PMT16-02416 City of Menifee Permit No.: PMT16-02416
29714 HAUN RD. Type: Residential Plumbing
'ACCEO MENIFEE,CA 92586
MENIFEE Date Issued: 0 7127/2 0 1 6
PERMIT
Site Address: 28236 ENCINO DR, MENIFEE, CA 92586 Parcel Number: 336-272-030
Construction Cost: $5,873.00
Existing Use: Proposed Use:
Description of REPLACE 40 GAL GAS WATER HEATER SAME LOCATION
Work:
Owner Contractor
ROBERT LEE A R S AMERICAN RESIDENTIAL SERVICES OF
28236 ENCINO DR CALIFORNIA INC
MENIFEE,CA 92586 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone:9512769744
CHRISTINA CALHOUN License Number:765074
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIU
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Fee Description Qttv Amount($)
- ni Water Heater 'I 110
Building Permit Issuance 1 27.00
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 Men'Ifee.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
with a licensed contmctor(s)pursuant to 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 3ofthe Business and ❑lam exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. , 1 the following reason:
License Class CIO C26 t'MW U se No. DSO y By my signature below I acknowledge that,except for my personal residence
Expires �E 1 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 DECLA ON Ir.. have built as an owner-builder if it has not been constructed in its entirety by
o 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 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 w,ww.leeinfo.ca.eov/calaw.html.
this permit is issued.
Date
Policy N
PROPERTY OWNER OR AUTHORIZED AGENT
o I have and will maintain worker's compensation insurance,as required by
section 3700 of the Labor Code,for the performance of the work for which in By my signature below I certify to each of the fpllowing:l am the property
this permit is issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
with all applicable city and county ordinances and state laws relating to
Carrier L building construction.I authorize representatives of this city or county to
Policyg `�93I .�O��6�i ��Expires 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
o I 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 Jr'
worker's compensation laws of California nd agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the e5lcer's comp r�Yatio ro sions of ction 3700 of the bor
Code,I shall rjh( r c �rt trovisi Will the applicant or future building occupant handle hazardous material or a
(/ z mixture containing a hazardous material equal to orgreater thatthe
Applicant Date amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURETO SECURE WORKER'S COMPENSATION tOVERAGE IS ❑Yes Vfdo
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($300,000),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 o Yes Owe
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) o Yes
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements underthe State of
1 hereby affirm under penalty of perjury that 1 am exempt from the California Health&5 Code, cti n 25 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the 2ERTY
MOWNER
rtm
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 T V?
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,prior to its UTHORIZED 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 Contractor's 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
❑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.epa.goy/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 Contractor's State License Law does not apply to an owner of a o 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.
ci 1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's 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.
r
v.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION Sew
4 '{
I- Menifee
DATE 1 Z La PERMIT/PLAN CHECK NUMBER
TYPE: COMMERCIAL ENTIAL ') MULTI-FAMILY C MOBILE HOME �% POOL/SPA %SIGN
SUBTYPE: C ADDITION :%ALTERATION C DEMOLITION ELECTRICAL C MECHANICAL
C NEW ;,C U BANG /< RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK �� UeaJ\ L•71 , '^•"^'�"'
PROJECTADDRESS 2. $7--Ske GhC\Y�_6 y�,'6�•• ! I �^ z'+Pz j,
ASSESSOR'S PARCEL NUMBER ��"��-1-- /��/�i�G".aGif.OT `'' V[J TRACT "J✓J-J `�I
OWNERNAME Le,--)
ADDRESS Q S GI.60 1�—�-
PHONE EMAIL
APPLICANT NAME r ) 6aT -
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILDER? C YES ONO
BUSINESS NAME
ADDRESS O O `� t2 • Y
PHONE 300 (pia 0(p T EMAIL
CONTRACTOR'S STATE LIC NUMBER �[gS�D7y LICENSE CLASSIFICATION C/O CZo cue
VALUATION $ S b 1 _ SQlr5 L SQ FT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION „n-I CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN 1 SMIP
INVOICE r PAIDAMOUNT C, " C.
AMOUNT (Cj'l.� CASH CHECK CREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT C CASH C CHECK$1 %CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED CYES O NO DL NUMBER NOTARIZED LETTER <% YES O NO
City of Menifee Building& Safety Department 29714 HOun Rd. Menifee, CA 92556 951-672-6777
www cityofinenifee.us Inspection Request Line 951-246-5213
� + h"o
mm
o � N �z a � of � ry `Y ••' U' D L �
' wa
c Y ;
° ° m w a o 5
rc o o y Y 3 r
O W a y _ 41 �
H > m m o E c
m •E
LL LL E E
o
c > a c o v
v C
m ZF.
L H m
qu c ,gyp w u
n .n` E E m o ti
m o
>n c a o
O. .fl N O Y = N c a
a t m u > 1O
a � .-� m m V C D
0 '3 i > 1+0° 2 V e
m 2 m «
006 o°f m Z r b �n s' . ?� •° .c �
o = a c h
co m a= 'i o a a v N v
L o m 1 � N d A 3 c
m -
W ° ° r —aai a v o E m
1— -
toQQ cmW� 3mY� �a>C ` •a°wa ut
W c •t �N=
x ceo dAy Eva
E
W ` CL m
OW EW + a o8>
C:n
N mo
C cmcdo
w1 Yn
QlOu M jdE
A l9 NvY a AmYQ
wQW = U
W Yul u cY .y e M�
w / v H
Lt, ` U
da
� C
N
LL O
Qo c v C c m
yryryc z Z �° ! ¢
W
I D rri •C a m N � d
j W 21I N O >
ul p
e-i 01 c E E
LL 2 p d EE p O O c m ^
U > m H U N mp V1 ` `•GJ�
O a N m d 0 J
•Q 4= C = C O �_'
" m a c o mc = c I
3 a1 p m C G G E H Y m
0
ts
f2 c m
` t1 d
NN ca
N
N m Y U N N L L C E UI U L
m m = 0 m to G d I
r _
Y N
C C d M
` •° to � d •° O a d
m m
O ` m O C
3 01 c a o c v m
5 C o m u E T
T GI m O. W m W C I.. « L 'C O O T
° 12 y o I.°.
o v = •� a s �? u m fi
c _
m w _ c E u 3 o p o m y
E E m m v r cc m a
m ° L° m L° a o E d_ c B L •J -N°
m ,- o d ❑
Y O V W m
¢ o M a v t` o` a
d o .dc c d `—' ° a s s E E a c I' o c
u to Z m e
•ril d Y Y }V; ', ' �+ ul Y k• y °' C I O C ❑ W
C C ':'• O d d d C O. o tad m ` 2- C
ho
Z N y pI d C p
y. '-O. v Y° S-
N
m q u m I? ? A! d m O d Q m 2 o
m 3 _ .d. afm ., y B m ?,� c E ti N
Vu iv E ei Q. NO > o C u 3 d V s m °. C C lb m T w °. C Z w °'
w tpi N_EXamMm ° 08 r V> H td n W pf H J
N
U 6=.1 N O1 d y
V 1 a : z U Q 1.0 Io .