PMT15-03776 City of Menifee Permit No.: PMTIS-03776
29714 HAUN RD. Type: Residential Plumbing
<ACCELA? MENIFEE,CA 92586
MENIFEE Date Issued:
12/08/2015
PERMIT
Site Address: 25641 DRIFTVIEW DR,MENIFEE,CA Parcel Number: 339-450-009
92584 Construction Cost: $2,630.00
Existing Use: Proposed Use:
Description of REPLACE 50 GAL GAS WATER HEATER IN GARAGE
Work:
Owner Contractor
MARICELA JARA A R S AMERICAN RESIDENTIAL SERVICES OF
25641 DRIFTVIEW DR CALIFORNIA INC
MENIFEE,CA 92584 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 QQtt t Amount(S)
Residential Water Heater 1 83.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
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 builiding operations being carded 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_Bleg_Permit_Templale.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ 1 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:
Chapter 9(commencing with section 7000)of Division 3 of th Busin and By my signature below I acknowledge that,except for my personal residence in
Professions Code aA r9y license is in full force an - which I must have resided for at least one year prior to completion of
License Clas 1,0 License improvements covered by this permit,I cannot legally sell a structure that I have
Expires Signature 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
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 the following declarations: htto:/hvww.lecinfo.m.00v/calaw.html.
I have and will maintain a certificate of consentt of self-insure for workers'
compensation,issued by the Director of Industrial Relao rovided for by Date
Section 3700 of the Labor Code, for the performance of work for whichthis
permit is issued. Property Owner or Authorized Agent
Policy# ❑ By my Signature below, I certify to each of the following: I am the property
1 have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property ownerrhalf. I have read this
section 3700 of the Labor Code, for the performance of the work for which this application and the information I e provide correct. I agree to comply
permit is issued. y workers'oorppensation insurance carrier and policy number are: with all applicable ci cou ordinance nd stale laws relating to building
(Iw,1, ( cons�Iae ryy sentatives orcounty to enter the ahove-
Carrier L (�{ 5identiFf' tion, rposes. /1 p
Policy#W-7 6110k. Expires �I( 4 Date `r6
Property Owner or Authorized Agent 1(This section need not be completed if the permit is for City Business License# O�- /T��
one-hundred dollars($100)or less) ty _
❑ I certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not emPlov any persons in any manner so as to become subject to the Will the applicant or future building occupant handle hazardous material or a
workers compensation laws of California, and agree that Wish"became mixture containing a hazardous material equal to or greater that the
subject to the workers'compensation provisions of Se 37 Odf the Labor amounts specified on the Hazardous Materials Information Guide?
Code,I shall forthwith comply with those provisions DYES NNO
Applicant;_ 12 ikvI q Date; 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 DYES b 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 DYES ❑kNO
CONSTRUCTION LENDING AGENCY I have read the Hazardous terial Information Guide and the SCAQMD
hereby affirm that under the penalty of perjury there is a construction lending permitting checklist.I u tand mvrrequire nts under the Slate of
agency for the performance of the work which this permit is issued (Section California Health a ety Cr Section_ O5 and 25534 concerning
3097 Civil Code) hazardous m al re ✓
OWNER BUILDER DECLARATIONS 19YES / I2•��r,
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date r
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 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:
www.epa.gov/lead 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 purpose of sale). Firm Certification No.:
❑ 1, as owner of the property an exclusively contracting with licensed ❑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 contractorfs)pursuant to the Contractors State License Law). If vour protect does not comDIv with EPA RRP rule Please fill out the RRP
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
.&A . Menifee
DATE I Z `3 h� PERMIT/PLAN CHECK NUMBER ►"rt�' 0--3
TYPE: ❑COMMERCIAL MRESIDENTIAL [-]MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL [I MECHANICAL
❑NEW ®PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK //JJ C—QL-A(- wig 5c) &q wc—
PROJECTADDRESS y�[-�VICIJ L1�
ASSESSOR'S PARCEL NUMBER ",�C��.JI./�O LOT TRACT
)
OWNER NAME ry O L—N (Z A
ADDRESS U C-bi C ItL
PHONE :7n EMAIL
APPLICANTNAME V3 0 2 L,L�F—IJ
ADDRESS 16ao 'L.f 1(52S O
PHONE 95I py{ ( g371 EMAIL
CONTRACTOR'S NAME t�vc— O 2 OWNERBUILDERT ❑YES❑NO
BUSINESS NAME
ADDRESS I � W q L I IN{U�1 61- �c y£(1-50�-- CA
PHONE 9, rl 3111 / 37� EMAIL 2Q
CONTRACTOR'S STATE LIC NUMBER / `� / LICEN C IFICATION J(P
VALUATION$ �o3v LSO FT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I SMIP
INVOICE UNT
AMOUNT � PAID AMO
. O CASH O CHECK k O CREDIT CARD VISAIMC
PLAN CHECK FEES PAIDAMOUNT OCASH 0CHECK# 0 CREDIT CARD VISA(MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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