PMT16-02697 City of Menifee Permit No.: PMT16-02697
29714 HAUN RD. Type: Residential Plumbing
<ACCEL/ - MENIFEE, CA 92586
MENIFEE Date Issued: 0811812016
P E R M I T
SiteAddress: 29980 THORNHILL DR,MENIFEE, CA Parcel Number: 336-142-009
92586 Construction Cost: $1,617.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING 40 GAL WATER HEATER IN INTERIOR CLOSET
Work:
Owner Contractor
JOE DALBIS A R S AMERICAN RESIDENTIAL SERVICES OF
29980 THORNHILL DRIVE CALIFORNIA INC
MENIFEE, CA 92586 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone: 9012719700
ANDREW ALLEN License Number: 765155
A R S INC DBA RESCUE ROOTER
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Fee Description Qtv Amount
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 pennit 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.Bldg_Pe"it Templatarpt Page I of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
I hereby affirm on der penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of t he rid o I am exempt from licensure under the Contractor's State License Law far
Professions Code and my license is in full force and eff the following reason:
License Class Ucen: By my signature below I acknowledge that,except for my personal residence
Expires 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
R'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
u 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-insu re 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
this permit is issued. www.Ieginfo.m.goyJcaIaw.htmL
Policy If Date
PROPERTY OWNER OR AUTHORIZED AGENT
--CPI have and will maintain worker's compensation insurance,as required by
I
section 3700 of the Labor Code,for the performance of the work for which a By my signature below I certify to each of the following:I am the property
e alf.I have read this
this permit is issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property owne�pfel
numberl,e: application and the informa I It rovide correct.I agree to comply
with all applicabl cl" ou rifina rid state laws relating to
c'
Ce
,.a, 1( 1 b if I c nstru I ut . a repr a f this city or county to
Policy#W J�Jf,�I Expires it, e tert eab a in I rope ct' purposes.
(This section need not to be completed Is the permit
is for cme�hunclred Date— W6116
dollars($100)or less )RIZED AGENT
o Icertify that in the performan the wciVor which this permit is issued,
114hall not emplo) =ka I V ma 'so agAecome subject to the CITY BUSINESS LICENSE#
worker's compen xl:�om',�"e that If I should become HAZARDOUS MATERIAL DECLARATION
�r an. I pro i s of Section 3700 ofthe Labor
subject to the wo,� �n
Code,I shall w th pranihilons. Will the applicant or future building occupant handle hazardous material or a
f5�1 ;Kromyl Date mixture containing a hazardous material equal to or greater that the
Applicant amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKEWS COMPENSATION COVERAGE IS u Yes /PIT.
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 guideXim
CONSTRUCTION LENDING AGENCY a Yes 1 0
1 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 boun ary of a school?
T1
(Section 3097 Civil Code) ciYes 9rN
OWNER BUILDER DECLARATIONS I have read a azard Ma lal orm on Guide and the SCAQMD
permitting ec fis und tan myre urements under the State of
I hereby affirm under penalty of perjury that I am exempt from the California H I Safe Cu3` Se ' 255 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the ha ardous a ri ortinIi-
checkmark(s)I have placed nextto theapplicable item(s)(Section 7031.5 t,
Business and Professions Code).Any city or county that requires a permit to 17yS Date (P
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(RRPI
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
a nd 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 a pplica nt to a civil Pena Ity 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
a 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 I )portion of the work,and the structure is www.epa.goyllead or contact the National Lead Information Center at
not intended or offered for sa le.(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 ci An EPA Lead-Safe Certified Renovator Will be responsible for this project
property who,through employees'or persona I effort,builds or Im proves 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
not built or improved for the purpose of sale. o No EPA Lead-Safe Certified Firm is required for this project bemuse:
a I,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 Uicense 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
M e n i fe e
DATE PERMIT/PLAN CHECK NUMBER
TYPE: []COMMERCIAL DIRESIDENTIAL [:]MULTI-FAMILY [:]MOBILEHOME [:]POOL/SPA F]SIGN
SUBTYPE: [:]ADDITION F]ALTERATION F]DEMOLITION r_�ELECTRICAL FIMECHANICAL
[—]NEW [2PLUMBING [I RE-ROOF-NUMBER OF SQUARES_
DESCRIPTION OF WORK ep ioaler beAer Lio ad v5 /m
j
B 'ot G8,=tyeDe;I.
PROJECTAIDDRESS e�)Mlyo Zhofl-fihfll qc�tl uIldl g
ASSESSOR'S PARCEL NUMBER LOT TRACT AUG 18 2016
OWNER NAME D_a 11015 Received
ADDRESS
PHONE . I!R (R�2 r-2,07 EMAIL
APPLICANTNAME
ADDRESS f 5_��09
A, ve e S
,-71
PHONE ?5-7 11 EMAIL
CONTRACTOWS NAME 0,c-5CC,-- j�200�-ev� OWNERBUILDER? [JYE§RW
BUSINESS NAME
ADDRESS (Q& L�who 9 9t V,(r,5 IJe C A qJ5z,7
PHONE 9,,V jLf19-5-71 EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE C SIFICATION c-3 i�
VALUATION$ IC17 7�
L SO FT
I APPLICANT'S SIGNATURE DATE (y//
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION SMIP CI N OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE76REEN
INVOICE - ]
AMOUNT PAIDAMOUNT
UCASH COCHECK# OCREDITCARD VISAIMC
PLAN CHECK FEES PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
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