PMT18-03096 City of Menifee Permit No.: PMT18-03096
+ 29714 HAUN RD.
A,g' MENIFEE, CA 92586 Type: Residential Plumbing
,6r �
MENIFEE MENIFEE Date Issued: 0 612112 01 8
PERMIT
Site Address: 31022 LARCHWOOD ST, MENIFEE, CA Parcel Number: 372-012-003
92584 Construction Cost: $1,400.00
Existing Use: Proposed Use:
Description of REPLACE 40 GAL GAS WATER HEATER IN GARAGE
Work:
Owner Contractor
DICK ZAJICKEL A REEMDY ROOTER&PLUMBING INC
31022 LARCHWOOD STREET PO BOX 77355
MENIFEE,CA 92584 CORONA, CA 92877
Applicant Phone:9512728966
ANTHONY MARCH License Number:730544
A REEMDY ROOTER&PLUMBING INC
PO BOX 77355
CORONA, CA 92877
Fee Description Oft Amount l5)
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.rpl 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 contractors)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)AyrRivision 3 of the Business and 01 am exemptfrom licensure under the Contractor's State License Law for
Professions Code and my license is in f fort nd-a ect. I r the following reason:
License Class C'3�p Lic se �`J `+" By my signature below I acknowledge that,except for my personal residence
Expires IT 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
❑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 Cade,for the performance of work for which www.leeinfo.ca.eov/calaw.html.
this permit is issued.
Policy g Date
PROPERTY OWNER OR AUTHORIZED AGENT
o I have and will maintain worker's compensation insurance,as required by
section 3700 of the tabor Code,for the 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 worker's compensation insurance carrier and policy owner or authorized to act on the property ownerss 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 8 Expires enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
XI certify that in the performance of the work for which this permit is issued,
Ishallnoterpiaig any persons in any manner so as to became subject to the CITY BUSINESS LICENSE If
worker's c pe s of Califomia,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject t the or eIs om ensatian provisions of Section 3700 of the Labor
Code,I sh II fo ith o 7ose pionsWill the applicant or future building occupant handle hazardous material or a
ApplicantDate miMure containing a hazardous material equal to orgreater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SEC KER'S COMPENSATION COVERAGE IS uYes oNo
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(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY o Yes o 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 boundary of a school?
(Section 3097 Civil Code) o Yes o No
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 permltting checklist.I understand my requirements under the State of
California Health al Safety Code,Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the
hazardous material reporting.
checkmark(s)I have placed next to the applicable items)(Section 7031.5
oyes o No
Business and Professions Code).Any city or county that requires a permit to
Date
construct,after,improve,demolish or repair any structure,prior to its 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 Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRPJ
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
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 70",Business and Professions 1-80D-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 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. a 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
Cade: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: ( PERMIT/PLAN CHECK NUMBER -
GRADING/ PLANNING CASE NUMBER/OTHER RELATED CASES
TYPE: O COMMERCIAL O RESIDENTIAL C: MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION OALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW *PLUMBING 4 RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK L{Q QgY k GJQ6 L.WxtQr GkC �(1 ¢Vnq__ ),{
OCCUPANCY GROUP CONSTRUCTION TYPE SPRINKLERS OYES ONO
PROJECTADDRESS LuIoaDW4 jt l` wQ( CR• ZIP ga56��vnoo
ASSESSOR'S PARCEL NUMBER 37 LOT TRACT City Of Menifee
OWNER NAME ylCt1, \ rV1n (�
ADDRESS �k6S'� -V�'U' Y.1 g�- 1 I&\_V Q( Z CAR. Q[%i� 8
PHONE EMAIL Receiveo
'
APPLICANT NAME AN-hom4 Mayon
ADDRESS ?.0. 60 7n�5Sr3 CQcOW'R CIA.
PHONE gcj1 a-F20-VIR P EMAIL
CONTRACTOR'S NAME "AC,^,1'i11-II lO1(� Myrk OWNER BUILDER? O YES ONO
BUSINESS NAMEA U� 9\wkw (' PlU lV �
ADDRESS 0cc1,) (1 r CA • 9 9Sr)()
PHONE 451 anpt 'RgULo EMAIL
CONTRACTOR'S STATE LIC NU LICENSE CLASSIFICATION C�
VALUATION $ UL(C SQ FT L SQ FT P
APPLICANT'S SIGNATURE DATE I l8
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION ACCEPTED BY: CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE
INVOICE TOTAL 5, GREEN SMIP X
OWNER BUILDER VERIFIED OYES O NO DRIVERS LICENSE# NOTARIZEDLETTER O 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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