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PMT15-01015 i City of Menifee Permit No.: PMT15-01015 i _ 29714 HAUN RD.MENIFEE, CA 92586 Type: Residential Plumbing MENIFEE Date Issued: 04/21/2015 PERMIT Site Address: 25373 MAMMOTH LAKES CIR, MENIFEE, Parcel Number: 339-471-015 CA 92584 Construction Cost: $1,549.00 Existing Use: Proposed Use: Description of REPLACE EXISTING WATER HEATER, SAME SIZE AND LOCATION Work: Owner Contractor CYNTHIA AMADOR A R S AMERICAN RESIDENTIAL SERVICES OF 25373 MAMMOTH LAKES CIRCLE CALIFORNIA INC MENIFEE, CA 92584 965 RIDGE LAKE BLVD STE 201 Applicant Phone: 9012719700 ANDREW ALLEN License Number: 765155 A R S INC DBA RESCUE ROOTER 1520 W LINDEN STREET RIVERSIDE, CA 92507 Fee Description Qtv Amount I$) Residential W�2Sef Heatcef I 83'OOA ,u.,.,. .ra u.r .4',w. 1..+. _sa, ,r..sa.,v. „kw.[_.5aua�mtro,.,.. .a�,ixi 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 underwhich 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 license is in full f ce and effec Code:The Contractor's License Law does not apply to an owner of a property License Cis License No. who builds or improves thereon, and who contracts for the projects with a Expires 7 Signature '�"z� licensed contractor(s)pursuant to the Contractors State License Law). WORKERS'COMPENSATION DECLARATION ❑ lam 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 1 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 .Q 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:htti)'//www.leginfo.ca.gov/calaw.html. permit is issued.My workers'compensation insurance carrier and policy number are: Carrier 1, (:/ZTY / r/Z, Property Owner or Authorized Agent Date Expires � Policy# t.J � ❑ 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 ordinancesapd state laws relating to building construction.I authori vep5ptntatives o s city or county to enter the above- ElI certify that in the performance of the work for which this permit is issued,I identified j-Oft r'ape ion I u poses. 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 ✓� (��2 f �( K subject to the workers'compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.. //� Property Owner or Authorized Agent Date City Business License# Date; f � � � ` Applicant; ����777/// ___� 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, DYES 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 pa NO 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 Q 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 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, qNO 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 Ej1'ES INFORMATION GUIDE AND THE SCAQMD PERMITTING she is exempt from icensure 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 D 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, HAZARDOUS MATERI REP G. p rty, or my employees with wages as their sole compensation,will do( )all of or( ) porting of the work, and the structure is PROPERTY O HORIZED NET 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). BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION ` 'Menifee DATE LI '1 r� 1 S PERMIT/PLAN CHECK NUMBER Fj— O 1 5 TYPE: ❑COMMERCIAL O RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ❑SIGN SUBTYPE: ❑ADDITION ❑ALTERATION []DEMOLITION ❑ELECTRICAL ❑MECHANICAL ❑NEW ©PLUMBING ❑RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK Jti1A'Tc.(L H6-A-rCA, (LEIPL/-kGu+ "j T' '/O 6AL 0" GAS I rj & $1S PROJECTADDRESS 26-3-73 MAMMOI t1 LAKES �2. ASSESSOR'S PARCEL NUMBER _539 L'I7 1 OI C LOT TRACT OWNER NAME 147"HiA AMA-00I, C' ADDRESS 253-73 P1AMK OFT_H LAI-;C 2. Building & Safety Dept. PHONE k1l 261 lqy6- EMAIL APR 2 1 2015 APPLICANT NAME A nJ D(LC--Q A L L E r3 ADDRESS 16aa W . L I rIDL=N S i F tve&6%0= L,q. 'd 2s0 7 PHONE 9Ct 3L/I 9,371 EMAIL CONTRACTOR'S NAME ( %eSC_I,JI=. "OO\c(L /FIQ OWNERBUILDER? ❑YES O BUSINESS NAME ADDRESS 920c(G.SLPc Lf 2S o7 PHONE 95-1 3y 1 93 7 1 EMAIL CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION L (p VALUATION $ 15"L►q L SQ FT APPLICANT'S SIGNATURE DATE q 2 0 ('r— DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN SMIP )C INVOICE I PAID AMOUNT AMOUNT 1 '`+CASH C)CHECK# i%CREDITCARD VISA/MC PLAN CHECK FEES PAID AMOUNT 4„CAS14 "CHECK# CREDIT CARD VISA/Mc OWNER BUILDER VERIFIED >YES " NO DLNUMBER NOTARIZED LETTER `.% YES iJ NO City of Menefee Building& Safety Department 29714 Haun Rd, Menifee, CA 92586 951-672-6777 www.cityofinenifee.us Inspection Request Line 951-246-6213 d S O M N n o rt V O a -. d N '! 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