PMT18-02635 City of Menifee Permit No.: PMT18-02635
29714 HAUN RD. Type: Residential Plumbing
^CCELR? MENIFEE,CA 92586
MENIFEE Date Issued: 0 512 912 01 8
PERMIT
Site Address: 29761 PAINTED DESERT DR, MENIFEE, Parcel Number: 340-140-009
CA 92584 Construction Cost: $1,000.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING 50 GAL GAS WATER HEATER IN GARAGE
Work:
Owner Contractor
AC BUENAVISTA AFFORDABLE WATER HEATERS AND PLUMBING
29761 PAINTED DESERT DRIVE 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 Qtv Amount 181
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 carded 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_BIdgPermit Template.rpt Page 1 of 1
G Vein � ( u eg bk
CITY OF MENIFEE (�/(��,Q�
LICENSED DECLARATION property who builds or improves there- on',and-wAo contrac or t e pr js cts
1 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 01 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 C- License No. 6 5:T By my signature below I acknowledge that,except for my personal residence
Expires q-3D-Ib Signature in which l must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I
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 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.leginfo.ca.gov/calaw.htmi.
Polity It Date
have 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 D By my signature below I certify to each of the following:I am the property
this permit is issued.My worker's compensation insurance carder 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 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_r-�-l -O( —Ier 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 370D of the Labor
Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or
Applicant- _ mixture containing a hazardous material equal to or greater that the
Pp Dates-I S'( �iS amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SE WORKER'S COMPENSATION COVERAGE Is oYes mYa
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($100,000),IN occupant require a permit far the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY ❑Yes 00
1 hereby affirm that under the penalty of perjury there is a construction WIII tf(e proposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) oYes err o
OWNER BUILDER DECLARATIONS I have read..the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist I understand my requirements under the State of
Contractor's License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 2S534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material repartin .Business and Professions Code).Any city or county that requires a permit to oyes 7 Date J
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AU ORIZED AGENT
issuance,also requires the applicant for the permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING fRRPI
License Law(Chapter 9(commencing with Section 70D0)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)or that he or she is exempt from licensure receiving compensation for most work that disturbs paint in apre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply pre-1 with
than
n($SO ).for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and 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 crAn 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 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 & SAFETY PERMIT/PLAN CHECK APPLICATION MENIFEE
DATE: aG( PERMIT/PLAN CHECK NUMBER
PLANNING CASE 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 90PLUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK enifee
uI I
PROJECTADDRESS "LG{' ( l Gr,i}..{-�( �S i"� C]-✓ ZIP gz Y 2 9 2010
ASSESSOR'S PARCEL NUMBER ( - I yO 'F)� LOT TRACT i-I
OWNER NAME G. I-riAu
ADDRESS Z 1 - q `Z--
PHONE EMAIL
APPLICANT NAME
ADDRESS G„✓'�-i
PHONE EMAIL
CONTRACTOR'S NAME X J 0 r LO OWNER BUILDER? O YES O
BUSINESS NAME , („�c�.{..ey.
ADDRESS ��S COLnrj t �� a I Gam.
PHONE —'I EMAIL >
CONTRACTOR'S STATE LIC NUMBER & T'SC4 5 LICENSE CLASSIFICATION C
VALUATION 00 SQ FT L SQ FT
APPLICANT'S SIGNATURE DATE •Z G ` ��
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION A CEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
INVOICETOTAL 1 4, GREEN I_ SMIP h
OWNER BUILDER VERIFIED O YES 0 NO DRIVERS LICENSE k NOTARIZED LETTER U YES O NO
City of Menifee Building &Safety Department 129714 Haun Rd., Menifee,CA 92586 (951)672-6777
www.cityofmenifee.us
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