PMT15-02783 i
City of Menifee Permit No.: PMT16-02783
29714 HAUN RD.MENIFEE, CA 92586 Type: Residential Plumbing
s usw", MENIFEE Date Issued: 09/09/2015
B
�A
PERMIT
Site Address: 26321 CHAMBERS AVE, MENIFEE, CA Parcel Number: 335-241-009
92586 Construction Cost: $2,262.00
Existing Use: Proposed Use:
Description of WATER HEATER REPLACEMENT40 GAL ELECTRIC IN GARAGE
Work:
Owner Contractor
RAMON TORRES A R S AMERICAN RESIDENTIAL SERVICES OF
26321 CHAMBERS AVE CALIFORNIA INC
MENIFEE, CA 92586 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone: 9012719700
ANDREW ALLEN License Number: 765155
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIi
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Fee Description Qtv Amount t$1
MR t
e 0
Building Permit Issuance 1 27.00
General Plan Maintenance Fee-Plumbing 1 4.15
$115.15
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
City Of Menifee
LICENSED DECLARATION ❑ 1 am exempt from licensors under the Contractors'State License Law for the
following reason:
I hereby affirm under penalty or perjury that I am licensed under provisions of
Chapter 9(commencing with section 7000)of Division 3 of She Busyness and By my signature below I acknowledge that, except for my personal residence in
Professions Code and- cnse is in full force and eff t .�`" �� which must have resided for at least one year prior to completion of
License Class License N I improvements covered by this permit, I cannot legally sell a structure that I have
�1
-'� - built as an owner-building if It has not been constructed in its entirety by licensed
Expires Signature
contractors. I understand that a copy of the applicable law, Section 7044 of the
WORKERS'COMPENSATION 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.leginfo.ca.gov/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
QQ,�,,, I 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
soon 3700 of the Labor Code, for the performance of the work for which this application and the information I have provided is correct. I agree to comply
permit is issued,Myworkers'compensation insurance carrier and policy number are: with all applicable city and county ggxrd�nces state laws relating to building
yy� construction.I au<�,repr aniatives o tiscity or county to enter the above-
Carrier 1 rU/l• lBg� identified propy�i ,o t ,,i 5�lectionq POPS. 0
/ Date
Policy# _ l^)I'��'0Jt>daG /� Expires a..-
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
❑ I certify that in the performance of the work for which this permit is issued, I
shall not emolov any persons in and maser so as to become subject to the Will the applicant or future building occupant handle hazardous material or a
workers'compensation lay�s of��aalifo,r��.i�and agree that if I should become mixture containing a hazardous material equal to or greater that the
subject to the workers'c�om��e9isat�i rf'provisions of Section 3700 of the Labor amounts specified on the Hazardous Materials Information Guide?
Code, I shall forth 'th c m01y w'ttY�yse provisio 5. ❑YES 19 NO
Applicant Date; 4 �/ 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 El YES lE7 NO
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 []YES '& NO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist. I understand my requirements under the State of
agency for the performance of the work which this permit is issued (Section California Health&Safety Code",Secti�2r5Oard25534 concerning
3097 Civil Code) hazardous material ir��gAmg. :j
OWNER BUILDER DECLARATIONS AYES ❑ NO�Z /
Date
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the reason(s)indicated below by the checkmark(s)I have placed PROPERTY 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 Iicensure 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:
www.epa.govdead or contact the National Lead Information Center at
❑ 1, as owner of the property, or my employees with wages as their sole 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).
❑ 1, as owner of the property an exclusively contracting with licensed El 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 FlII out the RRP
Acknowledgement.
APPLICATIONBUILDING & SAFETY PERMIT/PLAN CHECK
Menifee
DATE q 5 PERMIT/PLAN CHECK NUMBER
TYPE: dCOMMERCIAL RESIDENTIAL ❑MULTI-FAMILY [:]MOBILE HOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑MECHANICAL
❑NEW ❑PLUMBING ❑RE-ROOF-NUMBEEROF SQUARES
DESCRIPTION OF WORK 60 IA(t-11444- V <, a&-fC.L �(,J G4-/C4(>6
PROJECTADDRESS /-E
..��yyC AM 7 V E
ASSESSOR'S PARCEL NUMBER 71' (",J -OVI LOT TRACT L"ALf-I
OWNER NAME RPttto j 10tt _6-5
ADDRESS 26 Z C. Hwrk&fAgJE 'ram°
PHONE �jL� � ���� EMAIL
APPLICANT NAME t-Er-1
ADDRESS (-
G1 N,c,�PHONE ) 1JLJ+ 93-7I EMAIL
CONTRACTOR'S NAME y IULLµ,ga 5-eN%LLS OWNERBUILDER? ❑YES❑NO
BUSINESS NAME 14 0e T-f t—
ADDRESS 16atc vi L-(NvEN S +j v R-5 tOc C I-
PHONE 3c.41 EMAIL
CONTRACTOR'S STATE LIC NUMBER `J LICEE CLASSIFICATION L
VALUATION$ ET-%' L SO FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN 160 SMIP
INVOICE PAID AMOUNT
AMOUNT '15•I : CASH <}CHECK# '.'.'CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 'DCASH %CHECK# '"CREDITCARD VISA/MC
OWNER BUILDER VERIFIED 1 YES =:' NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building& Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityo finenifee.us Inspection Request Line 951-246-6213
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