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PMT15-03821 City of Menifee Permit No.: PMT15-03821 _ 29714 HAUN RD. Type: Residential Plumbing ACC iLA> MENIFEE, CA 92586 MENIFEE Date Issued: 12/11/2015 PERMIT Site Address: 27085 MONK ST, MENIFEE, CA 92586 Parcel Number: 335-304-005 Construction Cost: $4,250.00 Existing Use: Proposed Use: Description of INSTALL TWO-WAY CLEANOUT ON SEWER Work: Owner Contractor ALLEN GROVER A R S AMERICAN RESIDENTIAL SERVICES OF 27085 MONK ST 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 CALIFORNU 965 RIDGE LAKE BLVD SUITE 201 MEMPHIS, CA 38120 Fee Description OQt Amount ISI Sewer 1 150,00 Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 General Plan Maintenance Fee-Plumbing 1 7.50 $185.50 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 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 forfefted. AA_Bldg 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 o he Busiss an By my signature below I acknowledge that,except for my personal residence in Professions Code an y license Is in full force and which I must have resided for at least one year prior to completion of License Cla c License improvements covered by this permit, 1 cannot legally sell a structure that I have Expires J I 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 of the following declarations: htto•/Avww.lecinfo.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 II 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 information I have provided is correct. I agree to comply permit is iss ed.My wod errs'c mpensation insurance Cartier and policy number are: with all applicable city a pun finances fate laws relating to building construction.I out re allves o s city or county to enter the above- Carrier I� I n4 f 7 identified pro or t ction es. Policy# y G�[3 I Expires W I t Date 12�I ('�{ 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 qq I certify that in the performance of the work for which this permit Is issued,I sh'al1 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 of9ARomia, and agree that if I should become mixture containing a hazardous material equal to or greater that the subject to the workers' tion visions of Section 3700 of the Labor amounts specified on the Hazardous Materials Information Guide? Code,I shall forth ' ith ose provisions. OYES CNO Applicant• ate; �- � � I� 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 ❑YES '151.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 OYES ❑ENO 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 unde tend my requiremen der the State of agency for the performance of the work which this permit is issued (Section California Health& C ,Section 25 d 25534 conceming 3097 Civil Code) hazardous me OWNER BUILDER DECLARATIONS 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 checkmafk(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 PAINTING RRP Any city or county that requires a permit to constmct, alter, improve, demolish, (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: ro www.epa.gov/lead 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 Contractors State 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 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 ❑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 contractors)pursuant to the Contractors State License Law). If your project does not comply with EPA RRP rule please fill out the RRP Acknowledgement C APPLICATION k6`Menifee A di i lbl—DATE 12 r 11-I 4'- PERMIT/PLAN CHECK NUMBER fFA 5- 0'3 z TYPE: ❑COMMERCIAL RESIDENTIAL []MULTI-FAMILY ❑MOBILEHOME POOL/SPA [_]SIGN SUBTYPE: []ADDITION ❑ALTERATION []DEMOLITION ❑ELECTRICAL ❑MECHANICAL ❑NEW [2]PLUMBING ❑RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK A) cL_ 2 IJo-fi- OLJ S&c je. PROJECTADDRESS D I�j�j.1;5ND�It sf ASSESSOR'S PARCEL NUMBER 5 --30!4'WJ LOT TRACT I Dr- OWNER NAME A Lt-J ('/Zo r?— ADDRESS e27063 ON,L y PHONE 5(0�? co�?& 0 EMAIL APPLICANT NAME Aporz--ej q (.-t. " ADDRESS nn 1ST I--1 1-11joaf..l S-r- e vgtcSiOG; PHONE `7J / 3'/l P37 f EMAIL CONTRACTOR'S NAME G>5coCE 2a0 i z=/- OWNER BUILDER? ❑YES❑NO BUSINESS NAME ADDRESS b,,JJ5'e+J ST PHONE �S .fit( 173-7 EMAIL CONTRACTOR'S STATE LIC NUMBER 7(p�J S� LICE LASSIFICATION (,3 Zp VALUATION$ 7 d L 5Q FT APPLICANT'SSIGNATURE DATE CITY STAFF USE ONL Y DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP INVOICE �/(/1�/� PAIDAMOUNT AMOUNT ' v �` O 1 rs CASH 0 CHECK# O CREDITCARD VISA/MC PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED 0 YES O ND DL NUMBER NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Department29714 Haun Rd. Menifee, CA 92586951-672-6777 www.cityofinenifee.us Inspection Request Line 951-245-5213 �?-7o S Pw k- s PT- city of Menifee v/ Building & Safety Dept. I tj 5 —I}— DEC 112M jwo 47 A4 C,Z). �RoN L v CITY OF MENIFEE BUILDING AND SAFETY PA.RWENT 5l 'AN APPROVAL C� REVIEWED B DATE `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 dty regulations and ordinances. This set of approved plans must be kept an the jobsite until completion.