PMT18-02634 City of Menifee Permit No.: PMT18-02634
29714 HAUN RD. Type: Residential Plumbing
CCELA7. MENIFEE, CA 92586
MENIFEE Date Issued:
05/29/2018
PERMIT
Site Address: 29401 EL PRESIDIO LN, MENIFEE, CA Parcel Number: 340-550-009
92584 Construction Cost: $1,800.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING 50 GAL GAS WATER HEATER IN GARAGE
Work:
Owner Contractor
PAULINA HOH AFFORDABLE WATER HEATERS AND PLUMBING
29401 EL PRESIDIO LANE 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 Qty Amount($1
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_Pennit_Template.rpt Page 1 of 1
GVeT Gu - A%&4jfot
CITY OF MENIFEE (�]^,�
LICENSED DECLARATION property who builds or improves thereon,andw ocontrac or ep
I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(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 Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class G 3 S° License No._C Z-T-3 G By my signature below I acknowledge that,except for my personal residence
Expires Signature in which l must have resided for at least one year priorto completion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legallysell a structure that 1
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
this permit is issued. www.leeinfo.ca.eov/calaw_html.
Policy# Date
10�fiave and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which o By my signature below I certify to each of the following:I am the property
this permit is issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
Carrier J. c c o c�-f tC 7a .� with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# C-251A S03 V<eq 10;— Expires r»( -O ( -1 enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred
dollars($100)or less Date
PROPERTY OWNER OR AUTHORIZED AGENT
o 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#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's 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
Applicant Date mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SE WORKER'S COMPENSATION COVERAGE IS o Yes UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES 4FvNa
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,0Doj,IN Will the intended use of the building by the applicant or future building
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR occupant requires 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
forguidelines
CONSTRUCTION LENDING AGENCY o Yes/g��a
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) ❑yes (011M.0
OWNER BUILDER DECLARATIONS 1 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
Contractor's 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 item(s)(Section 7031.5 hazardous material reportin .
Business and Professions Code).Any city or county that requires a permit to oYes Flo Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWN ER ORAL IZED 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 Contractor's 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 ins pre-1978
and the basisfor the allegedects th applicann. t
to a civil
it penalty of not o residence or childcare facility to be RRP-certified firms and comply with
than
Applicant fora permit subjects the applicant toacivil penalty of not more required practices.This includes rental property ownersand property than($500). p p y
managers who do the paint-disturbing work themselves or through their
o I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.eoa.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a o An EPA Lead-Safe Certified Renovator will he responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. n No EPA Lead-Safe Certified Firm is required for this project because:
o I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING &I
SAFETY PERMIT/PLAN CHECK APPLICATION
enifree
DATE �� PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL }(RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW PLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK r
PROJECT ADDRESS 2q L+C) PC dL1 L N ity of Menife
ASSESSOR'S PARCEL NUMBER _a4Q— � �� I LOT TRACT In9 eept'
PROPERTY OWNER'S NAME ,L{ (\J a QY 9 Z01$
ADDRESS 2qLfD f E l E c LN .
PHONE C�,�f - I �- (�(P(p EMAIL
APPLICANT NAME
ADDRESS MC/ n
PHONE EMAIL
EMAIL
CONTRACTOR'S NAME OWNER BUILDER7 0 YES ONO
BUSINESSNAME
ADDRESS
PHONE QII,0 EMAIL (Q
CONTRACTOR'S STATE LIC NUMBER l2l,1�-1n` LICENSE CLASSIFICATION
VALUATION$ IBOC) —SQFT LSQFT
APPLICANT'S SIGNATURE DATE 4 -- — C
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN ` - SMIP K
INVOICE pgiD AMOUNT
AMOUNT �� "� •�� OCASH 0CHECK It 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0 CHECK It OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City 1'f N7enifee Building&Safety Department 29714 Naun Rd. Menijee, CA 92586 951-672-6777
wwwXityafinenifee.tl>lnsoection Request Line 951-240'-6213
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