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PMT14-02827 City of Menifee Permit No.: PMT14-02827 29714 HAUN RD.` Type: Residential Plumbing �CCIEL—M' MENIFEE, CA 92586 MENIFEE Date Issued: 1 012 312 01 4 PERMIT Site Address: 27365 COMWELL ST, MENIFEE, CA Parcel Number: 335-331-012 92586 Construction Cost: $1,414.00 Existing Use: Proposed Use: Description of WATER HEATER REPLACEMENT 40 GAL ELECTRIC LOCATED IN GARAGE Work: Owner Contractor RICHARD KATTNER A R S AMERICAN RESIDENTIAL SERVICES OF 37365 COMWELL STREET CALIFORNIA INC MENIFEE, CA 92586 965 RIDGE LAKE BLVD STE 201 Applicant Phone: 9012719700 ANDREW ALLEN License Number: 765155 A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNh 965 RIDGE LAKE BLVD STE 201 MEMPHIS, CA 38120 Fee Description qty Amount Building Permit Issuance 1 27.00 $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_Bidg_Permit_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 withsection 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professions Professions Code a my license is in full force and effect. Cade:The Contractor's License Law does not apply to an owner of a property License Class G I fP License No. ( who builds or improves thereon, and who contracts for the projects with a Expires 7 3( It 6 Signatu / �— licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATION DECLARATION ❑ I am exempt from Iicensure under the Contractors'State License Law for the ❑ I 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 Section 3700 of the Labor Code, for the performance of work for which this which must have resided for at least one year prior to completion of permit is issued. improvements covered by this permit. I cannot legally sell a structure that I have 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 I have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:bttp:/-/22m.leoinfo.ca.gov/calaw,htmi. permit is issued.My workers'compensation insurance carrier and policy number are: Carrier L—( f3&fL 1 11 f N-� Property caner or uthorize gent Date Expires 10 Policy# 1,ui�631zrs;F Name of Agent Phone# ❑ By my Signature below, I certify to each of the following: I am the property 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 and county ordinances and state laws relating to building construction. I authorize representatives of this city or county to enter the above- ❑ I certify that in the performance of the work for which this permit is issued,I identified property In mTpection S. shall not employ 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 tp Code, I shall forthwith comply with those provisions. Property Owner or Authorized Agent Date Date; Applicant; — City Business License# 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 �7I10 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 3097 Civil Code) WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE Lender's Name ❑YES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION Lender's Address FROM THE SOUTH COAST AIR QUALITY MANAGEMENT (?FNO 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 item(s)(Section 7031.5. Business and Professions Code: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A Any city or county that requires a permit to construct, alter, improve, demolish, nNO 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 tyIES INFORMATION GUIDE AND THE SCAQMD PERMITTING she is exempt from Iicensure 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 El1, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIAL REPORTING. compensation, will do( ) all of or( ) porting of the work, and the structure is PROPERTY OWNS ©ft7�K♦�RIZED AGENT not intended or offered for sale.(Section 7044, Business and Professions Code; �eR90; C__u.__r_� 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). (CAYY O ME NIFEE PLCK No: ermit No: City of Menifee 29714 Haun Road Building & Safety Dept. Date: Date: Menifee, CA 92586 (0 •23—Zit Phone: (951)672-6777 OCT 2 3 2014 Amount: Amount t t�` Fax:(951)679-3843 Ck#: Ck#: Received ow COsog Building Combination Permit To Be Completed By Applicant Legal Description: Planning Case: F: L: Rt: R: Property Address: Assessor's Parcel Number: 273G5 LOnTWG-4- s 335' 31 - 0 2 Project/Tenant Name: N E� Unit#: Floor#: Name: Phone No. I C. 4*T fIJ,5x 9f'r YYa x Fax No. Property Address: Unit Number Zip Code n f, Owner 27� loS Cp•"1 wC't-� s 72 S-0 & Email Address: Name: Phone No. Fax No. N Applicant Address: Unit Number Zip Code Email Address: Name: Phone No. Fax No. FSG v s-E $s 1 3Yt 4 7/ Contractor Address%s7d w z�/-)OEM S. City / `AL fre State Zip Code d� '✓err-Z:S' ontractor�s y�ygtn�e`ss License o. Contractor's C76taattgo f California License No. Classification -I Number of Squares: Square Footage Description of Work: Cost of Work:$ Applicant's Signature Date: To Be Completed By City Staff Only Indicate As R-Received or N/A-Not Applicable 5 Completes sets of fully dimensioned,drawn to sate plans which Include: 1 set or documents which Include ❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Geo Tech/Soils Report(on ed only) ❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8%x 11) ❑ Foundation Plan ❑ Cross Section El Structural Calculations ❑ Plumbing Plan ❑ Single Line diagram for else.services over 400 AMP ❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan ` ❑ Sound Report-Residential Class Code: Indicate New Construction Alteration' Addition' Means/Method 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 it Indicate all Geo-tech.Haz.Zone At Project Sprinklered YES or NO that a 1 Coastal Zone Completion: Construction PP Y Type(s): C Of O YES or NO f Noise Zone Required? Listed on Historic Resources Inventory CITY PLANNING STAFF ONLY APPROVALS: Costal Commiss Arch.Review Board Landmark Comm. Planning Comm.Zoning Administrator Fee Exempt: City Project Elec.Vehicle Chargerl I Landmark Seismic Retrofit Ome pedIdalAass:Blldg_ roya Expedite Project(s): Child Care City Project Green Building Landmark I Affordable Housing For Staff Use Only BuildinglSafel Permit Specialist City Planning Civil Engineering EPWM-Admin I Transportation Mgml. Rent Control THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY