PMT16-02797 City of Menifee Permit No.: PMT16-02797
29714 HAUN RD. Type: Residential Plumbing
<A—CCF—LA—> MENIFEE, CA 92586
MENIFEE Date Issued: 08/25/2016
P E R M I T
Site Address: 26684 TROPICANA DR, MENIFEE, CA Parcel Number: 331-400-060
92585 Construction Cost: $1,978.00
Existing Use: Proposed Use:
Description of REPLACE EXISTING 40 GAL WATER HEATER IN GARAGE
Work:
Owner Contractor
FRANCES HOPKINS A R S AMERICAN RESIDENTIAL SERVICES OF
26684 TROPICANA DRIVE CALIFORNIA INC
MENIFEE, CA 92585 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone:9012719700
ANDREW ALLEN License Number.765155
A R S INC DBA RESCUE ROOTER
1520 W LINDEN STREEET
RIVERSIDE,CA 92507
Fee Description Qy. Amount
Residential Water Heater 1 83.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 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 Bidg_Permit—Templaterpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts forthe projects
I hereby affirm under 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 the Business and a 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 .136 License N By my signature below I acknowledge that,except far my personal residence
Expires INIM 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
a I hereby affirm under penalty of perjury one of the followriing 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 Teq uest 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.leRmfo.ca.nov/caIaw.htmL
Policy 9 Date
ave and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZEDAGENT
n"on 3700 of the Labor Cade,forthe performance of the work forwhich my signature below I certify to each of the following:I am the property
a Y
this permit is issued.My worker's compensation insurance ar rrier and policy Knemr or authorized to act on the property owner's behalf.I have read this
numberarel,,� application and the information I have provided is correct.I agree to comply
Ca m6th all applicable city and coun" hances and state laws relating to
;dr
rrier 1 �6 �vc I building c stru 1 th presentatives of this city or county to
policy#13(�J(,$Qb 16 1 Expires (b enter th dentiflau e4 for Inspection purposes.
(This section need not to be completed is the permit is ftr-c,ne-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
,or!'erfify that in the performance of the work for which this permit is Issued,
I shall t I t b subject to the CITY BUSINESS LICENSE#
Q2 0 n pers;p :,.n."er so ,tothato,I e
o;n
_ CE nee ii;rn
worker's=cpen,atiy,, ph h should become HAZARDOUS MATERIAL DECLARATION
subject to the wor s com ion ions of Section 3700 of th Labor
c
Code,I shall f KHM7=11: ci�__Icms Will the applicant or future building occupant handle hazardous material of a
57,W mixture containing a hazardous material equal to or greater that the
Applicant !--.Date amounts spWfied on the Hazardous Materials Information Guide?
10�
WARNING:FAILURE TO SECURE WORKER'S COMPENSAI I ayes dNo
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of th e building by the applicant or future building
AND CIVIL FINES UP TO ON E HUNDRED THOUSAND DOLLARS($10D,000),IN occupant req uire 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 forguidelines
CONSTRUCTION LENDING AGENCY a Yes -tf�N.
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) a Yes,/�No
OWNER BUILDER DECLARATIONS I have read the Hazarclo�;Aatenal Information Guide and the SCAQMD
permitting checkllsti.f nder "'quirep,01,under the State of
California He I Z
I hereby affirm under penalty of perjury that I am exempt from the ,,t de Section and 25534 concerning
c
It d us �T
alt
Contractor's License Lawforthereason(s)indicated below bythe zar 0 en�
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 2CA=
c
Busmessand Professions Code).Any city or county that requires a permitto f-1 Date
Op
construct,alter,improve,demolish or repair any structure,prior to its ROPERTY C WNER OR AUTHORIZED AGENT
issuance,a Iso requires the applicant for the permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractoes State EPA RENOVATION,REPAIR AND PAINTING(RRPJ
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 Cade)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-certlfied 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
a 1,as owner of the property,or my employee with wages as their sole employees.For more information about EPAs Renovation Program visit;
compensation,will do I I all of or I I portion of the work,and the structure is www%epa.floy/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-80D-424-LEAD(5323).
Code,The Contractoes State License Law does not apply to an owner of a a 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 wlithin 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. a No EPA Lead-Safe Certified Firm is required for this project because:
a 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 RAP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
,,&Menifee
DATE PERMIT/PLAN CHECK NUMBER%�Mu -00101-1
TYPE: []COMMERCIAL V]RESIDENTIAL [-]MULTI-FAMILY E]MOBILEHOME E]POOL/SPA []SIGN
SUBTYPE: F]ADDITION F]ALTERATION F]DEMOLITION [-]ELECTRICAL FIMECHANICAL
E]NEW [EPLUMBING EIRE-ROOF-NUMBER OF SQUARES-
DESCRIPTION OF WORK P"9,010(s wafec h-�dfe L40 4A 1(on !U.s
in 16tr p
PROJECTADDRESS Atp a84 'TrooicAra Dy,'- . &roo6j , ciq VZ-,>,85_
v
ASSESSOR'S PARCEL NUMBER 53k- 4tb -0Lp6 LOT TRACT
OWNER NAME fm
CitY Of Menifee
ADDRESS (0 1 Ca ri'l R'Divolayd 67,X-R� Building & Sa#p4, n pt.
PHONE 775- _3i7 Js'�� EMAIL AUG 2 5 2016
APPLICANT NAME Anlrev� Alleo
ADDRESS Lf0Jev7 54 �9(,L/y,
V5-6-7 HeCeived
PHONE q5-1 f EMAIL
CONTRACTOR'S NAME R65CL)t OWNERBUILDER? []YESMNO
BUSINESS NAME
ADDRESS )5)0 JJ Zlden 54 rvia CA V07
PHONE ?�-13qjI371 EMAIL
CONTRACTOR'S STATE LIC NUMBER 19 57� LICENSE CLASSIFICATION
VALUATION$ jq-7j �L SO FT
APPLICANT'S SIGNATURE DATE T�7
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP
INVOICE I w5 vz:� PAIDAMOUNT
AMOUNT 1 1 0 CASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT CASH 0 CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED COYES -_ NO DL NUMBER NOTARIZED LETTER YES 0 NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
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