PMT16-01242 City of Menifee Permit No.: PMT16-01242
_ 29714 HAUN RD.
'�CCEL/-> MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE Date Issued: 04/2012016
PERMIT
Site Address: 29087 OAK DALE RD, MENIFEE, CA Parcel Number: 339-334-002
92584 Construction Cost: $1.300.00
Existing Use: Proposed Use:
Description of REPLACE 50 GALLON GAS WATER HEATER, SAME LOCATION
Work:
Owner Contractor
SUSAN KARR A R S AMERICAN RESIDENTIAL SERVICES OF
29087 OAK DALE RD CALIFORNIA INC .
MENIFEE, CA 92584 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone:9512769744
KENNY PEERY License Number.765074
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNI,i
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS,CA 38120
Fee Description gty Amount lS)
Residential Water Heater 1 83.00
Building Permit Issuance 1 27.00
GREEN FEE 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.
6
AA_Bldg Permit_Template.rpt Page 1 of 1
f CITY OF MENIFEE
/ LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
j( I hereby affirm under penalty of perjury that 1 am under provisions of with a licensed mntrector(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contractor's State License Law far
Professions Code and my license is in full force and effect, the following reason:
License Class I,(D'c License No. 65 7 By my signature below l acknowledge that,except for my personal residence
Expires (a-3b-17 Signature in which l 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 fallowing 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 worker's 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 ,,,v,A,.leeinfo.ca.eov/calaw.html.
this permit is issued.
Policy# Date
❑I have and will maintain worker's 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 worker's compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this
number art: f� application and the information I have provided is correct.I agree to comply
Carrier 1__ d/ 1 1 F with all applicable city and county ordinances and state laws relating to
--7 building construction.I authorize representatives of this city or county to
Polity#701500( 101 s/ Expires �o't30 1 / enter the above identified properly for inspection 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
❑I certify that in the performance of the work for which this permit is issued, rs 7> 7//�
I shall not emPlov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# 1!73&0 '
workers compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
C I shall forthv ith comply with se provisions. 't Will the applicant or future building occupant handle hazardous material or a
icant �, `UU• l mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
ARNING:FAILURE SE016ORKER'S O NSATION COVERAGE IS ❑Yes aRo
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND 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(SC[ion or See permitting checklist
IN SECOON 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES fo Coast
AirlQua
CONSTRUCTION LENDING AGENCY Dyes 0<0
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 A*90
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAOMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist I understand my requirements under the State of
Contractor's License Law for the reason(s)indicated below by the - California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous aterial reporting.
es No
Business and Professions Code).Any city or county that requires a permit to �—�—`
construct,alter,improve,demolish or repair any structure,priorto its Date
issuance,also requires the applicant for the permit to file a signed statement ROPERTYO N OR AU O AGE
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRPI
License Law(Chapter 9(commencing with Section 70D0)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 than($500). eq P p perry owners and property
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.gov/lead or contact the NationalLead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Cade,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 RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
5
,, Menifee
DATE 2q-c5k) 16 PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL e'YRESIDENTIAL O MULTI-FAMILY 0 MOBILE HOME r, POOL/SPA O SIGN
SUBTYPE: :%ADDITION :%ALTERATION O DEMOLITION O ELECTRICAL c' MECHANICAL
ONEW APLUMBING " RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK 50 �O-/ nA) ` -b�ne
PROJECT ADDRESS 0?969 G1Wk #� Kh MfAf AK � g� �8
ASSESSOR'S PARCEL NUMBER 1>3 ` 33 - 00;1,LOT I 4 TRACT �j D
OWNER NAME ADDRESS c �7 Ivi PfE7 Crd/ 9aSp p
PHONE �q�9 �� -3�(.b EMAIL
APPLICANT NAME v
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME 04 n7i OWNER BUILDER? O YES NO
BUSINESS NAME n
ADDRESS 0 3Q I l CA! 9a7,50
PHONE 8a) f�1e�_�� `75 EMAIL
CONTRACTOR'S STATE LIlC,NUMBER 74,56 7� Cjj LICENSE CLASSIFICATION C 0 C3
VALUATION $ 13UrJ Db SO FT 114 �p� L SQ FT
APPLICANT'S SIGNATURE DATE -ao- 141
s I �
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP '`, �� \(�
INVOICE `/ PAIDAMOUNT v,
AMOUNT J CASH CHECK# �>CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED CO YES 0 NO DL NUMBER NOTARIZED LETTER 0 YES :) NO
City of Menifee Building&Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-6177
www.cityofinenifee.us Inspection Request Line 951-246-6213
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