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PMT16-01908 City of Menifee Permit No.: PMT16-01908 29714 HAUN RD. Type: Residential Plumbing <A-CCEL/? MENIFEE,CA 92586 MENIFEE Date Issued: 0 6/1 712 01 6 PERMIT Site Address: 26329 TROY LN, MENIFEE, CA 92585 Parcel Number: 331473-008 Construction Cost: $1,800.00 Existing Use: Proposed Use: Description of REPLACE WATER HEATER 40 GAL GAS, SAME LOCATION Work: Owner Contractor DESIREE PABIN A R S AMERICAN RESIDENTIAL SERVICES OF 26329 TROY LN CALIFORNIA INC MENIFEE, CA 92585 965 RIDGE LAKE BLVD SUITE 201 Applicant Phone:9012719700 ANDREW ALLEN License Number.765155 A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIr 965 RIDGE LAKE BLVD SUITE 201 MEMPHIS, CA 38120 Fee Description ON Amount ISI 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 $116.16 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_Bldg_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 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 Business and D 1 am exempt from licensure under the Contractors State License Law for Professions Code and my license is in full force and effect. the following reason: License Ciasq L5 4 License No By my signature below I acknowledge that,except formy personal residence Expires 7�31T1�L 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 D I hereby affirm under penalty of perjury one ofthe.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 this permit is issued. www.IeRinfo.ca.gov/caIaw.html. Polity R Date 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 D 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 are: application and the information I have provided is correct.I agree to comply �N with all applicable cityand county ordinances and statelaws relatingto Carrier Y g building construction.I thou representatives of this city or county to Policy# uL�(e'S1�7b'; I Expires �h 15� enter the above'd i opertyf inspection purposes. (This section need not to be completed is the permit is for one-hundred � Dare (0_ dollllars($100)or less PR PERTY OWNER OR AUTHORIZED AGENT ck 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 CRY BUSINESS LICENSE N workers compensation laws of;alifornia,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the workers co pt'n �ro sat'orvis' s of Section 3700 of the labor Code,1 shall forthw m ith th ovisions. Will the applicant or future building occupant handle hazardous material or a / mixture containing a hazardous material equal to or greater that the Applicant / Date amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS D Yes a-No UNLAWFUL,AND SHALL SUBJECTAN 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 ❑Yes 151-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 afthe lending agency for the performance of the work which this permit is issued outer boundary of a school? (Section 3097 Civil Code) D Yes EfNo OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of Contractors License Law for the reason(s)indicated below by the California Healt a de,Se n 25505 and 25534 concerning hazardous terial checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 �(, s ' Business and Professions Code).Any city or county that requires a permit to f"ie Date r. construct,alter,improve,demolish or repair any structure,priorto its PROPERTYOWNER OR AUTHORIZED AGENT issuance,also requires the applicant forthe permitto file a signed statement that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING(FIRM 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 Rcensure 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($S00). managers who do the paint-disturbing work themselves or through their o 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.eoLa�,g_ov/lead/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 D 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. o No EPA Lead-Safe Certified Firm is required for this project because: o 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 • • APPLICATION Y Sri ' Menifee DATE PERMIT/PLAN CHECK NUMBER IV L� to TYPE: ❑COMMERCIAL ©RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA ❑SIGN SUBTYPE: ❑ADDITION ❑ALTERATION ❑DEMOLITION ❑ELECTRICAL ❑MECHANICAL ❑NEW X❑PLUMBING ❑RE-ROOF-NUMBER OF SQUARES DESCRIPTION OF WORK RQ[dLf W h a 4 0 n PROJECT ADDRESS .0 f ASSESSOR'S PARCEL NUMBER 55,0�2I ' �"���GOSLOT 'C5 TRACT OWNER NAME ADDRESS "rf-a L.K1 OM.o ¢ (-A ).Sv PHONE 410 (e-89 -7014 EMAIL APPLICANT NAME n ADDRESS I Sl-O W L,tn 54-- 1 X07 PHONE q5I 391 ,3--I I EMAIL CONTRACTOR'S NAME OWNERBUILDER? ❑YES[�NO BUSINESS NAME 1 ADDRESS I5,'20 W LIK,d6n S� IVC( d ( CA `1)�rv'7 PHONE 95-f 341 g3-11 EMAIL CONTRACTOR'S STATE LIC NUMBER 1(,SSS LICENSE CLASSIFICATION VALUATION $ wo L SO FT APPLICANT'S SIGNATURE DATE (P DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE GREEN i SMIP INVOICE C., PAID AMOUNT AMOUNT 5 J %CASH CHECK# CREDIT CARD VISA/MC PLAN CHECK FEES PAID AMOUNT ^CASH OCHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES 0 NO DLNUMBER NOTARIZEDLETTER O YES O NO City of Menifee Building&Safety Department 29714 Haun Rd. 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