PMT16-01715 City of Menifee Permit No.: PMT16-01715
29714 HAUN RD.
rAnCCEL/-> MENIFEE, CA 92586 Type: Residential Plumbing
MENIFEE Date Issued:
06/03I2016
PERMIT
Site Address: 30593 WILLOW VILLAGE DR, MENIFEE, Parcel Number: 364-14"27
CA 92584 Construction Cost: $2,100.00
Existing Use: Proposed Use:
Description of REPLACE GAS WATER HEATER, 50 GAL IN GARAGE
Work:
Owner Contractor
JASON SMITH A R S AMERICAN RESIDENTIAL SERVICES OF
30593 WILLOW VILLAGE DR CALIFORNIA INC
MENIFEE, CA 92584 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
Oft Amount 1$1
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 building 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_Pennit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or Improves thereon,and who contracts for the projects
with a licensed contractor(s)pursuantto the Contractors State License Law).
I hereby affirm under penalty of perjury that I am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the iness and ❑I am exempt from licensure under the Contractors State License Law for
Professions Code andly license is In full force and e // the following reason:
License Class Licen b By my signature below I acknowledge that,except for my personal residence
Expires Signatur 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 sy„w,wleznfo.ca.gov/calaw.htm].
this permit is issued.
Policy q
PROPERTY OWNER OR AUTHORIZED AGENT Date
I have and will maintain workers compensation insurance,as required by
ectian 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
number ar application and the information I have provided Is correct.I agree to comply
�UI _ ! with all applicable city and county ordinances and state laws relating to
Carrier / ' J✓/ 1 building constru lauth 'zerepre enf2tives of this city or county to
Policy N (��7���1C Expires '� I I� enter identi rope inspection purposes.
�1
(This section need not to be completed is the permit is for one-hundred Date Cl
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
1 lertify that In the performance of the work for which this permit is issued,
I shall not employ any persons 1,r1any� er so as ecome subject to the CITY BUSINESS LICENSE it
workers compensation la C lifer ia,and ee that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker om �ion pro ' ons of Section 3700 of the Labor
Code,I shall fort I 'h�os wslons. Will the applicant or future building occupant handle hazardous material ora
6 �, C mixture containing a hazardous material equal to or greater that the
Applicant Date ( amounts specified an the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes rf No
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(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY in Yes qNo
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 boyndary of a school?
(Section 3097 Civil Code) ❑Yes h No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material InIF tion Guide a d the SCAQMD
permitting checklist.l urrstagd yrequiremen n erthe State of
I hereby affirm under penalty of perjury that I am exempt from the California Health& oa ection 2550 d15534 conceming
Contractors License Law for the reason(s)indicated below by the h rdous mat r ort
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 !3ap ❑
Er
Business and Professions Code).Any city or county that requires a permit to oYesDate C�
construct,alter,improve,demolish or repair any structure,prior to its PR ERTY 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 IRRP)
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 far a permit subjects the appllcant 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 orthrough 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.epa.gov/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
❑No EPA Lead-Safe Certified Firm is required for this project because:
not built or improved for the purpose of sale.
❑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
4 �
Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: ❑COMMERCIAL ❑✓ RESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME POOL/SPA ❑SIGN
SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL [—I MECHANICAL
❑NEW ❑✓ PLUMBING ❑RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK Replace water heater, 50 gallon gas in garage
PROJECT ADDRESS 30593 Willow Village Or
ASSESSOR'S PARCEL NUMBER '(Af< i '� LOT $14 TRACT V1 3
OWNER NAME Jason Smith
ADDRESS 30593 Willow Village Dr. Menifee, CA 92584
PHONE (951)318-523B EMAIL
APPLICANT NAME Andrew Allen
ADDRESS 1520 W. Linden St. Riverside,CA 92507
PHONE (951)341-9371 EMAIL
CONTRACTOR'SNAME Rescue Rooter/ARS OWNERBUILDER? ❑YES ✓❑NO
BUSINESS NAME
ADDRESS 1520 W. Linden St. Riverside, CA 92507
PHONE (951)341-9371 EMAIL
CONTRACTOR'S STATE LIC NUMBER 765155 LICENSE-CPASSIFICATION C36
VALUATION$ $2,100.00 / L SQ Fr
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN I SMIP
INVOICE PAID AMOUNT
AMOUNT CIS OCASH vCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECKa OCREDITCARD VISA/MC
OWNERBUILDERVERIFIED OYES O NO DLNUMBER NOTARIZED LETTER 0 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
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