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PMT15-00968 City of Menifee Permit No.: PMTIS-00968 29714 HAUN RD. Type: Residential Plumbing <R6CEI.-/�k MENIFEE, CA 92586 MENIFEE Date Issued: 04/16/2016 I PERMIT Site Address: 29010 DEL MONTE DR, MENIFEE, CA Parcel Number: 337-403-001 92586 Construction Cost: $14,000.00 Existing Use: Proposed Use: Description of REPLACE EXISTING WATER HEATER, SAME SIZE AND LOCATION, INSTALL DUAL SWEEP Work: CLEANOUT ON MAIN SEWER AND 35' LINER FROM CLEANOUT UPSTREAM Owner Contractor TER] DITASQUALE A R S AMERICAN RESIDENTIAL SERVICES OF 29010 DEL MONTE DRIVE CALIFORNIA INC MENIFEE, CA 92586 965 RIDGE LAKE BLVD STE 201 Applicant Phone: 9012719700 ANDREW License Number: 765155 A R S INC DBA RESCUE ROOTER 1520 W LINDEN STREET RIVERSIDE, CA 92507 Fee Description Qtv Amount I$1 Sewer 1� 150.00 GREEN FEE 1 1.00 $261.00 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 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 with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professions Professions Code and my license5i�F .fect. Code:The Contractor's License Law does not apply to an owner of a property License CI ss C. Licen �� who builds or improves thereon, and who contracts for the projects with a Expires 31 Signature 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 ❑ 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 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 en I have and will maintain workers' compensation Insurance, as required by Business and Professions Code,is available upon request when this application is action 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:htto'//www leoinfo.ca.gov/caIaw.htmL permit is issued.My workers'compensation insurance carrier and policy number are: Carrier L (NS Property Owner or Aut orized Agent Date Expires I o [I �� Policy d ❑ By 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 and county ordinances and state laws relating to building consi ri reprfeas Ives oft ' y or county to enter the above- ❑ I certify that in the performance of the work for which this permit is issued,I identifiedfied propert he coon purp shall not emolov any persons in any manner so as to become subject to the workers' compensation compensation laws of California, and agree that if I should become subject to the workers'compensation provisions of Section 700 of the or property Owner or Authorized Agent Date Code, I shall forthwith comply with those provisions i �6�'(� City Business License# Date; 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, ❑YES OCCUPANT HANDLEA HAZARDOUS MATERIAL ORA DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL LABOR CODE, INTEREST,AND ATTORNEYS FEES CJNO 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 IN 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, b NO 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 AYES 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 ❑ I, as owner of the property, or my employees with wages as their sole HAZARDOUS MAT RIA PORYING,// compensation,will do( )all of or ( ) porting of the work, and the structure is PROPERTY OR AUTHO&r;6'�GENT not intended or offered for sale.(Section 7044,Business and Professions Code; I 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). BUILDING & SAFETY PERMIT/PLAN CHECK A. • • uilding & SafetyeDept. Menifee APR 16 2015 DATE 6- s PERMIT/PLAN CHECK NUMBER TYPE: ❑COMMERCIAL ®RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME POOL/SPA ❑SIGN SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑MECHANICAL ❑NEW F❑PLUMBING ❑RE-ROOF-NUMBER OF SQUARES /Hp o0 DESCRIPTION OF WORK 0 1H ( M H 0 J M n a 4 W ✓ 351 G✓ -t7O lean awY iM m PROJECT ADDRESS Zq 01 D i9el gm4e Or. ASSESSOR'S PARCEL NUMBER 137 goy peu LOT TRACT OWNER NAME e('� 17; ADDRESS Q ooQ DC / �GDn� J/ ,� Jfl PHONE 20b> T 3l, gb, —n EMAIL APPLICANT NAME L i-6,tj ADDRESS /yl 6004V PHONE /� EMAIL CONTRACTOR'S NAME Aa5coz; OWNER BUILDER? ❑YES NO BUSINESS NAME ��// ff ADDRESS SZrJ tj L-WDFw.f S KWe✓5 OL- RSp PHONE S l '{ �I I q rS EMAIL CONTRACTOR'S STATE LIC NUMBER ?(pslS 5 LICENSE CLASSIFICATION VALUATION $ Poo Q FT L SQ FT APPLICANT'S SIGNATURE DATE CITYSTAFFUSEONLY DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP INVOICE _ AMOUNT �„ PAID AMOUNT CASH >CHECK# :i CREDIT CARD VISA/MC PLAN CHECK FEES PAIDAMOUNT c; CASH v''CHECKA CI CREDIT CARD VISA/MC OWNER BUILDER VERIFIED ("YES ';% NO DL NUMBER NOTARIZED LETTER 0 YES C NO City of Menifee Building& Safety Department 29714 Houn Rd. Menifee, CA 92586951-572-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 Qity of atf e $wilding & Safefety Dept, (f l T DATE APR 16 2015 s ,awheapermitfor,oran eic iVed p:o,isions of the federal,state or city ,, „flu of dinance,. 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