PMT16-01801 City of Menifee Permit No.: PMT16-01801
29714 HAUN RD. Type: Residential Plumbing
<A—CCEL-A> MENIFEE, CA 92586
MENIFEE Date Issued. 06/10/2016
PERMIT
Site Address: 29224 GLENCOE LN, MENIFEE, CA Parcel Number: 372-370-032
92584 Construction Cost: $2,077.50
Existing Use: Proposed Use:
Description of REPLACE EXISTING 50 GAL WATER HEATER, SAME LOCATION
Work:
Owner Contractor
GARRY EVAN A R S AMERICAN RESIDENTIAL SERVICES OF
29224 GLENCOE LANE CALIFORNIA INC
MENIFEE, CA 92584 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone:9512769744
KENNY PEERY License Number:765074
A R S INC DBA RIGHTIME
3030 MYERS STREET
RIVERSIDE, CA 92503
Fee Description ,Oyt 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 builiding operations being carded 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 S1dg_Permit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
I hereby affirm under penalty of perjury that lam 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 Business and O 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 Clasr C 10)620-C fP License No. 76 50 7 /f By mysignature below l acknowledge that,except for my personal residence
Expiresignature ¢�� in whichlmust have resided forat least one year prior to completion of
df `/JI improvements covered by this permit l cannot legally sell a structure that
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
,prI hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that copy of the applicable law,Section
have and will maintain a certificate of consent ofself4risure for worker's 7044 of the Business and Proressions 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 wvnv.leeinfo.ca.eov/cataw.html.
this permit is issued.
Policy# Date
O I 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 l certify to each of the following:I am the property
this permit is issued.My workers compensation insurance carder and policy owner or authorized to act an the property owners behalf.I have read this
number are: I y� application and the information I have provided is correct I agree to comply
Cartier L---t�/� � with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# Expires - `20 ( enter the above identified property 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
❑1 certify that in the performance of the work for which this permit is issued,
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
workers compensation laws of California,and agree that if I should becomeF
ARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shall forthw'h comply with those provisions. the applicant or future building occupant handle hazardous material or
Applicant �Date � ture containing a hazardous material equal to or greater that the
Yunts specified on the Hazardous Materials Information Guide.
WARNING:FAILURE TOS ' REWORK S COMPENSATION COVERAGE IS es 'a-WO
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($10D,000),IN upant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR st Air Quality Management District(SCAOMDj?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES uidelines
CONSTRUCTION LENDING AGENCY s �s0oI hereby affirm that under the penalty of perjury there is a construction 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 r boundary of a school?(Section 3097 Civil Cade) s o�OWNER BUILDER DECLARATIONS ve read the Hazardous Material Information Guide and the SCAQMD
I herebyaFfrtn under penalty of perjury that I am exempt from[he itting checklist I understand my requirements under the State of
Contractors License Law for the reasons)indicated below by the rdo a Health alSafety Code,Section 25505 and 25534 concerning
rdous material reporting.checkmark(s)I have placed next to the applicable items)(Section 7031.5 ❑NoBusiness and Professions Code).Any city or county that requires a permit to ,_QQ W Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR OFI—R12EDA6ENf'
issuance,also requires the applicant for the permit to file a signed statement C�
that he or she is licensed pursuant to the provisions of the Contractors Stale EPA RENOVATION,REPAIR AND PAIMING(RRPI
License Law(Chapter9(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 of5ectiaq 7031.5 by residence or childcare facility to be RRP-certified firms and comply with
an Applicant fora permit subjects the applicant toacivil penalwoFnot 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 =rw.epa.Roy/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 crAn 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:
❑1,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
1 ♦ ♦ ♦ 1 • ♦ . :.:i
- ,Menifee
DATE ^ ��' PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY c7 MOBILE HOME O POOL/SPA
qR��� fee
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANIii\I ILding & Sate y Dept.
ONEW PiPLUMBING ORE-ROOF-NUMBER OF SQUARES 016
DESCRIPTION OF WORK
n ,, Receiv d
PROJECTADDRESS of Q /0Ar l 4�� - g
ASSESSOR'S PARCEL NUMBER ���-`,�J'�Q - (_)aGL LOT TRACT
OWNER NAME rr
ADDRESS f
PHONE (o�� 5o5r-'��} C�� EMAIL
APPLICANT NAME IV IV -(-=R-
ADDRESS t - O
PHONE (7CO) pQ- ('��p7S EMAIL
CONTRACTOR'S NAME,Idn 1 C� OWNER BUILDER? O YES >ONO
BUSINESS NAME �, /� Iw�p�c n C �j 2
ADDRESS C�/ O7�//�v/�\ p(.._+r/ I Ee-Sl
PHONE ld�f�� (mow 06 �5 EMAIL
CONTRACTOR'S STATE LIC NUMBER 'LSD I LICENSE CLASSIFICATION C, C
VALUATION$ /90 7-7. 5c) SOFT L SO FT
APPLICANT'S SIGNATURE DATE 6_ 0 - ) ((I
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN - SMIP x
INVOICEJ
AMOUNT • ,� PAID AMOUNT
O CASH O CHECK# O CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# 0 CREDIT CARD VI5A/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 951-672-6771
www.cityofinenifee.us Inspection Request Line 951-246-6213
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