PMT14-02461 II
City of Menifee Permit No.: PMT14-02461
_ 29714 HAUN RD. Type: Residential Plumbing
i+ CCELA-> MENIFEE, CA 92586 I!
swmumu sds+,xe MENIFEE Date Issued: 09/12/2014
i
PERMIT
Site Address: 27880 BLAZE LN, MENIFEE, CA 92585 Parcel Number: 331-400-014
Construction Cost: $1,275.00
Existing Use: Proposed Use:
Description of WATER HEATER REPLACEMENT 48 GALLON GAS
Work;
Owner Contractor
LANCE BOYD A R S AMERICAN RESIDENTIAL SERVICES OF
27880 BLAZE LN CALIFORNIAINC,
MENIFEE, CA 92585 965 RIDGE LAKE BLVD STE 201
Applicant Phone: 9102719700
ANDREW ALLEN License Number: 765155
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNh
965 RIDGE LAKE BLVD STE 201
MEMPHIS, CA 38120
Fee Description ON Amount '
e la ae_,
Building Permit Issuance 1 27.00
!0
$111.00
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_Permlt_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION
I hereby affirm under penalty or perjury that I am licensed under provisions of ❑ I, as owner of the property an exclusively contracting with licensed
Chapter 9 (commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professions
Professions Code and my license is in full force and S ct. Code:The Contractor's License Law does not apply to an owner of a property
License Class L3G License No. �rf7 who builds or improves thereon, and who contracts for the projects with a
Expires 1 Signatures l licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION DECLARATION
❑ I am exempt from licensure under the Contractors'State License Law for the
❑ 1 hereby affirm under penalty of perjury one of the following declarations: following reason:
I have and will maintain a certificate of consent of self-insure for workers' By my signature below I acknowledge that, except for my personal residence in
compensation,issued by the Director of Industrial Relations as provided for by which I must have resided for at least one year prior to completion of
Section 3700 of the Labor Code, for the performance of work for which this improvements covered by this permit, I cannot legally sell a structure that I have
permit is issued.
Policy# built as an owner-building if it has not been constructed in its entirety by licensed
contractors. I understand that a copy of the applicable law, Section 7044 of the
f" I have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is
ction 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:http�//www.leciinfo.ca.gov/Gaiaw.html.
permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier 't^&90 11 Property Owner or Authorized Agent Date
Expires 1011114 Policy# WLl G91-ST�b�f^n�
Li
my Signature below, I certify to each of the following: I am the property
Name of Agent Phone# owner or authorized to act on the property owner's behalf. I have read this
(This section need not be completed if the permit is for application and the information I have provided is correct. I agree to comply
one-hundred dollars($100)or less) with all applicable city an county ordinance and state laws relating to building
construction. Ztheinsipectl
presenlativ his city or county to enter the above-
0 I certify that in the performance of the work for which this permit is issued,I identified p rposes.
shall not emolov any persons in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers'compensation provisions of Section 3700 of the Labor property Owner or Authorized Agent Date
Code, I shall forthwith comply with those provisions
City Business License#
Date; 4� l�^ I`I Applicant;
WARNING: FAILURE TO SECURE WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDING
($100,000), IN ADDITION TO THE COST OF COMPENSATION, AYES OCCUPANT HANDLE A HAZARDOUS MATERIAL ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES }ENO EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS
I hereby affirm that under the penalty of perjury there is a construction lending INFORMATION GUIDE?
agency for the performance of the work which this permit is issued (Section WILL THE INTENDED USE OF THE BUILDING BY THE
3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE
Lender's Name DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address rNO DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR
OWNER BUILDER DECLARATIONS GUIDE LINES
I hereby affirm under penalty of perjury that I am exempt from the Contractor's PRINT NAME:
License Law for the reason(s)indicated below by the checkmark(s)I have placed DYES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable items)(Section 7031.5. Business and Professions Cade: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A
Any city or county that requires a permit to construct, alter, improve, demolish, C01\10 SCHOOL?
or repair any structure, prior to its 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 License Law (Chapter 9 (commencing with I HAVE READ THE HAZARDOUS MATERIAL
Section 7000)of Division 3 of the Business and Professions Code)or that he or tYES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from licensure and the basis for the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREMENTS
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than ($500).) CODE, SECTION 25505 25533 AND 25534 CONCERNING
❑ 1, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL f EPORtING.
compensation, will do ( ) all of or ( ) porting of the work, and the structure is PROPERTY OW i THORIZ AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale. If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
CITY OF MENIFEE PLCKNo:
29714 Haun Road Date: Date:
Menifee, CA 92586 13
Phone: (951)672-6777 Amount: Amouny11 db
Fax:(951)679-3843 Ck#: Ck#:
Building Combination Permit
LOT14 To Be Completed By Applicant
Legal Description: u UL QE Planning Case: F: L: Rt: R:
Property Address: a E Assessor's Parcel Number: 33 < o I
1-1 ILK �
Project/Tenant Name: Unit#: Floor#:
D I
Name: one No. Fax No.
LAac-� 13 0�0 —1 , ors
Property Address: Unit Number Zip Co
Owner 3LdAI.& L• Z y75
Email Addraesi,
Name: Phone No. Fax No.
A��enl 9sl
Applicant Address: Unit Number Zip Code
IS'2v W LINDcrJ Si g25'87
Email Address:
Name: �1 Phone No. Fax No.
1�LSL-JE oo 60- Ss� ?4-[ 49?I
Contractor Address: City State Zip ode
l o I,4NO� IT
�to2(ls p� f2S o�
ontractor s ity usmess License o. I Contractor's City Srate of California License No. Classification:
a C L�{�
Number o(Squares:
Square Footage
Description of Work: w H u r gas Cost of Work:$ 2 7
Applicant's Signature Date: 2 � 1
To Be Completed By City Staff only
Indicate As R-Received or N/A-Not Applicable
5 Completes sets of fully dimensioned,drawn to sale plans which include: 1 set of documents which include
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Geo Tech/Soils Report(on cd only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on B 1/x 11)
❑ Foundation Plan ❑ Cross Section ❑ Structural Calculations
❑ Plumbing Plan ❑ Single Line diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration' Addition' Means/Methods
Work Type: Repair' Retrofit' Revision to Existing Permit' Required? YES NO
Proposed Building Use(s): Existing Building Use(s):
#Buildings: #Units: #Stories: Will the Building Have a Basement?
Y of N
Bldg.Code Occupancy Group Indicate Indicate if Indicate all Geo-tech.Haz.Zone
At Project Sprinklered YES or NO
� Construction that apply: Coastal Zone
Completion: Type(s): C Of O Noise Zone
Re ulred? YES or NO
q Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board I ILandmark Comm. Planning Comm.Zoning Administrator
Fee Exempt: City Project I Elea Vehicle Chargerl I Landmark Seismic Retrofit I bpociaivase,ulag.
Official Approval
Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing
For Staff Use Only
Building/Safety Permit Specialist Oily Planning Civil Engineering EPWM-Adman Transportation mgmt 1 Rent Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY