PMT18-02666 City of Menifee Permit No.: PMT18-02666
29714 HAUN RD.
MENIFEE,CA 92586 Type: Residential Plumbing
MENIFEE MENIFEE Date Issued: 0513112018
PERMIT
Site Address: 29301 LAKE HILLS DR, MENIFEE, CA Parcel Number: 333-393-030
92585 Construction Cost: $2,000.00
Existing Use: Proposed Use:
Description of REMOVE AND REPLACE 50 GALLON WATER HEATER-SAME SIZE AND LOCATION
Work:
Owner Contractor
COLIN BATES HAUGEN PLUMBING INC
29301 LAKE HILLS DRIVE 300 CARLSBAD VILLAGE DR
MENIFEE, CA 92585 SUITE#108A426
Applicant Phone:7607297777
HAUGEN PLUMBING INC License Number:870118
300 CARLSBAD VILLAGE DR
SUITE#108A426
CARLSBAD, CA 92008
Phone:7607297777
Fee Description Qtv Amount I$)
Water Heater 1 83.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 4.15
$115.15
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
CITY OF MENI FEE
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 contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑1 am exempt from licensure under the Contractors State License Law for
Professions Code in my license is in full force and effect. the following reason:
License Class � Ucens o.
By my signature below I acknowledge that,except for my personal residence
Expires Signature in which I 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
m 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 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 370D of the Labor Code,for the performance of work for which
this permit is issued. www.leeinfo.ca.gov/calaw.htmi.
Policy p Date
D I 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 o 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
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
Polity If Expires enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred 7Oate
($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
rtify 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 K
workers compensation laws of California,and agree that If I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker n s comp ation pJ ovisions of Section 3700 of the Labor
Code,I shall forth 40 o 1 6s T. 1 S. ) {4/ Will the applicant or future building occupant handle hazardous material Ora
Applicant Date %/ !1 mixture containing a hazardous material equal to or greater that the
amounts sp ified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKE COMPENSATION COVERAGE IS D Yes 71
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(SC lion or See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidCoast
Air Q s
CONSTRUCTION LENDING AGENCY ❑yes �a
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within low feet of the
lending agency for the performance of the work which this permit is issued outer boun ary of a school?
(Section 3097 Civil Code) ❑Yes iVNo
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
1 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 Item(s)(Section 7031.5 hazardous mat real re rting.
Business and Professions Code).Any city or county that requires a permit to es ° U
Date
construct,alter,improve,demolish or repair any structure,prior to its p ERN O ER q THORIZ 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.REPAIRAND HINTING IRRPI
License Law(Chapter9(commencing with Section 7DOO)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 n for to beork that distuified rbs
and comply With
thanApplicant 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
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.epagov/lead/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 D An 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. °No EPA Lead-Safe Certified Firm is required for this project because:
D I,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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATIONMENIFEE
i�,
DATE: PERMIT/PLAN CHECK NUMBER P�l I b '0 Z W (6 W
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//���'P//LUMBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK V ,
PROJECT ADDRESSanal
ZIP
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME
l
ADDRESS /
PHONE �f EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME WNER BUILDER? O YES O NO
BUSINESS NAME
ADDRESS
PHONE ( Z2�—-777-:7 — EMAIL
CONTRACTOR'S STATE LIC NUMBER ��1� LICENSE CLASSIFIC ION l/
VALUATION$ OOD N DO JiQ FT L SQ FT
APPLICANT'S SIGNATURE DATECITYSTAFFUSEOA
_fr
DEPARTMENT DISTRIBUTION ACCEPTED BY: I W CITY OFF MENIFEEEBByUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE d ;,,J � 1
INVOICETOTAL I I j5` , 15 IGREEN SMIP
OWNER BUILDER VERIFIED O YES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
City of Menifee Building &Safety Department 129714 Haun Rd., Menifee, CA 92586 (951)672-6*77
www.cityofinenifee.uLity of Menifee
Building Dept.
MAY 31 2018
Received
1
`m < m An DR —y
0 Tmmom
W N 1-• O ." a m 0 .Js N 2 N ° o^�� 3 l� O D a Z 9 T m O
J S an d d Op .. (� >
x
N N m Jm m n D ti Z r
m o o J m b o
oo w n °. c o GZf S f0 r m m m -v
m m m m m £ x m N O D z
a m m a d uoJi n n x a m m 3 m N 1 'TI m A 5' D
Z R 3 D 9
w a w -� m r m D
RL
n
m J m < y J o d N (p m D 2 Z am m Q
Z
o, W O _j 3 O N 0 3 m J N m M A N O O M co
3 » o m H 3 m m <m `L
11
ct
^ G a 3 RBI
3 . n n m m rr 1 l_v` m Z1
.. ,V,1_ N
m m a = m m m ct o 3 —I
y
N c o
-O O d J
N �
C 9 N N �-
ND
� a3 � m a a
d m 3
• — d � W 2 J
y .mdr d d d m n w
ry N d A m � �. _ •c
x
c
RL
aq
m' � O � .t n C N a n. d Y 3 •
w J a
N
3
� n � A u °_ o d �•c
^ n c 09 n
❑ IR
m m 0 =K a m era cm
MD' �1
MD' 'm E m N
• ^ m
CD
n n n n ` T � T ••O
cmco WNW'
`m Rn
01
£ — n m J o o GQ
m 2 3
- x - m
3 m ? 3 w N Z
J
ry °
P"T tic - ozo w OFFICE COPY
n a s z o
p n
N O x >• -i f] p A W �1 2 2 F T 3 Z W
n m m m 0
m m - :5 3 m
p A
D m �' v » c n D -0
m m m
0 m
m ❑ p a m m N m c �. n F m '�
J o O m Z N 1
N N m > N m O' V A O C O < O
of m ' 3 m n D .J. 3 ai <' a D O1 -. =w O %*' m �n 2
J ❑ m a PF C O m c m a N 91 �' ° w N
x
x 'm o' -4 m S w w J 3 3
oz
N W n M c mn � .. = m c f° 0
£ o
m m m £ —
>
w
0 0
m m m v m m <
° n m m v s O1 m 3 a T �•
oT m v� O j 3 p 0 a
m > m y d a m
mt O m e m N N
a�' m
N N � N W N m j -. J N O •+. O.
O J m
-
��I m 0 n ¢ m m m
y p mCD
m m rt a a
m N
:Z N :COD 7 3 m nAl
o J 3 m m m 3 f+
CD
m C
3
l.d of w m n =p m
C. o m = N rn
0
m J m
J � �- a M� m N m
P"T� 1% . nn c moc"3
OFFICE 0v