PMT15-03777 City of Menifee Permit No.: PMT15-03777
29714 HAUN RD.
�RCCELA MENIFEE,CA 92586 Type: Residential Plumbing
MENIFEE Date Issued: 1 210 812 01 5
PERMIT
Site Address: 23870 LODGE DR, MENIFEE, CA 92587 Parcel Number: 350-244-038
Construction Cost: $3,600.00
Existing Use: Proposed Use:
Description of REPLACE 40 GAL ELECTRIC WATER HEATER IN EXTERIOR ENCLOSURE
Work:
Owner Contractor
JOSE AYALA A R S AMERICAN RESIDENTIAL SERVICES OF
23870 LODGE DR CALIFORNIA INC
MENIFEE, CA 92587 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone:9012719700
ANDREW ALLEN License Number:765155
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNU
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS,CA 38120
Fee Description O-t. Amount ISI
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 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_8Idg_Permit_Template.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION ❑ lam 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 a94 i Jy license is in full force and of - which I must have resided for at least one year prior to completion of
License Cla l0 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: hh,>p:/A w .leginfo.m.gov/calaw.htmi
I have and will maintain a certificate of consentt of self-insure for workers'
compensation,issued by the Director of Industrial Relations as provided for by Dale
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
secI have and will maintain workers' compensation insurance, as required by owner or authorized to act on the rope owner"half. I have read this
p
tion 3700 of the Labor Code, for the performance of the work for which this application and the information I v-ee prde '§cdrect. I agree to comply
permit is issued. y workers'corpensation insurance carrier and policy number are: with all applicable ci cou ordinance nd late laws relating to building
t ( construction.I a nze r tenta8ves or county to enter the above-
Carrier L < r N� idenlifiedp rty fo nspecbon,p rposes. y
Policy#W(.7 b�y1S0Kn Expires I �, (y, Date
t 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)
❑ I certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIAL DECLARATION
shall not employ 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��'YYppsho�d become mixture containing a hazardous material equal to or greater that the
subject to the workers'compensation provisions of Se "(or�37 0,df the Labor amounts specified on the Hazardous Materials Information Guide?
Code,I shall gforthwith comply with those provisions DYES kNO
Applicant; 1 Z��'��'7 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 El YES 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 EkNO
CONSTRUCTION LENDING AGENCY I have read the Hazardous_yaterial Information Guide and the SCAQMD
I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist.1 u 'Stand require ills under the State of
agency for the performance of the work which this permit is issued(Section California Health a ety C ,Section, O5 and 25534 concerning
3097 Civil Code) hazardous m al�re
OWNER BUILDER DECLARATIONS BYES
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date
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: EPA RENOVATION.REPAIR AND PAINTING lRRP Any city or county that requires a permit to construct, alter, improve,demolish, )
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.govAead or contact the National Lead Information Center at
❑ I, 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 Slate License Law does not apply to an owner of a property O 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 Finn 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 ❑No EPA Lead-Safe Certified Finn is required for this project because:
contractors to construct the project(Section 7044, Business and Professions
Code:The Contractors 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 contraclorls)pursuant to the Contractors State License Lawl. If vour proiecl does not comoly with EPA RRP rule please fill out the RRP
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
AS, Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: ❑COMMERCIAL ®RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION []DEMOLITION [-]ELECTRICAL []MECHANICAL
❑NEW ❑PLUMBING ❑RE-ROOF-NUMBEROFSQUARES
DESCRIPTION OF WORK 6 L4o &AL- tic-vv,<<-
PROJECTADDRESS -5 8770 LL?Ovc Ore-
ASSESSOR'S PARCEL NUMBER �,�� dt44 -0✓OLOT r-_-� TRACT
OWNER NAME 005tr` PrLA
ADDRESS 23 f37 0 t -v obc- -Q 71-
PHONE 9s 1 7919 23011 EMAIL
APPLICANT NAME rl {Ji(LLl w '�'I�IIJ
ADDRESS ST cVEI�57 QL.
PHONE q51 5W g3-7 EMAIL
CONTRACTOR'S NAME rSC.uG 4a 'U7� OWNER BUILDER? ❑YES❑NO
BUSINESS NAME
ADDRESS iGa1b W
PHONE G'ISl 3tef 0-? ( EMAIL
CONTRACTOR'S STATE LIC NUMBER (jSISS LICENSE CLASSIFICATION
VALUATION$ 0 O � QFF g
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION I.A CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN ' SMIP
INVOICE ,5 5 PAIDAMOUNT
AMOUNT 1 0CASH 0CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES 0 NO DL NUMBER NOTARIZED LETTER O YES >> NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-6 72-6777
www.cityofinenifee.us Inspection Request line 951-246-6213
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