PMT18-04419 City of Menifee Permit No.: PMT18-04419
29714 HAUN RD.
/ r MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE MENIFEE Date Issued: 0 911 012 01 8
PERMIT
Site Address: 26182 GERMANTOWN DR, MENIFEE, CA Parcel Number: 335-143-020
92586 Construction Cost: $3,588.00
Existing Use: Proposed Use:
Description of REMOVE AND REPLACE 50 GALLON GAS WATER HEATER-SAME SIZE AND LOCATION
Work:
Owner Contractor
DONALD EDWARD AFFORDABLE WATER HEATERS AND PLUMBING
26182 GERMANTOWN DR INC
MENIFEE, CA 92586 28358 CONSTELLATION ROAD#698
Applicant Phone: 8553459087
AFFORDABLE WATER HEATER License Number:627368
AFFORDABLE WATER HEATERS AND PLUMBING INC
28358 CONSTELLATION ROAD#698
VALENCIA, CA 91355
Fee Description ON Amount f$)
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 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_Bidg_Permit_Template.rpt 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 contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contractors State License Law for
Professions Code and
my license is in full farce and effect. j the following reason:
License Class C J� License o. �� `� By my signature below 1 acknowledge that,except for my personal residence
Expires Signatu e 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 DECLARAT N 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 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 3700 of the Labor Code,for the performance of work for which www,leeinfo.ca.eov/calaw.html.
this permit is issued.
Policy# Date
y'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 ❑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: 1'l ` application and the information I have provided is correct.I agree to comply
Carrier ��5 CU e� I hL P J� with all applicable city and county ordinances and state laws relating to
r [[77�� C� / building construction.I authorize representatives of this city or county to
Policy# V �"l�'432L�9�07.Expires 1 enterthe above identified propertyfor inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($300)or less PROPERTY OW NER 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 37DO of the Labor
Code,I shall forthwith comply v it those provisions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
Applicant Date amounts sp�scified on the Hazardous Materials Information Guide?
WARNING: AILURETO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes 0
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 guide��li�r}}es
CONSTRUCTION LENDING AGENCY ❑Yes 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 boun ary of a school?
(Section 3097 Civil Code) ❑Yes kNo
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
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Sectic 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous terial repo ing.
Business and Professions Code).Any city or county that requires a permit to Dyes o 0
construct,alter,improve,demolish or repair any structure,prior to its Date 7 bbb
issuance,also requires the applicant for the permit to file a signed statement PROPERTY OWN OR AUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING(RAP)
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 Cade)or that he or she is exempt from litensure 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
❑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.epa.aov/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 ❑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. /N1PA 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
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 APPLICATION
't enIfee
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 YPLUMBING O RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Qa e
PROJECTADDRESS Z(p [bZ N)-CAfy) �-Z_e
ASSESSOR'S PARCEL NUMBER LOT TRACT
PROPERTY OWNER'S NAME D" NaAd
`Y ADDRESS ZVJ 8 Z LW
PHONE LjLi -173GI EMAIL City ofMenitee
APPLICANT NAME I ept.
ADDRESS CAtAGN C, �IV 2018
PHONE ��Qt( ,04CA EMAIL Pen in en I
CONTRACTOR'S NAME OWNER BUILDER? O YES ONO
BUSINESS NAME
ADDRESS I
PHONE Zl}'�-.5���9\6 EMAIL W ,
CONTRACTOR'S STATE LIC NUMBER &; y l��_ LICENSE CLASSIFICATION
VALUATION$ SO FT L SO FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER`
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE f�
LAU PAID AMOUNT Cam\ OCASH OCHECK# OCREDITCARD VISA/MC
CHECK FEES PAIDAMOUNT OCASH OCHECK# 0 CREDIT CARD VISA/MC
ILDER VERIFIED O YE5 O NO DL NUMBER NOTARIZED LETTER OONO
Ciry Of Niellifee Building&Safety Department 29714 Hour, Rd. Menifee, CA 92586 951-672-6777
:vww.dtyofinenifee.us Inspection Request Line 951-246-5213
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