PMT16-02655 City of Menifee Permit No.: PMT16-02655
29714 HAUN RD. Type: Residential Plumbing
<A-CCEL/? MENIFEE, CA92586
MENIFEE Date Issued: 08/15/2016
PERMIT
Site Address: 26692 CALLE GREGORIO, MENIFEE,CA Parcel Number: 330-291-002
92585 Construction Cost: $2,052.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING 40 GAL WATER HEATER, SAME LOCATION
Work:
Owner Contractor
JAMES HENRIQUES - A R S AMERICAN RESIDENTIAL SERVICES OF
26692 CALLE GREGORIO CALIFORNIA INC
MENIFEE, CA 92585 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone:9512769744
KENNY PEERY License Number:765074
A R S INC DBA RIGHTIME
3030 MYERS ST
RIVERSIDE, CA 92503
Fee Description ON Amount lbl
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
$116.15
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_Bidg 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 contractors)pursuant to the Contractors State License Law).
. I hereby affirm under penalty of perjury that 1 am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and D 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 Oasr l I License No. By my signature below I acknowledge that,except for my personal residence
Expires -z5U�/T7/ ignature in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.)cannot legally sell a structure that I
have builtas an owner-builder if it has not been constructed in its entirety by
tI hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand thata 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 370D of the labor Code,for the performance of work for which vnvw.leeinFo.ca.epv/alaw.html.
this permit is issued.
Policy g Date
D 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 carrier and policy owner or authorized to act on the property owners behalf.l have readthis
number are: I application and the information I have provided is correct I agree to comply
Cartier L(� with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
PolicyR Expires - 250 enter the above identified property for inspection purposes.
(This section need not to be completed is the permit�for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
D I certify that in the performance of the work for which this permit is Issued, "7
(shall not employ any persons in any manner so as to become subject to the CITY BUSINESS UCENSEtF ��'1 ��,•� /
workers compensation laws of California,and agree that if I should become
RDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shall forthw'h comply with those provisions. ill the applicant or future building occupant handle hazardous material or
mixture containing a hazardous material equal to or greater that the
Applicant J QE1�—Date =fir, amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURETOS REWORK S COMPENSATION COVERAGE IS aYes
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use ofthe 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 OFTHE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY O Yes /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 D�
OWNER BUILDER DECLARATIONS 1 have read the Hazardous Material Information Guide and theSG4QMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist I understand my requirements undertheState of
Contractors License Law for the reason(s)indicated below by the hazardous
HealthalSafety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable items)(Section 7031.5 hazardous material reporting.
Business and Professions Code).Any city or county that requires a permit to OY DNp
construct,alter,Improve,demolish or repair any structure,prior to its 2ED AGEIPr-
TW Date j0
Issuance,also requires the applicant for the permit to file a signed statement PROPERNOWNER OR OR1 EO
that he or she is licensed pursuant to the provisions of the Contractors 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 basts For the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-ceded firms and comply with
an Applicant for a permit subjects the applicant to civil penaQof 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 ownerof the property,army employee with wages as theirsole 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.eoa.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 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. ❑No EPA Lead-Safe Certified Firm is required for this project bemuse:
❑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
& SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL JVRESIDENTIAL C MULTI-FAMILY O MOBILE HOME O POOL/SPA C SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION C ELECTRICAL O MECHANICAL
O NEW `+#i-PLUMBING O RE-ROOF-NUMBER OF SQUARES-
DESCRIPTIONDESCRIPTION OF WORK Y-F, l.:d= / \ _ice.
PROJECTADDRESS CID-- )S�S�,ej
ASSESSOR'S PARCEL NUMBER LOT TRACT
OWNER NAME City of Menifee
& Safety DeP .
ADDRESS � (v .� /--� �
PHONE CgST - EMAIL
APPLICANT NAME �.^ /n�Recenicve
ADDRESS ""�� - 2S S \��-, 5 QVA
PHONE ('%W) -b- .e f� EMAIL
CONTRACTOR'S NAMES A : V -v (�. -, OWNER BUILDER? O YES)ONO
BUSINESS NAME � -,
ADDRESS// �� pk� '"�� \IC>�S1 -C C � - 0
PHONECsoo ) CQ��`OL�75 EMAIL
CONTRACTOR'S STATE LIC NUMBER7(L=c /7 LICENSE CLASSIFICATION C LO C.3
VALUATION$ ,- `� �,Q�j SQ FT L SO FT 9
APPLICANT'S SIGNATURE - DATE
5TA f USE ONLY] Ilk_
ff
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP
INVOICE 1 ,� PAIDAMOUNT C
AMOUNT CASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DLNUMBER NOTARIZEDLE17ER O YES O NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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