PMT15-03778 City of Menifee Permit No.: PMT15-03778
29714 HAUN RD. Type: Residential Plumbing
'c7�CCEUA—> MENIFEE,CA 92586
MENIFEE Date Issued: 12/08/2015
PERMIT
Site Address: 28655 PORTSMOUTH DR, MENIFEE, CA Parcel Number: 339-174-004
92586 Construction cost: $23,000.00
Existing Use: Proposed Use:
Description of INSTALL CLEANOUT ON SEWER LINE
Work:
Owner Contractor
PAUL MOORE A R S AMERICAN RESIDENTIAL SERVICES OF
28655 PORTSMOUTH DR CALIFORNIA INC
MENIFEE, CA 92586 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone:9012719700
A ALLEN License Number:765155
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNII
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Fee Description City Amount I$1
Piping/Repiping Single Family Residential 1 163.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 8.15
$199.15
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_Bldg_Pennit Template.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 Busln and By my signature below I acknowledge that,except for my personal residence in
Professions Code an l y license is in full force an which I must have resided for at least one year prior to completion of
License Clasp, 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 t the following for workers; htto./Aw leginfo.m.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
sI have and will maintain workers' compensation insurance, as required by owner or authorized to act on the property ownerrhalf. I have read this
ection 3700 of the Labor Code, for the performance of the work for which this application and the information I e provid correct. I agree to comply
perm@ is issued. y workers'compensation insurance carver and policy number are: with all applicable cl cou ordinan�d state laws relating to building
1 �Iv,1, 11 construction.I a nze r sentatives or county to enter the above-
Carrier L W{ �5 A r identified p rty fo ectioR rposes.
Policy#w L-7 ry)oo-L ( Expires D I t Date 12 erg_ I K
lT�l 4 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 emolov 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 lha sho become mixture containing a hazardous material equal to or greater that the
subject to the workers'compensation provisions of Se o 37 ,df the Labor amounts specified on the Hazardous Materials Information Guide?
Code,I shall forthwithcomply with those provisions DYES �NO
Applicant; I L A-1 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 N 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 ❑,NO
CONSTRUCTION LENDING AGENCY I have read the Hazardous tedal Information Guide and the SCAQMD
hereby affirm that under the penalty of perjury there is a construction lending permitting checklist.I u _.and require rtts under the State of
agency for the performance of the work which this permit is issued (Section California Health ety C ,Section. 05 and 25534 concerning
3097 Civil Code) )DYES
m re
OWNER BUILDER DECLARATIONS )DYES
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:
Any city or county that requires a permit to construct, alter, improve, demolish, EPA RENOVATION,REPAIR AND PAINTING(RRPI
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 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 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
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE PERMIT/PLAN CHECK NUMBER V l'5—
TYPE: []COMMERCIAL INRESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL [—]MECHANICAL
[-]NEW ®PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK I N-'5—1 1,L. L L,E,fl,t-1 0 L-twZ �SZU��
PROJECTADDRESS 5 90 PA 0aV (L - ?69LAI-�
ASSESSOR'S PARCEL NUMBER 37A- 1,t411D[;04 LOT TRACT
OWNER NAME L)lr OO&C
ADDRESS �JTFli
PHONE EMAIL
APPLICANT NAMES I-tof(z-P Aw-r 1 //
ADDRESS (QL0 W L N'DEIJ -5 - e 'ic"iOG
PHONE qs( 31.I � Q3Z EMAIL
CONTRACTOR'S NAME p (C_ OWNER BUILDER? ❑YES❑NO
BUSINESS NAME
ADDRESS rAgLO I.INDCa
PHONE q5 13L( 6r3-) ) EMAIL
CONTRACTOR'S STATE LIC NUMBER 7(p`SISS ICENSECLASSIFICATION C3�o
VALUATION$ 0,9, p �� L SO FT
APPLICANT'S SIGNATURE DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION to CITY OF MENIFEE BUSINE55 LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN ' SMIP
INVOICE �LlQ• PAIDAMOUNT
AMOUNT __lI 11 OCASH C)CHECK# OCREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT I OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER C 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
City of Menifee
Building & Safety Dept.
DEC 0 8 2015
Received
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U.EAN�
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-- V
CITY OF MENIFEE r'
BUILDING AND SAFETY DEPARTMENT r
PLAN APPROVAL
REVIEWED B 9� lLWAdIaI�IiS O►
DATE � /1
'Approval of these plans shall not be construed to be a permit for,or an
approval of,any violation of any provisions of the federal,state or city
regulations and ordinances, This set of approved plans must be kept on the c
jobsite until completion. �`