PMT16-03000 City of Menifee Permit No.: PMT16-03000
29714 HAUN RD.
<A—CCIELA—> MEN]FEE,CA 92586 Type: Residential Plumbing
MENIFEE Date Issued: 0910912016
P E R M I T
Site Address: 27614 GENEVIEVE DR, MENIFEE, CA Parcel Number: 335-382-027
92586 Construction Cost: $1,925.00
Existing Use; Proposed Use:
Description of REPLACE 40 GAL GAS WATER HEATER IN GARAGE
Work:
Owner Contractor
KATHY TROUTMAN A R S AMERICAN RESIDENTIAL SERVICES OF
27614 GENEVIEVE DR CALIFORNIA INC
MENIFEE, CA 92586 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone:9012719700
ANDREW ALLEN License Number.765155
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNII�
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Fee Description QtV Amount
Residential Water Heater 1 83.00
Building Permit Issuance 27.00
GREEN FEE 1.00
General Plan Maintenance Fee-Plumbing 4.15
$115.16
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specificalions or from preventing bulliding 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_Permit—Template.rpt 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).
Chapter!)(commencing with section 7000)of Division 3 of3thp Business and o I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is In full force and e the following reason:
License Cla �3(o U By my signature below I acknowledge that,except for my personal residence
Expires Signat 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
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.gay/calaw.htmi.
Policy# Date
JfI 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 42.Bymy 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
numberar application and the information!.�ave prov"I is correct.I agree to comply
with a!lgapplicablo,c' d y or -and state laws relating to
s
on 5bi.e,;epr!2ti, f thi ity or county to
Pro Ssen a ives a is c
enterth app"c"R
Carrier buildin �con
Policy# 6)(,-U9 Expires th civ d p,76,tt"ection purposeq I
(Th is section need not to be com pleted is the Perm it is for one-hund red Z Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
(I I certify that in the performance of the work for which this permit is issued,
I shall not employ any persopeTh5a;WnydIne,so a become,subject to the CITY BUSINESS LICENSE#
Y so 0
y
rri.,
,a
worker's compensatio C rnia,a ree that if I should become HAZARDOUS MATERIAL DECLARATION
so
r f 5,
subject to the w sialkm pr s of Section 3700 of the Labor
,I pro s
Code,I shall fig ply'with I provisions. Will the applicant or future building occupant handle hazardous material or a
Applican75;51!1� Date 191 1� mixture containing a hazardous material equal to or greater that the
I amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION CI!IVERAGE IS n Yes 9,No
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($100,0oo),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 a Yes Au
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) ciYes 46No
OWNER BUILDER DECLARATIONS I have read the Hazardou etarinformatio OeandtheSCAQMD
0'
isum
permitting checklist role ad my re 1;R;Vnts under the State of
t
05.
I hereby affirm under penalty of perjurythat I am exemptfrom the California Hea SO ode,Secti 05 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the hazardo a la orfin���5
Y
checkmark(s)I have placed next to the applicable item(s)(Section 7031.!i Ye 0
Businessand Professions Code).Any city or county that requires a permitto Date
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 IBM
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 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 pemit subjects the applicant to a civil penalty 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 sale 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.gov/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 o 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. a 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.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
Menifee
DATE PERMIT/PLAN CHECK NUMBER FKTIkD- oft6c)
TYPE: F—ICOMMERCIAL E]RESIDENTIAL E]MULTI-FAMILY [JMOBIUEHOME F]POOL/SPA OSIGN
SUBTYPE: [—]ADDITION [:]ALTERATION F]DEMOLITION E]ELECTRICALE]MECHANICAL
[JNEW [—]PLUMBING F]RE-ROOF-NUMBER OF SQUARES_
DESCRIPTION OF WORK el�lfftl t
1A Z1d!je?11&7 qg 5 /P 6dj1a,,7e
PROJECTADDRESS �P? syn K,146 v
ASSESSOR'S PARCEL NUMBER TRACT n41- i
OWNER NAME 4& 1/6
ADDRESS �Vu
PHONE EMAIL
APPLICANT NAME
ADDRESS Lw&'
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILDER? El YESE�JNO
BUSINESS NAME 1�1 CA/IC xw�" *
ADDRESS 1) C�J L fdt, 9 V1 Vt,cdO
PHONE wl �"SV EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
Q FT
VALUATION$ 5:�e�s
APPLICANrs SIGNAI DATE
CITY STAFF USE ONLY
ULPARTMLNT DISTRIBUTION uiyuu-mtNIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE � GREEN SMIP
INVOICE PAID AMOUNT
AMOUNT 1105.1s I 1 0 CASH 0 CHECK# 0CREDrrCARD VISA/MC
PLAN CHECK FEES PAID AMOUNT I 1 0 CASH 0 CHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DL NUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee,CA 92586_q5l-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
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