PMT15-04011 City of Menifee Permit No.: PMT15-04011
29714 HAUN RD. Type: Residential Plumbing
S+-CCEL/-> MENIFEE,CA92586
-"-A 3A.- MENIFEE Date Issued: 1212912015
PERMIT
Site Address: 26255 SUNNYWOOD ST, MENIFEE, CA Parcel Number: 335412-001
92586 Construction Cost: $1,700.00
Existing Use: Proposed Use:
Description of REPLACE 30 GAL GAS WATER HEATER IN GARAGE
Work:
Owner Contractor
TED HYBBERT A R S AMERICAN RESIDENTIAL SERVICES OF
26255 SUNNYWOOD 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 PI r Amount
Residential Water Heater 1 83.00
Building Permit Issuance 1 27.00
Additional Plan Review Plumbing 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_B1d9 Permit 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 the Businessand my signature below I acknowledge that,except for my personal residence in
Professions Code and my Jcense is in full force and effec which I must have resided for at least one year prior to completion of
License Class v ly License No. improvements covered by this permit,I cannot legally sell a structure that I have
Expires 9JI 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: hHo://www.lealnio.p.cov/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
I have and will maintain workers' compensation insurance, as required by
owner or authorized to act on the roperty owne' behalf. I have read this
section 3700 of the Labor Code, for the performance of the work for which this application and the inf tion ave provid correct. I agree to comply
permit is iss ed.My workers'compensation insurance carrier and policy number are: with all applicable nd ordina nd stale laws relating to building
construction. o' resents' iscityorcountyloentertheabove-
Carrier IbCV IHf identifie e r e�spe purposes.
Policy# IJL,_7 JItt�V§(a 51 Expires loI Date l2'Z�j`a 5
Property Owner or Authorized Agent
(This section need not be completed if the permit is for City Business Ucense#
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 any_imanner so as to become subject to the Will the applicant or future building occupant handle hazardous material or a
workers'compensation la f mia nd agree that if I should become mixture containing a hazardous material equal to or greater that the
subject to the workers' Wipe on visions of Section 3700 of the Labor amounts specified on the Hazardous Materials Information Guide?
Code,I shall forth m ith se provisions. G OYES kNO
Applicant; Date; I �' 2-/ r 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(SCAOMD)?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
($1 00,000), 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 ❑YES 'U NO
CONSTRUCTION LENDING AGENCY I have read the Hazardous Material formate uide and the SCAOMD
I hereby affirm that under the penalty of perjury there is a construction lending permitting checklist.I u erstan y requ' ants under the State of
agency for the performance of the work which this permit is issued (Section California Health f ty C ecti 5505 and 25534 concerning
3097 Civil Code) h@zardous me po
OWNER BUILDER DECLARATIONS 131(ES i
1 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(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
❑ I, as owner of the property, or my employees with wages as their sole 1-80D-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 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
x'.
Menifee
DATE cl I S PERMIT/PLAN CHECK NUMBER I5- O
TYPE: ❑COMMERCIAL Q RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION []ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑MECHANICAL
❑NEW QPLUMBING ❑RE-ROOF-NUMBEROFSQUARES
DESCRIPTION OF WORK ( CW16 C7 G JJ o-v-
PROJECTADDRESS U
ASSESSOR'S PARCEL NUMBER 15�G% 'L( W '� 1(7� ' LOT L � TRACT 057 �'
OWNER NAMEY, WC✓�-
ADDRESS 1(0�-
01
PHONE "15 ) �b/� `�- Z EMAIL
APPLICANT NAME A N oat -1 A L-L E-r,, nn
ADDRESS vj ST fZ-tvGvCS Vp L
PHONE �' 3-7 1 EMAIL
CONTRACTOR'S NAME :s C-uG -i—'TL. OWNERBUILDER? ❑YES❑NO
BUSINESS NAME I
ADDRESS /yc v ,{Jv�
PHONE �' j � 1j-7 EMAIL
CONTRACTOR'S STATE LIC NUMBER /U/CE CLASSIFICATION C
VALUATION$ 1700 / LSQFT
APPLICANT'S SIGNATURE / DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION ,•n CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN 6v SMIP
INVOICE tk�^•'�j-� PAIDAMOUNT O
AMOUNT "/ �J OCASH OCHECKN CREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH OCHECKA OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER 0 YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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