PMT15-02686 City of Menifee Permit No.: PMT15-02686
29714 HAUN RD.MENIFEE, CA 92586 Type: Residential Plumbing
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W", MENIFEE Date Issued: 0 812 812 01 5 l�
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PERMIT
Site Address: 29415 CARMEL RD, MENIFEE, CA 92586 Parcel Number: 338-072-025
Construction Cost: $3,500.00 'I
Existing Use: Proposed Use:
Description of INSTALL DUAL SWEEP CLEANOUT ON SEWER LINE
Work:
Owner Contractor
EARL WINN A R S AMERICAN RESIDENTIAL SERVICES OF
29415 CARMEL ROAD CALIFORNIA INC
MENIFEE, CA 92586 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone: 9012719700
ANDREW ALLEN License Number: 765155
A R S INC DBA RESCUE ROOTER
1520 W LINDEN ST
RIVERSIDE, CA 92507
Phone: 9513419371
Fee Description OQrt Amount 1$1
e
Building Permit Issuance 1 27.00
F E
$178.00
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 staled, 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 am exempt from licensure under the Contractors'State License Law for the
I hereby affirm under penalty or perjury that I am licensed under provisions of following reason:
Cha
ter 9
cing with
ion
By my signature below I
e that, except for my personal residence in
Prof
ssions
is in full
which I must have
for
t least one year prior to
on of
Expires
x License
Cie �j anted/ny license S toat r000f of e Business � as an improvements covered
o er owner-building resided
Itdhasrmit, I cannot
oot legally
s I a structure
by tIhave licensed
p �i g contractors. I understand that a copy of the applicable law, Section 7044 of the
WORKERS'C MPENSATION DECLARATION Business and Professions Code,is available upon request when this application is
submitted or at the following Web site:
❑ I hereby affirm under penalty of perjury one of the following declarations: http://www.leoinfo.ca.00v/calaw.html.
I have and will maintain a certificate of consent of self-insure for workers'
compensation, issued by the Director of Industrial Relations as provided for by Date
Section 3700 of the Labor Code, for the performance of work for which this
permit is issued. Property Owner or Authorized Agent
Policy# ❑ By my Signature below, I certify to each of the following: I am the property
have and will maintain workers' compensation insurance, as required by
owner or authorized to act on the property owner's behalf. I have read this
section 3700 of the Labor Code, for the performance of the work for which this application and the info>r,-, firm 1- ave providd correct. I agree to comply
permit is issued.Myworkers'compensation insurance carrier and policy number are: with all applicable cif.9'nif aJ•nty ordman e�-nd state laws relating to building
constr, ut�y�n�-( r�sentative ytK,,pity or county to enter the above-
Carrier � 1/1 fg ( identife o a fLhe' s ection uses` �+ l
Policy# W�(y�i t�`'a�" I Expires 4 Cy l ( ' - Date
Property Owner or Authorized Agent
(This section need not be completed if the permit is for City Business License#
one-hundred dollars($100)or less)
HAZARDOUS MATERIAL DECLARATION
❑>,(certify that in the performance of the work for which this permit is issued, 1
shall not employ any persons in any manner so as to b come subject to th
= Will the applicant or future building occupant handle hazardous material or a
workers' compensation laws of California, and agrepAKst if I,sh6u1d begprrfe mixture containing a hazardous material equal to or greater that the
subject to the workers'compensation provisions ect'on-Voo of l 61-abor
�P ,� ..�' amounts specified on the Hazardous Materials Information Guide?
Code, shall forthwith comply with those pro r6n � ❑YES ENO
Applicant; �r D Will the intended use of the building by the applicant or future building
occupant require a permit for the construction or modification from South
WARNING: FAILURE TO SECURE WORKERS' Coast Air Quality Management District(SCAQMD)?See permitting checklist
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL for guidelines
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND EYES SNO
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, Will the proposed building or modified facility be within 1000 feet of the outer
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE boundary of a school?
LABOR CODE, INTEREST,AND ATTORNEYS FEES DYES LSNO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information ide and the SCAQMD
I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist. I ygyFrderstand my requir ents under the State of
agency for the performance of the work which this permit is issued (Section California Health&S'afety Code,Sectio 505 and 25534 concerning
3097 Civil Code) hazardous ra repwrting.
OWNER BUILDER DECLARATIONS Ell YES
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date r�l}
License Law for the reason(s)indicated below by the checkmark(s)I have placed ISROPERTY OWNER OR AUTHORIZED AGENT
next to the applicable item(s)(Section 7031.5. Business and Professions Code:
Any city or county that requires a permit to construct, alter, improve, demolish, EPA RENOVATION, REPAIR AND PAINTING (RRP)
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 The EPA Renovation, Repair and Painting(RRP)Rule requires contractors
provisions of the Contractor's State License Law (Chapter 9 (commencing with receiving compensation for most work that disturbs paint in a pre-1978
Section 7000)of Division 3 of the Business and Professions Code)or that he or residence or childcare facility to be RRP-certified firms and comply with
she is exempt from licensure and the basis for the alleged exemption. Any required practices.This includes rental property owners and property
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to managers who do the paint-disturbing work themselves or through their
a civil penalty of not more than ($500).) employees. For more information about EPA's Renovation Program visit:
❑ I, as owner of the property, or m employees with wa es as their sole. www.epa.gov/lead or contact the National Lead Information Center at
p p Y y9 1-800-424-LEAD(5323).
compensation,will do( ) all of or( ) porting of the work, and the structure is
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 ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
who, through employees' or personal effort, builds or improves the property,
provided that the improvements are not intended or offered for sale.If,however, Certified Firm Name:
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 Firm Certification No.:
purpose of sale).
❑ I, as owner of the property an exclusively contracting with licensed Ll No EPA Lead-Safe Certified Firm is required for this project because:
contractors to construct the project(Section 7044, Business and Professions
Code:The Contractor's License Law does not apply to an owner of a property
who builds or improves thereon, and who contracts for the projects with a
licensed contractor(s)pursuant to the Contractors State License Law). If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
i
BUILDING SAFETY PERM IT/PLAN CHECK APPLICATION
Menifee
DATE Z �� PERMIT/PLAN CHECK NUMBER
TYPE: ❑COMMERCIAL N RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION [:]ELECTRICAL ❑MECHANICAL
❑NEW ❑PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK L ' ' USJ
t
PROJECT ADDRESS C>7 _
ASSESSOR'S PARCEL NUMBER ', 01&•(095 LOT TRACT City of Menife
ul Ing a ety ept.
OWNER NAME I„R(Z �jIoN
ADDRESS _
PHONE , 3og 3 3 h'(o "'/ t/6 EMAIL
APPLICANT NAME L r3 n
ADDRESS w 51— V 0 C✓4 %5_V
PHONE EMAIL
CONTRACTOR'S NAME (_L2L= OWNER BUILDER? OYES2940
BUSINESS NAMES
ADDRESS 1 6;'2 c) L S_ c—
PHONE 951 SLI1 // EMAIL
CONTRACTOR'S STATE LIC NUMBER -7U61gj 'ICENSE CLASSIFICATION �O
VALUATION$ �jOC7 S FT / LSQFT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY —
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN 1 SMIP K
INVOICE 1 PAIDAMOUNT
AMOUNT <..•CASH 'C'CHECK# UCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH ':.'CHECK# `.'CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED YES `' NO DL NUMBER NOTARIZED LETTER YES C:^ NO
City of Menifee Building&Safety Department 29714 Houn Rd, Menifee, CA 92586 951-5 72-6 777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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City of Menifee
Building & Safety Dept,
AUG 2 8 2015
ReceNed
UN
CITY OF MENIFEE
BUILDING AND SAFETY DEPART E Tc
PLAN APPROVAL `n
�J u ►
REVIEWED BY
DATE
'Approval of these plans shall not be construed to be a permit I or,or an
approval of,any violation of any PF9Vi;iQAS of the fecclee I,state or city QQ��
7� 1-1t" n§end1$dinances. This set of approved plans must b kept on the
job unt 1 ompletion.
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