PMT16-02699 City of Menifee Permit No.: PMT16-02699
< -6MLA 29714 HAUN RD. Type: Residential Plumbing
A —> MENIFEE,CA 92586
MENIFEE Date Issued: 0811812016
P E R M I T
Site Address: 30092 CARMEL RD, MENIFEE, CA 92586 Parcel Number: 336-143-012
Construction Cost: $1,500.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING 40 GAL WATER HEATER, SAME LOCATION
Work;
Owner Contractor
DANNY HARRIS A R S AMERICAN RESIDENTIAL SERVICES OF
30092 CARMEL ROAD CALIFORNIA INC
MENIFEE, CA 92586 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone: 9512769744
CHRISTINA CALHOUN License Number:765074
A R S INC DBA RIGHTIME
3030 MYERS STREET
RIVERSIDE, CA 92503
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 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_Bldg_Permt—Temp1ate.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuantto the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and ci 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:
cza valle _�17
License Class Lic Wft.�&&A By my signature below I acknowledge that,except for my personal residence
Expires Signatureig llx'�P"yl '6 in which I must have resided for at least one year prior to completion of
-r— —( — improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S=COMPENSATION DECLARLK'�`L' have built as an owner-builder If it has not been constructed in its entirety by
o 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 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.leginfo.ca.gov/calaw.html.
Policy# Date
ci I have and will maintain worker's compensation Insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which o 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
with all applicable city and county ordinances and state laws relating to
Carrier L I kzc� building construction.I authorize representatives of this city or county to
PolicV#IUSN"Flabusiclil'A Expires la:wrl enter the above identified property for inspection purposes.
(This section need notto be completed is the permit 1! for o I
Is ne-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
o I certify that in the performance of the work for which this permit is issued,
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's comp f S ct- n 3700 of the Labor
yogtion pro 0 a 10
Code,I shall f i c vith tho vl�rsm;- 1 ns Will the applicantor future building occupant handle hazardous material or a
mixture containinga hazardous material equal to or greater that the
Applica 'Eate amounts specified on the Hazardous Materials Information Guide?
..T
WARN[ IL[IRFTOqFrl]RF&:KE ESCOMPEE o Yes-4-Ne
UNLAWFUL,AND SHALL SUIRECT 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 o Yes Gmt.
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 Ao-
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 CallforsW Health&Saf� d�eS n 255 nd 25534 concerm.ng
C
Contractor's License Law for the reason(s)indicated below by the h S.
Businessand Professions Code).Any city or county that requiresa permit Le
,17
checkmarks)I have placed next to the applicable item(s)(Section 7031.5 to az 0 sm 4r, r" 47
construct,alter,improve,demolish or repair any structure,pTiorto its �54 ? � Date
issuance,also requires the applicant for the permittofilea signed statement W11ERTY OWNER OR AUTHORIZED AGENT
thatheorsheis licensed pursuarittothe provisionsof the Contractor's State EPA RENOVATION,REPAIR AND PAINTING IRRPJ
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 Ucensure 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-certifled 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 dothe paint-disturbing work themselves or through their
o 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 I )all of or I )portion of the work,and the structure is www.epa.gov/lead or contact the National Lead Information Center at
not intended or offered forsale.(Section 7044,Business and Professions 1-BOG424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a ti An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employeee 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
nut built or improved for the purpose of sale. ci No EPA Lead-Safe Certified Firm is required for this project because;
o 1,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 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
A
�Alk._ Meni ee
DATE 1,5 PERMIT/PLAN CHECK NUMBER emk 0 - 0Q( &?e)
TYPE: 0 COMMERCIAL 61CRESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA 0 SIGN
I menifee,
SUBTYPE: 0 ADDITION 0 ALTERATION 0 DEMOLITION 0 ELECTRICAL Q M&AWQ� SaMty Der
ONEW WLUMBING C RE-ROOF-NUMBER OF SQUARES- AUG 18 2016
DESCRIPTION OF WORK 41C.N ww,�w Ww�
Recejj�tzrj
PROJEcTADDRESS W91 Z- CCIAZWN M-0
ASSESSOR'S PARCEL NUMBER L4 LOT TRACT
OWNERNAME
ADDRESS
PHONE Laoc6 —ni6o — 87.v2� EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'SNAME OWNER BUILDER? 10 YES �,4W
BUSINESS NAME
ADDRESS -f)O 9C) nLk�� Q_ Z NJ 044 . 9-zs-b-;�
PHONE 15Ck CoCiLO EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION CA C) (_ZC)
VALUATION$ 1 S-00 S 11-7 L SQ FT
APPLICANT'S SIGNATURE
DATE =841(a
_A=r-,T 2 2 1_0.7*1 1*
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP -7c
INVOICE I PAIDAMOUNT I 1 0 CREDIT CARD VISA/MC
AMOUNT OCASK OCHECK#
PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# OCREDITCARD VISAIMC
OWNER BUILDERVERIFIED 0 YES 0 NO DL NUMBER NOTARIZED LEITER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
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