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PMT15-04010 City of Menifee Permit No.: PMT15-04010 29714 HAUN RD. Type: Residential Plumbing '1 CC iUA->. MENIFEE,CA 92586 0-1kgyt, MENIFEE Date Issued: 12/29/2015 PERMIT Site Address: 28641 PORTSMOUTH DR,MENIFEE, CA Parcel Number: 339-174-005 92586 Constmctlon Cost: $16,856.00 Existing Use: Proposed Use: Description of REPLACE SEWER LINE, REDRAIN TWO BATHROOMS, INSTALL DUAL SWEEP CLEANOUTS Work: Owner Contractor MARK STRONG A R S AMERICAN RESIDENTIAL SERVICES OF 28641 PORTSMOUTH DR 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 CALIFORNI/ 965 RIDGE LAKE BLVD SUITE 201 MEMPHIS, CA 38120 Fee Description Dot r Amount($1 Plumbing Fixtures and Vents,fixtures 2 116.00 Sewer 1 150.00 Building Permit Issuance 1 27.00 GREEN FEE 1 1,00 General Plan Maintenance Fee-Plumbing 1 13.30 $307.30 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_Pern it_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 afire under penalty or perjury that I am licensed under provisions of following reason: Chapter 9(commencing with section 7000)of Division 3 of the Business_nd my signature below I acknowledge that,except for my personal residence in Professions Code and m Jicense is in fui force and effec / which I must have resided for at least one year prior to completion of License Class Ci 1p License No. 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: ❑ 1 hereby affirm under penalty of perjury one of the following declarations: http://www.feciinfo.ca.gov/calaw.html. 1 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 I have and will maintain workers' compensation insurance, as required by owner or authorized to act on the roperty owns' behalf. I have read this section 3700'of the Labor Code, for the performance of the work for which this application and the in ation aye provid correct. I agree to Comply emit is iss ed.1M workers'Com ensation insurance carder and policynumber are: with all applicable nd ordina nd stale laws relating to building P Y �y (( I p Constructior. on resentati is city or county to enter the above- Carder I Lr' T-1 ))1t identifie e r e7spe ' purposes. Policy# W(.Z 6tiJ�V"�(D h1 6cpires I Ica Date 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 ❑ 1 certify that in the performance of the work for which this permit is issued,I shall not employ any persons in anyjnanner so as to become subject to the Will the applicant or future building occupant handle hazardous material or a workers'compensation la f C ma nd agree that if I should became mixture containing a hazardous material equal to or greater that the subject to the workers' Peion visions of Section 3700 of the Labor amounts specifiedon the Hazardous Materials Information Guide? Code,I shall forth ' m ith se provisions. G DYES `� NO Applicant; r Date; Y Z"/ f }/ 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 bNO 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 El YES i ]NO CONSTRUCTION LENDING AGENCY I have read the Hazardous Material formati uide and the SCAQMD I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist.I u erstan y requ' ends under the State of agency for the performance of the work which this permit is issued (Section California Health f ty C ecti 5 05 and 25534 concerning 3097 Civil Code) h rdous mat po OWNER BUILDER DECLARATIONS ❑ S ❑ i I hereby affirm under penalty of perjury that I am exempt from the Contractor's Date Ucense 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.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 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). ❑ 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 properly 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 I � 0 TYPE: ❑COMMERCIAL RESIDENTIAL ❑MULTI-FAMILY []MOBILE HOME ❑POOL/SPA []SIGN SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION []ELECTRICAL []MECHANICAL [—]NEW OPLUMBING ❑RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK Lace,I ffSCwL,- -rvwQ c,A hCt>DMS 66\ Sw e.c JeG DJ js PROJECTADDRESs �Jl(,��2q�(j(-`/��MJ.G1"I�l C1r ASSESSOR'S PARCEL NUMBER LOT a � TRACT OWNERNAME �Ak�-L. ADDRESS 'A\ PHONE �� 3c C7 EMAIL APPLICANT NAME N 0(« A t_(,t,t_) ADDRESS 1S-2U C^j L ( rv\0 .IN 18-( vC9'S PHONE S S( 3�f I 1;3 7 EMAIL CONTRACTOR'S NAME fSCE c7-[-(` (L OWNERBUILDER? ❑YES❑NO BUSINESS NAME ADDRESS l��.O fi•.J Lfn.iOra" 51- VGYLs 0�- PHONE S-� ��{l Cj '� �/ EMAIL CONTRACTOR'SSTATE LIC NUMBER LICEN SSIFICATION CC VALUATIONS 1 4j5 w Q F L SO,FT q APPLICANT'S SIGNATURE DATE 12 - z CITY STAFF USE ONLY DEPARTMENT DISTRIBUTION /V CITY OF MENIFEE BU5INE55 LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN I SMIP INVOICE PAID AMOUNT AMOUNT I I I OCASH OCHECK# OCREDITCARD VISA/MC PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER :% 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 0uilding & Safety Dept. DEC 2 9 2015 Received 000 � Reamm J1 O �ooKS P E ~ INY(Rld, p�a� SwEcF LA.Et}rf ov:S CITY OF MENIFE -- BUILDING AND SAFETY DEPARTMENT V PLAN APPROVAL r`�Mv✓TF` 02 ? Q REVIEWED BY �Of DATE 'Approval of these plans shall not be construed to be a permit for,or an o 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 l► jobsite until completion. �--