PMT18-03095 City of Menifee Permit No.: PMT18-03095
Ar 29714 HAUN RD, Type: Residential Plumbing
ff® MENIFEE, CA 92586
MENIFEE MENIFEE Date Issued 06/21/2018
PERMIT
Site Address: 29088 STONE RIDGE ST, MENIFEE,CA Parcel Number: 340-021-016
92584 Construction Cost: $1,379.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING 50 GAL GAS WATER HEATER IN GARAGE
Work:
Owner Contractor
ROY DELENA AFFORDABLE WATER HEATERS AND PLUMBING
29088 STONE RIDGE STREET 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 ,Ott Amount iEl
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
$115.15
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 staled,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
C-j � G u e A be
CITY OF MENIFEE �]^� rip
LICENSED DECLARATION property who builds or improves there' on,and w o contras ort a pH—rLjects
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 70DD)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 C 3 License No. By my signature below I acknowledge that,except for my personal residence
Expires -�i0^1�t5 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
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 forworkers 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.goy/calaw.htmi.permit is issued.
Policy If Date
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 0 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
Carriers r,.c r c c o n•f -t•(�-f ��5•� with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# OSkSOW-Ce 704o Expires r,) -O enterthe 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
❑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#
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
mixture containing a hazardous material equal to or greater that the
Applicant Date -5• IS^( �iC
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURETOSE WORKER'S COMPENSATION COVERAGE IS ❑Yes In
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intendeduse of the budding by the applicant orfuture building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000I,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 forguidelines
CONSTRUCTION LENDING AGENCY 0 Yes 0
I hereby affirm that under the penalty of perjury there is a construction Will tIfe/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) 0 Yes (I to
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 underthe 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 material reportin .
Business and Professions Code).Any city or county that requires a permit to ciYes o Date '«'• I
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 Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRP)
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 rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
01,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.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 aAn 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:
01,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 CMECK APPLICATION
4enifee
DATE (jla\\iIIs PERMIT/PLAN CHECK NUMBER $—
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY :% MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION DEMOLITION O ELECTRICAL O MECHANICAL
O NEW PLUMBING O' RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK C
SU ,z
PROJECTADDRESS 2q S �1'�J 'L —\�C S� a
ASSESSOR'S PARCEL NUMBER a4b - L6-)1-0JU LOT TRACT eity of enl ee
,QQ PROPERTY OWN ER'SNAME n �{��2\`�la BuildingDept,
ADDRESS_2 9 C E 6 / C�y'V \
PHONE 15� 7 / -IJ�CI�� EMAIL
I.
APPLICANTNAME r� �5i` 6(,.LeiM -
ADDRESS 4CAMe
PHONE r6%-.JQtk ,044tAl� EMAIL
CONTRACTOR'S NAME OWNER BUILDER? C YES`&NO
BUSINESS NAME L;C
ADDRESS
PHONE q0L�q EMAIL J"ry Val CJ,
CONTRACTOR'S STATE LLII,C NUMBER > sIA LICENSE CLASSIFICATION
VALUATION$ \� 1�-1—" SQ FT LSO,FT/^ G
APPLICANT'S SIGNATURE - DATE G " Z, - O
DEPARTMENT DISTRIBUTION �/ CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP „
INVOICE PAID AMOUNT AMOUNT \ .I� OCASH 0CHECK4 0CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT CCASH 0CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
Building&Safety Department 29714 Noun Rd. Menifee, CA 92586 951-0-7'-r;777
www.cityafinenifee.us Inspection Request Line 951-246-6213
z m x• o
N
° a R
.-r 7 n �
61 m 1 '1 N S h
N t' in ^n4 � w S � o mo � � � mD
� o a c aq B (D 0 3 0�° M ~ � v CL 'p �n z p
; � tiwHBz w 5' m 3 � �" �
s
3 m N o 3 H x m x m cu a
.'
30° n ' D
cc
4 O (D
= o a z
y = O O C ;. 0— O. O — x Z n
° 9 m S ° F ' o $ Z
-' U) N
3 i ; u° CD °° L° o " x IC
ET m
a s
c o A rt N o f �J to .Zm1
r m
j 7 7 w a o vi
a to d' 3 m 01 m HrD
z fi
m v m 51 n O vi _ -n •� u u 1 F 7
m O 3 c c C
c R ? m a
d T m m 3 c rL a°a�
a q
�. v o
o o m 3 H o J ry ;• c
wIC fp
o 4mc" CL 0
a. P nrl f D ° 4
.� a• _ 3 g m x• o. .o � N o0
s � z T
� � � z 9 '�' �• f G � N 19 m
a 0 o n ¢4 g
o. Q �
o, 3 x
m °� c
H d H
°• 7 a m ^ ° f9
n 2 n' n _<` ' T
M n
� 3 i r 3
CD o 0 a
a a _m 9 `C
N
O o
rVr n O 4 �°N' y 4 0 =C m
wo a a' ti -ten `` c c A `,9^q ° 0 8
�n o F' .. a m
P m (�D q v m z
� F a a w o
'D 5 gga p coCA Ck. CD A
OD
? o' , X mo _ C, o
o a'o � � _
s tu
Z
w m 4'n }r+ r c p go d ai ,n ¢s ro' 91
W
m Of CL VZ y 3 05
3 ® uq
}� ORlu yr (0 ®
p Ci m � � o n a 0.
P o a m 0 ro m
m
e D m M• m c N
ID M
O3 : m obi
in
a^ 4J"� a d c M d 0 m c v � c w
roro R' ° o a °^ a a
°
° a ^ 4 g a °
2 ' u o 4 3 v e 'd o °
at n c n o > a ea ° .°. 3 4
ro
w 1r M• a fie' e 7 a � < �° g
ro a a c d fD g n °@aq
n 1 a ro m co v o• m
��' ❑ 4 m'
o o
M �0 o ro v o S 3 N ° R d
oroi n, o a ? Ou O m C C N N
fD o S
o ? a 7 a 8 z � m ' m �01•.
1p T O M a 4
V O '9 ('� VI N � CI C ? N ,N� o ,
c °° 3 o_ ID $
w ro m ° a O �° y 7 0 3 o W a
N Q ro (B ro N, N C S
n f
NN h N n 7 to " n O
V)
( O > > ' O 7
N C CD m
VG N 4 O 7 --
^_
— —C
N m 3 o m o ro, 3 m a c Y
Ncr ro
ro m N
• I
M m
3 C. v
OQ a CL 4 g, o f'o c Prf
� 01 •� x W
R n 3
�: Ip A obi
C a d .Nr
d
'~ B
7