PMT16-02656 City of Menifee Permit No.: PMT16-02656
29714 HAUN RD. Type: Residential Plumbing
�A►CCF-64 MENIFEE,CA 92586
MENIFEE Date Issued: 08/15/2016
PERMIT
Site Address: 28409 SUN CITY BLVD, MENIFEE,CA Parcel Number: 335-302-036
92586 Construction Cost: $24,443.00
Existing Use: Proposed Use:
Description of INSTALL NEW 2-WAY CLEAN-OUT WITH SPOT REPAIR ON MAIN SEWER LINE,65'
Work:
Owner Contractor
ROBERT SOKO A R S AMERICAN RESIDENTIAL SERVICES OF
28409 SUN CITY BLVD CALIFORNIA INC
MENIFEE,CA 92586 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 Oft Amount
Sewer 1 150.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 7.50
$185.50
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.
Page 1 of 1
AA_eldg_Pennit_Template.rpt
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).
. 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 ❑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 CIasr l _r_License No. By my signature below I acknowledge that,except for my personal residence
of
Expires._ ? signature in eatsmus have resided by
is r atper it.I cannotne legally
el completion that
improvements covered by this permit.)cannotlegally 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
'pi hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that copy of the applicable law,Section
have and will maintain a certificate of consent of self4mure 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.leninfo.ca.gov/calaw.html.
this permit is issued.
Date
Policy# PROPERTY OWNER OR AUTHORIZED AGENT
❑I have and will maintain worker's compensation insurance,as required by
O By my signature below I certify to each of the following;I am the property
section 3700 of the Labor Code,for the performance of the work for which
this permit is issued.My worker's 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
with all applicable city and county ordinances and state laws relating to
Cartier �� 99LI�l�Gr`�r N building construction.l authorize representatives of this city or county to
Policy#7L^.7I 5OF,�,1bIT Expires (7 enter the above identified property for inspection purposes.
(This section need not to be completed is the permit if for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT �1 //
❑Icertify that in the performance of the work for which this permit is issued, CITY BUSINESS LICENSE#��) 1
)shall not employ any persons in any manner so as to become subject to the
worker's compensation laws of California,and agree that if I should become RDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,1 shall forth w'h comply with those provisions. ill the applicant orfuture building occupant handle hazardous material or a
7 mixture containing a hazardous material equal to or greater that the
Applicant Date `� I, amounts speciFed on the Hazardous Materials Information Guide?
WARNING:FAILURETO Sg6REWORKWS COMPENSATION COVERAGE 45 0Yes '0�
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use pf 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(SCAOMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguidelines
CONSTRUCTION LENDING AGENCY OYes c
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) 0 Yes D�
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist I understand my requirements underthe State of
I hereby affirm under penalty of perjury that I am exempt from the California Health&Safety Code,Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the azardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 DY O No
Business and Professions Code).Any city or county that requires a permit to &_444 Date I 1jG
construct,alter,Improve,demolish or repair any structure,prior to its PROPERTY OWNER OR ORI ED AGEiPi—�
issuance,also requires the applicant forthe permit to file a signed statement L�
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION REPAIR AND PAINTING fRRP)
License Law(Chapter9(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 permitsubjects the applicant to a civil penaQof not more required practices.This includes rental property owners and property
than(5500). 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.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 Contractor's State License Law does not apply to an owner of a [3 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 O No EPA Lead-Safe Certified Firm is required for this project because:
not built or improved for the purpose of sale.
o 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 PERMIT/PLAN CHECK APPLICATION
Menifee
DATE — J PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL -9 ESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW .e PLUMBING O RE-ROOF-NUMBER OF SQUARES c
DESCRIPTION OF WORK V L-,W W C I C M-� 0\,�
5c ti
PROJECTADDRESS iA CAK) C � LUD 1 �E CIS ��
ASSESSOR'S PARCEL NUMBER '!j -, c��Q LOT TRACT
Building & Safety ept.
OWNERNAME ��� 5—tJ
ADDRESS /S_ AUG 15 2016
PHONE Cgs //\> (p7C( - 1<)(A EMAIL n
APPLICANT NAME Received
ADDRESS 2jC� M C� t�s S \ ,�-71� - Cp\ a
PHONE bZ>� �p�� �(P��j EMAIL
CONTRACTOR'S NAME 1 - 1 1'lJtr OWNER BUILDER? 0 YES>&NO
BUSINESS NAME
ADDRESS �� Nti L�-S \���-� 1 �G CF� �-
PHONE (SCjj �1 1L> EMAIL
CONTRACTOR'S STATE LIC NUMBER
� 7 L LICENSE CLASSIFICATION Gl� CZO C
VALUATION$ (�2�j I Z,-I , 7, DL-,SO FT ? L SO,FT I
APPLICANT'S SIGNATURE - DATE
DEPARTMENT DISTRIBUTION l CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN \ SMIP JC
INVOICE p.� PAID AMOUNT Q �,/�
AMOUNT • � 5 Ow O CASH O CHECK# 0 CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0CASH 0CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Men ifee Building&Safety Department 29714 Ho Lin Rd. Menifee, CA 92586 951-672-6777
www.cityofinenifee.us Inspection Request Line 951-246-6213
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