w Policy R Date ,wfhave and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT section 3700 of the Labor Code,forthe performance of the work for which ❑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 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 ; L f/': �'w/ with all applicable city and county ordinances and state laws relating to building construction.I authorize representatives of this city or county to Policy# Expires enter the above idemifie property for inspection purposes. (This section need not to be completed is the permit is for onewhundred dollars($100)or less �� — Date PROPERTY OWNER OR AUTHORIZED AGENT ❑I certify that in the performance of the work for which this permit is issued, 63! v�k9®f)) I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE p (O��J' workers compensation laws of California,and agree that If I 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 greaterthatthe Applicant Date amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes_e!Vo 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($100,00D),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant require a permit for the construction or modification from South IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES Coast Air Quality Management District(SCAQMD)7 See permitting checklist for guidell s CONSTRUCTION LENDING AGENCY Dyes rfi No 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 bound of a school? (Section 3097 Civil Code) o Yes r -o 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 reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning checkmark(s)I have placed next to the applicable items)(Section 7031.S hazardous enal re ' g. Business and Professions Code).Any city or county that requires a permit to oyes No construct,alter,Improve,demolish or repair any structure,prior to its Date 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 IRRPI 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 rentalproperty than($500). 4 P he owners and property 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.gov/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 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. ❑No EPA Lead-Safe Certified Firm is required for this project because: ❑1,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. i� BUILDING1PERMIT/PLANir DATE PERMIT/PLAN CHECK NUMBER ( u TYPE: J COMMERCIAL - RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION 0 DEMOLITION O ELECTRICAL O MECHANICAL O NEW PLUMBING O RE-ROOF-NUMBER OF SQUARES / DESCRIPTION OF WORK Lj PROJECT ADDRESS It iy/s ASSESSOR'S PARCEL NUMBER 3a�.�oa -D/y- LOT TRACT OWNER NAME ©{-i CL CD 4 Z �/I/•,-Q� C/ ADDRESS PHONE :Z EMAIL APPLICANT NAME a,p` ADDRESS 1S�_ Oh-fq:r D PHONE EMAIL CONTRACTOR'S NAME OWNER BUILDER? OYES NO BUSINESS NAME ADDRESS i /fib r,* T"6k4aelo. Ao- 91 PHONE �oq_ /�� u" 7� EMAIL .I J.2.3S:C� jkIi6,Gry-z'21Q CONTRACTOR'S STATE LIC NWBER j'g77(7 9 LICENSE CLASSIFICATION// C� VALUATION$ 00,�U SO FT L SQ FT APPLICANT'S SIGNATURE DATE DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILa1NG PLANNING ENGINEERING FIRE l GREEN I SMIP �� f7I-e_ ✓ INVOICE I ( /I PAID AMOUNT AMOUNT l �/ G: CASH CCHECKH OCREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT CCASH OCHECKM 0 CREDIT CARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO 13U���{ppeni#ee My JS?Menifee Building& Safety Deemtment 29714 Haun Rd. 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