PMT16-02494 City of Menifee Permit No.: PMT16-02494
29714 HAUN RD. Type: Residential Plumbing
!t >CCELA—> MENIFEE, CA 92586
MENIFEE Date Issued: 08/03/2016
PERMIT
Site Address: 26435 BLUEBELL ST. MENIFEE, CA Parcel Number: 335-363-018
92586 Construction Cost: $1,850.00
Existing Use: Proposed Use:
Description of REPLACE WATER HEATER 40 GALLON GAS IN GARAGE
Work:
Owner Contractor
VIOLET MCFARLAND A R S AMERICAN RESIDENTIAL SERVICES OF
26435 BLUEBELL ST 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 QtY 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 carded on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise staled,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_eldg Pernit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts far the projects
with a licensed contractor(s)pursuant to the Contractors State License Law).
1 hereby affirm under penalty of perjury that I am under provisions of
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 Class License No. t 5 By my signature below I acknowledge that,except for my personal residence
Expires 'JJ 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
o l 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 www.IeRinfo.ca.gcsv/calaw.html6
this permit is issued.
Date
Policy R PROPERTY OWNER OR AUTHORIZED AGENT
erphave and will maintain worker's compensation insurance,as required by
section 3700 of the Labor Code,for the performance of the work for which ,p By my signature below I certify to each of the following:I 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
�S withal]applicable ci and cou)��ordinances and state laws relating to
Carrier t r �I I , building constru n.Ia t�arize re
Lathes of this city or county to
Policy RL�c-�1n�,ISd5�0�� Expires I I `4 enter the - iden fi property fy on purposes. f
(This section need not to be completed is the permit is forone-hundred r// Date
dollars($300)or less PROPERTY OWNER OR AUTHORIZED AGENT
.ia,(certify that in the performance of the work for which this permit Is issued,
I shall not employ any persons in mann so as to become subject to the CITY BUSINESS LICENSE p
worker's compensation la� Califo nd agree- at if I should become HAZARDOUS MATERIAL DECLARATION
subject to thehh worler pe� o rovisis o Section 3700 of the Labor
Code,I shall forth wi those pr sions. Will the applicant or future building occupant handle hazardous material or a
�, 7 (� mixture containing a hazardous material equal to or greater that the
Applicant Date R�3--� amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS Dyes 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($101),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 forguldelines
CONSTRUCTION LENDING AGENCY u Yes 15'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) o Yes efNo
OWNER BUILDER DECLARATIONS I have read the Hazarr o r1�Mateyya7 Infcrmation 6 de and the SCAQMD
permitting checklist�Gnder end my requi�ents under the State of
I hereby affirm under penalty of perjury that I am exempt from the California Hea te�Safety.Code,Section 5505 and 25534 concerning
Contractors License Law for the reason(s)Indicated below by the hazardous aterial re 21
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 Yes /// (/ / ,•1.—\ Cn
Business and Professions Code).Any city or county that requires a permitto Date J T
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 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 Iicensure 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($500). managers who do the paint-disturbing work themselves or through their
01,as owner of the property,or my employee with wages as their sale employees.For more Information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.epa.aov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-8DO-424-LEAD(5323).
Code,The Contractor's State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will he responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that itwas
❑No EPA Lead-Safe Certified Firm is required forthis project because:
not built or improved for the purpose of sale.
❑I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7D44,Business and Professions
Code:The Contractor's State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY • APPLICATION
,Menifee AUG o 3 tots
DATE - 3- lu PERMIT/PLAN CHECK NUMBER bZLl '1
TYPE: [-I COMMERCIAL RESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA [-]SIGN
SUBTYPE: [-]ADDITION []ALTERATION ❑DEMOLITION ❑ELECTRICAL [I MECHANICAL
❑NEW ❑PLUMBING ❑RE-ROOF-NU��M"" BEROF SQUARES
DESCRIPTION OF WORK A.IG{ 4L/ - L4 O q oi, 4'$
PROJECTADDRESS
ASSESSOR'S PARCEL NUMBER 33S^ 310'S 01 LOT V TRACT
OWNER NAME Viblej LI�TQ{ Ian
^ g
ADDRESS c� 7JLI��I
PHONE /5 I 67) T ?& EMAIL
APPLICANT NAME (Zi.J /I Oil-
ADDRESS S5- L j 0j&m 4-1 V�-•-5
PHONE �5/!yI 7S 7/ EMAIL
{J
CONTRACTOR'S NAME 96016✓ I& rj OWNER BUILDER? ❑YES2NO
BUSINESS NAME
ADDRESS ,.- /-1
PHONE 9sr N 93'( EMAIL
CONTRACTOR'S STATE LIC NUMBER �j I LICENSE CLASSIFICATION
VALUATION$ / .so: L SO FT �
APPLICANT'S SIGNATURE '' DATE 3 f
CITY STAFF eat
DEPARTMENT DISTRIBUTION ' CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE AEENINVOI SMIP
UNT \11 • `� PAID AMOUNT
AMO
O CASH O CHECKq OCREDIT CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT I O CASH O CHECK# O CREDIT CARD 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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