PMT15-00950 City of Menifee Permit No.: PMT15-00950
29714 HAUN RD.
�i_ MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE Date Issued: 04/15/2015
PERMIT
Site Address: 29798 CORAL TREE CT, MENIFEE, CA Parcel Number: 340-073-013
92584 Construction Cost: $4,027.00
Existing Use: Proposed Use:
Description of REPLACE 40 GAL GAS WATER HEATER
Work:
Owner Contractor
DAVID MARTIN A R S AMERICAN RESIDENTIAL SERVICES OF
29798 CORAL TREE CT CALIFORNIA INC
MENIFEE, CA 92584 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone: 9512769744
LAURA YENULONIS License Number: 765074
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNb
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Fee Description Qtv Amount I$1
4Zes[tlenl IlVaterl eafer G 77 ,
.— =z
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 building 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_Permit_Template.rpt Page 1 of 1
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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 C e and my license is in full force and effect. Code:The Contractor's License Law does not apply to an owner of a property
License Class�License No.'l 5 -1 who builds or improves thereon, and who contracts for the projects with a
Expires? .�5 Signature - ^4' licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATION D CL RATION
❑ 1 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. built as an owner-building if it has not been constructed in its entirety by licensed
Policy# 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:htto'//www leninLo ca oov/calaw html.
permit is issued.My workers'compensation insurance carrier and policy number are:
\ roperty weer or Authorized Agent Carrier Date
\�IOV-�-
Expires \_Z (l Ca Policy#kilL'1lp if bS(03(0Iy
p AA ❑ By my Signature below, I certify to each of the following: I am the property
Name of Agent � ttj -rN� l.0 Phone#�Li;(n_�o'1 4, =ONJ� owner or authorized to act on the property owner's behalf. I have read this
t be completed if the permit is for application and the information I have provided is correct. I agree to comply
(This section need no
one-hundred dollars be 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-
El I certify that in the performance of the work for which this permit is issued,I identified property for the inspection purposes.
shall not employ any persons in any manner so as to become subject to the p
workers'compensation laws of California, and agree that if I should become
subject to the workers'compensation provisions of Section 3700 of the Labor grope er or
t Authorized Agent Date
Code,I shall forthwith comply with those provisions. - �
` City B"m Li nse#
I Date; �-�t-\�i^)S Applicant; V i � '�
WARNING: FAILURE TO E RE WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS UN UL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMIN 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 OR A
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES jkNO 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 AYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
� FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address _ZI NO 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 ❑YES 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, �O 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 ❑YES 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 ,Ld l4O UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE SECOUS IONMAT 2 5051';E 5533 AND 25534 CONCERNING
❑ I, as owner of the property, or my employees with wages as their sole
compensation, will do( )all of or( )porting of the work, and the structure is PROP RTY OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property, y M�—
provided that the improvements are not intended or offered for sale. If,however,
the building or improvement is sold within one year of completion, the Owner-
Builder will have the burden of proving that it was not built or improved for the
purpose of sale).
PERMIT/PLANBUILDING & SAFETY AP
Menifee
DATE —I — PERMIT/PLAN CHECK NUMBER `� 50
TYPE: O COMMERCIAL ESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW WLUMBING 0 RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK
PROJECTADDRESS , -7
ASSESSOR'S PARCEL NUMBER 2li1O"01 -D 1 LOT _ TRACT g
OWNER NAME ,,
ADDRESS
(y,���I"I 1 5
PHONE EMAILC _'�
APPLICANT NAME YV� J� -\ t(lo
ADDRESS a Qa
C J
PHONE EMAIL f Lorv�
CONTRACTOR'S NAME RRINOM -p WNER BUILDER? O YES NNO
BUSINESS NAME
ADDRESS ° CJ
PHONE 4'\ EMAIL c- r
CONTRACTOR'S STATE LIC NUMBER U`J�i'"�� LICENSE CLASSIFICATION
VALUATION$ - '1 .(, SO FT t nLSQ FT
APPLICANT'S SIGNATURE �� '� ' ATE
UTYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION O� CIT'OFMENIFEEBU[SI�NESS LICEN NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP �; ,j®�
AMOUM
INVOICE �\`PO PAID AMOUNT
" OCASH O[HELKk OCREDR CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECKN OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED ()YES 0 NO DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
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