PMT16-00523 City of Menifee Permit No. PMT16-00523
29714 HAUN RD.
�F►CCEL/ > MENIFEE,CA 92586 Type: Residential Plumbing
r.�.,...-.,,Wk—' MENIFEE Date Issued:
03/01/2016
PERMIT
Site Address: 23710 CYPRESS PL, MENIFEE, CA Parcel Number: 350-262-031
92587 Construction Cost: $3,200.00
Existing Use: Proposed Use:
Description of INSTALL SEWER CLEAN OUT
Work:
Owner Contractor
LINDA AYALA A R S AMERICAN RESIDENTIAL SERVICES OF
23710 CYPRESS PLACE CALIFORNIA INC
MENIFEE, CA 92587 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone:9012719700
ANDREW ALLEN License Number:765155
A R S INC DBA RESCUE ROOTER
1520 W LINDEN STREET
RIVERSIDE,CA 92507
Phone:9513419371
Fee Description gyt Amount t$1
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 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_Permt_Template.rpl Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARA71ON property who builds or improves thereon,and who contracts for the projects
I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter!)(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect the following reason:
License Class
ee License No By my signature below I acknowledge that,except for my personal residence
Expires S G signature in which I must have resided for at least one year prior to completion of
improvements covered by this permit I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
❑I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section
have and will maintain a certificate of consent of self-insure for workers 7044 of the Business and Professions Code,is available upon request when
compensation,issued by the Director of industrial Relations as provided for this application is submitted or at the following website:
by Section 3700 of the Labor Code,for the performance of work for which www.IeRinfo.ca.gov/caIa%v.html.
this permit is issued.
Policy R Date
VI have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which ❑By my signature below I certify to each of the following:I am the property
this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this
numberart application and the information have provid5ijjis correct.I agree to comply
with all applicably an n ordina and state laws relating to
Carter r1 building con io a prize re ntatives of this city orcountyto
Policy♦ V-1c 1 I �'�3( Expires �.'D l b enter th led pro In pection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
d I certify that in the performance of a work fo ich this permit is issued,
I shall not employ any persons' y mann as to me subject to the CITY BUSINESS LICENSE g
workers compensation I alifo nd a a[if I should become HAZARDOUS MATERIAL DECLARATION
subject to the work c en rovi ' fsection 3700 of the Labor
Cade,I shall fo th r isions. I Will the applicant or future building occupant handle hazardous material or a
Applicant Date mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 ❑Yes d�No
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYERTO CRIMINAL PENALTIES Will the intended useof the building by the applicant or future building
AND CIVIL FINES UPTO ONE HUNDREDTHOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LIBOR CODE,INTEREST,AND ATTORNEYS FEES forguidel Pas
CONSTRUCTION LENDING AGENCY ❑Yes ❑No
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) ❑Yes td No
OWNER BUILDER DECLARATIONS Ihave read the Hazardous Ma rial Informa' Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist rstand m me nder the State of
Contractors License Law for the reason(s)indicated below by the California He it f�ty Cod 255 and 25534 concerning
checkmark(s)I have placed next to the applicable items)(Section 703L5 (h,�rzardou to epo g.
Business and Professions Code).Any city or county that requires a permit to _' D No
Date l I cY
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED AGENT
issuance,also requires the applicant for the permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRPI
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)or that he or she is exempt from Iicensure receiving compensation for most work that disturbs paint In a pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with
an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property
than($500), managers who do the paint-disturbing work themselves or through their
❑I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.eoa.¢ov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800.424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
Property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
❑I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RR
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
4)�
R"Menifee
DATE 3 PERMIT/PLAN CHECK NUMBER
TYPE: ❑COMMERCIAL ❑RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECFRICAL ❑MECHANICAL
[-]NEW QPLUMBING [I RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK iv S i Al t ��vi ;j Se. G�
J PROJECTADDRESS ,3-71 (2, S 9L 1
'ASSESSOR'S PARCEL NUMBER �' ' 'd19o1�[ � LOT TRACK.
Building & Safety Depi.
OWNER NAME IiINn� l�yP�l--A;
ADDRESS MAR 0 1 2016
PHONE `71LA 31 9) 31 (p3 EMAIL R
APPLICANT NAME p(L�
ADDRESS I aiD W LIN(JGN 5T
PHONE �57; �541 q-9-7 1 EMAIL
CONTRACTOR'S NAME P,16,5LVG V-001-*- - OWNERBUILDER? ❑YESE§NO
BUSINESS NAME C�
ADDRESS J69-fJ LrIJO+=.iJ S't" �.tvL(L-8�0� G� I407
PHONE q'5-1 --p!L4 1 EMAIL
CONTRACTOR'S STATE LIC NUMBER (0 TCENSE IFICATION
VALUATION$ )O 0 FT / L SQ FT 2 II _
APPLICANT'S SIGNATURE DATE J I W
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE /' PAIDAMOUNT OCASH OCHECK# 0CREDIT CARD VISA/MC
AMOUNT I 5 ' 0 5 6i0
PLAN CHECK FEES PAIDAMOUNT O CASH O CHECK q O CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O 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
9, 3-710
City of Menifee
Building & Safety Dept.
MAR 0 12016
Received
1Nsi�a�`
CITY OF MENIFEE
1
BUILDING AND SAFETY DEPARTMENT
L Cy 7 PLAN APPROVAL
REVIEWED BY- U&IA g 1 ,
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 city
regulations and ordinances. This set of approved plans must be kept on the
jobsite until completion,