PMT16-02493 City of Menifee Permit No.: PMT16-02493
29714 HAUN RD. Type: Residential Plumbing
�ACCELA—> MENIFEE, CA 92586
MENIFEE Date Issued: 08/0312016
PERMIT
Site Address: 26360 NOVA LN, MENIFEE, CA 92586 Parcel Number: 331A91-023
Construction Cost: $1,735.00
Existing Use: Proposed Use:
Description of REPLACE WATER HEATER 38 GALLON GAS IN GARAGE
Work:
Owner Contractor
DAVID GIARETA A R S AMERICAN RESIDENTIAL SERVICES OF
26360 NOVA LANE CALIFORNIA INC
MENIFEE, CA 92585 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone: 9012719700
ANDREW ALLLEN License Number:765155
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNL
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Fee Description Ot Amount lEl
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 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_81dg_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 contractor(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 3 of the Business and ❑1 am exempt from licensure under the Contractors State License Law for
Professions Code fan�dm'y license is in full force and effect. the following reason:
License Cl a s C_- 7�a License No. I5-/ By my signature below I acknowledge that,except for my personal residence
Expires 7J 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 1
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 www.leginfo.ca.goy/calaw.htmi.
this permit is issued.
Date
Policy 11
PROPERTY OWNER OR AUTHORIZED AGENT
d�have and will maintain workers compensation insurance,as required by
section 3700 of the Labor Code,for the performance of the work forwhich ,t3 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 polity 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
�� wfth all applicable ci and couyordinance�ndstate laws relating to
Carrier [ O 1 r , building constru n.I a ire represeyytatives of this dty car county to
Policy BUJ c.'7 tnu-i6 ow Expires 0 1 `f enter theca iden property fg Gion puryos/e9s. f
(This section need not to be completed is the permit is far one-hundred
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT -
,4rt certify that in the performance of the work for which this permit is issued,
I shall not emolov any persons in y moon so as to become subject to the CITY BUSINESS LICENSE B
workers compensation la�oCalifo nd agree• at if I should become HAZARDOUS MATERIAL DECLARATION
subject to shal er ens} o rovis ions.ection 3700 of the Labor
Code,I shall forth ;ens
those proLnsions. Will the applicant or future building occupant handle hazardous material or a
/� mixture containing a hazardous material equal to orgreater thatthe
Applicant s Date t�� amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes Ao
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 0 Yes lt�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 of the
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) D Yes emo
OWNER BUILDER DECLARATIONS I have readthe Han o6?Materj211hformatio/G de and the SCAQMD
permitting checklis.I unde5p nd my requi�w�nts under the State of
I hereby affirm under penalty of perjury that I am exempt from the
California Hea tt�&Safe °de,Section and 25534 concerning
Contractors License Law for the reason(s)indicated below by the 11
hazardous atenal re 6rting.
checkmark(s)I have placed next to the applicable items)(Section 7031.5 //////
Yes J+1�� P cQ T
Business and Professions Code).Any city arcounty that requires permit to � � // Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY 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 IRRPI
License Law(Chapter 9(commencing with Section 700D)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.eaa.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 not apply to an owner of a 0 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. ❑No EPA Lead-Safe Certified Firm is required for this project because:
01,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.
City of Menifee
BUILDING & SAFETYPERMIT/PLAN CHECK APPLICATION
Menifeeeeeived
DATE e. ` 3- (LO PERMIT/PLAN CHECK NUMBER '�>mTk b ' blq'l3
TYPE: ❑COMMERCIAL ®RESIDENTIAL ❑MULTI-FAMILY ❑MOBILE HOME ❑POOL/SPA []SIGN
SUBTYPE: []ADDITION ❑ALTERATION []DEMOLITION ❑ELECTRICAL [-]MECHANICAL
[-]NEW ®PLUMBING El RE-ROOF-NUMBER OF SQUARES
DESCRIPTION OF WORK P,eigiac-p— r e,,' -e f 4 �Ibrl
PROJECTADDRESS b6bQ hOV �7 �1
ASSESSOR'S PARCEL NUMBER511 L14R[- D23 LOT 3 l TRACT 2 �7CJ
OWNER NAME
^� .L�XVI� G((C
ADDRESS //__pt`CA v L
PHONE l0 I (p C(p�X EMAIL
APPLICANT NAME yt j ac'J e 10k- en f
ADDRESS 1�o1.O Q t✓� Sr _V Qy IOl L -)')-b-7
PHONE 951 'jL-(( L331 ( EMAIL
CONTRACTOR'S NAME Q OWNERBUILDER? ❑YE51:1140
BUSINESS NAME ADDRESS �I^^tt ,�,
L V1 V () L C.Iq
PHONE �S� 3C-I 1 �� ( EMAIL
CONTRACTOR'S STATE LIC NUMBER (Ji SISS LICENSE IFICAT10N C,3C.p
VALUATION$ (-1�) FT L SO FT --
APPLICANT'S SIGNATURE DATE
CITYSTAFF USE ONLY
DEPARTMENT DISTRIBUTION ( CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN 5 P
INVOICE PAID AMOUNT
AMOUNT 1S• 1 OCASH OCHECKN OCREDITCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# O CREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER 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
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