PMT16-01356 City of Menifee Permit No.: PMT16-01356
29714 HAUN RD.
�ACCELAl7. MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE Date Issued: 04/28/2016
PERMIT
Site Address: 29227 PEBBLE BEACH DR, MENIFEE, Parcel Number: 338-085-002
CA 92586 Construction Cost: $10.500.00
Existing Use: Proposed Use:
Description of REDRAIN BACK-TO-BACK BATHROOMS, REPLACE 35 FT OF SEWER&INSTALL CLEANOUT
Work:
Owner Contractor
THOMAS FISHER A R S AMERICAN RESIDENTIAL SERVICES OF
29227 PEBBLE BEACH DRIVE CALIFORNIA INC
MENIFEE, CA 92586 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone:9012719700
ANDREW ALLEN License Number:765155
A R S INC DBA RESCUE ROOTER
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Fee Description Oti Amount is
Sewer 1 150.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1,00
General Plan Maintenance Fee-Plumbing 1 7.50
$185.60
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_Permit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts forthe 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).
Chapter9(commencing with section 7000)of Division 3 of the B " ess an ❑I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effe the following reason:
License Oass Ucen 0. By my signature below I acknowledge that,except for my personal residence
Expires 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 builtas an owner-builder if it has not been constructed in Its entirety by
❑I hereby affirm under penaltyof perjury one of the following declarations:I licensed contractors.I understand thata 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 www.leeinfo.ra.eov/calaw.Ntml.
this permit is issued.
Policy 4 Date
{} ave and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
Ilion 3700 of the Labor Code,for the performance of the workfor 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 th perty o rs behalf.I have read this
number are: application and the inf a" jr,
Fir d is correct.I agree to comply
Cartier / I with all applicabl a unes and state laws relating to
huilding con ti authoriza ves of this city or county to
Policy4 Wlr�b•�f�DO 3 Expires 0 1 entert d ti ed propinsp ction purposes. vv
(This section need not to be completed is the permit is for one-hundred Date 2O L
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
certify that in the performance of the work for which t "s permit is issued,
1 shall not emolov any pers s m any er so as t came subject to the CITY BUSINESS LICENSE 4
workers compensany aws of 'a,and a e[hat if 1 should become HAZARDOUS MATERIAL DECLARATION
subject to thewo c0m on proviection 3700 of Labor
Code,lshall ith p ith tho r io I Will the applicant or future building occupant handle hazardous material or
Applic Date mixture containing a hazardous material equal to or greater that the
amounts speOfiecl on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 ❑Yes O4o
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($100A00),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 LABOR CODE,INTEREST,AND ATTORNEYS FEES forguideli s
CONSTRUCTION LENDING AGENCY ❑Yes o
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 boun ary of a school?
(Section 3097 Civil Code) ❑Yes o
OWNER BUILDER DECLARATIONS I have read the Hazardouvaterial Information Guid and the SCAQMD
I hereby affirm under penalty of perjury that am exempt from the permitting checklist. erstand equirem der the State of
Contractors License Law for the reasons)indicated below by the halifamia Health ery Co ion 25 a 25534 concerning
haZardousm d repo
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 es o -
BusinessandProfessionsCode).Any city or county that requires a permitto Date 'i I.7i4Ll�l�
construct,alter,improve,demolish or repair any structure,prior to Its pR PERTY 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(RRP)
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 licensure 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
❑1,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.eov/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 notapply to an owner of a ❑An EPA Lead-Safe Certified Renovatorwill 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 provingthat itwas
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.
BUILDINGAPPLICATION
Menifee
DATE a� PERMIT/PLAN CHECK NUMBER
TYPE: ❑COMMERCIAL ®RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ❑SIGN
SUBTYPE: []ADDITION ❑ALTERATION []DEMOLITION []ELECTRICAL [-]MECHANICAL
❑NEW ZPLUMBING [:IRE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK / Or - r _M
N2,.f
PROJECT ADDRESS
a �� '� e �/ aLh I of Menifee salety t
A55ESSOR'S PARCEL NUMBER Sgg -CE3r2: LOT TRACE
OWNER NAME S�L� �.q
ADDRESS a2 L eLlt-k ,0� C. (; [Ved
y
PHONE /Q�, R EMAIL
APPLICANT NAME rw Allen
ADDRESS Sa..a, 4,J y\ Sfi 4t CA &V-7
PHONE J I yl i 95J7 EMAIL
CONTRACTOR'S NAME OWNERBUILDERP []YESKNO
BUSINESS NAME
ADDRESS eyt 5:1' vj4Sv de-
PHONE 'IJ71 `,3(-( ( q j- EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLA5SWICATION
VALUATION$ S D p FT L SO FT
APPLICANT'S SIGNATURE —L DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN I SMIPINVOICE I
AMOUNT IS5
PAIDAMOUNT Z5.60 OCASH OCHECKq OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT ���✓/ `�/ pCASH CCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED O YES O NO DL NUMBER NOTARIZED LETTER O 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
CA R�bblz be&k pr
Ctty of Menifee
Building & Safety Dept.
APR 2 8 2016iL
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PLAN APPROVAL FETY DEPARTMENT
C�PAn�J�
REVIEWED BY
DATE
'Approval of these plans shall no 5e construed to be a permit for,or an
approval of,any violation of any ovisions of the federal,state or city
regu ations arek This set of approved plans must be kept on the
icbsite until completion.
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