PMT16-03053 City of Menifee Permit No.: PMT16-03053
29714 HAUN RD- Type: Residential Plumbing
<A-CClEI1-X-> MENIFEE,CA 92586
MENIFEE Date Issued: 0911412016
P E R M I T
Site Address: 25606 MOUNTAIN SPRINGS ST, Parcel Number: 339-450-027
MENIFEE,CA 925B4 Construction Cost; $1,450.00
Existing Use: Proposed Use:
Description of REPLACE WATER HEATER, 50 GAL GAS IN GARAGE
Work:
Owner Contractor
SAM CAIN A R S AMERICAN RESIDENTIAL SERVICES OF
25606 MOUNTAIN SPRINGS ST CALIFORNIA INC
MENIFEE,CA 92584 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone:9012719700
ANDREW ALLEN License Number.765155
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNI)
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Fee Description QtV Amount I$)
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
$116.16
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.
Ak131dg_Perrnit-Ternplaterpt Page I of I
CITY OF IVIENIFEE
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 contractar(s)pursuant to 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:
License Classl` NO —License By mysignature belowl acknowledge that,exceptfor mypersonal residence
Expires Signature inwhich I must have resided for at least one year prior to completion of
improvements covered bythispermit.I cannot legally sell astructurethat 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.Ieainfo.ca.gov/calaw.htmI.
Policy# Date
� ave and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
e2t,on 3700 of the Labor Code,for the performance of the work for which _aSy 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
num ber are, application and theVi formation I have provided is correct.I agree to comply
i 10A bt� on.] thorizer0?esentatives of this city or county to
Carrier withallapplic I f�dty and,9t nty ord-Wrices and state laws relating to
L4 , tti
10111 1 [filed 405;�&inspection purposes.
Policy# Expires ! i en P Ec! !7a�a6!
(This section need not to be completed is the permit is for one-hundred
dollars($100)or less 11_� Date
PROPERTY OWNER OR AUTHORIZED AGENT
CLJ certify that in the performance of the work for which this permit is issued,
I shall not employ any persons i.n an
y mannerso as to become subjectIm the CITY BUSINESS LICENSE# M01
worker's compensation lawsof'Ealifornia,and agree that If I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker' )To s of Section 3700 of the Labor Will the applicant or future building occupant handle hazardous material or a
Code,I shall forth inc ions.
mixture containing a hazardous material equal to or greater that the
Applicant,ef� Date 1 1 114 1 amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 15 ci Yes ciNo
UNLAWFUL,AND SMALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the I,ntended 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 guide"
CONSTRUCTION LENDING AGENCY ci Yes Ef'No
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 pemnit is issued outer boundary of a school?
(Section 3097 Civil Code) a Yes FIN.
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I riderstand equirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the California Health fiety Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the hazardous e I rep n
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 o6es
Business and Professions Code).Any city or county that requires a permit to 49�� Date
construct,alter,improve,demolish or repair any structure,priorto Its PROPERTY OWNErOR AUTHORIZED AGENT
Issuance,also requires the applicant for the permittoffle a signed statement
that he orshe is licensed pursuanitto the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING IRRP)
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 permit 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
ci 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.gav/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 ci 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. ci No EPA Lead-Safe Certified Firm is required for this project bemuse:
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 RAP rule please fill out the RRP
Acknowledgement,
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
&Menifee
I-SP
DATE qLeb PERMIT/PLAN CHECK NUMBER
TYPE: OCOMMERCIAL NRESIDENTIAL [-]MULTI-FAMILY []MOBILEHOME [:]POOL/SPA E]SIGN
SUBTYPE: F]ADDITION E]ALTERATION E]DEMOUTION F]ELECTRICAL [:]MECHANICAL
[-]NEW E]PLUMBING EIRE-ROOF-NUMBER OF SQUARES-
DESCRIPTION OF WORK w,,,4ee, h&�tv-.
PROJECTA69RESS 'J.2 54 Qg dbur)+ewo 5-privw-) 5+
ASSESSOR'S PARCEL NUMBER 15159-L+Fjo"00-11 ' LOT' c2-7 TRACT Q5S91-
OWNERNAME 50,6-N alf)
ADDRESS ol5l-oOco Kuun+ath Sp c(no :5+ N\e I Ge-c OUS-81i
I �Ij
PHONE qs� 3-1 o 99 11 EMAIL
APPLICANT NAME [)nA(eA,) Allen
ADDRESS 1,��n Li ydein 5� 9 (,j c-( s4e- CA qas-o-7
PHONE EMAIL
CONTRACTOR'S NAME J�f,�)C.QC ote OWNERBUILIDER? [:1YES3NO
BUSINESS NAME
ADDRESS ls�z W 54- Vey A e CU) 6W,9-7
PHONE qG71 '#4 1 EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION (,0
VALUATION $ L4—!3 LSQ FT
APPLICANT'S SIGNATURE DATE 1V
CITYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION CITYOFMENIFE W
(A smIP E n5�$.E�BER
BUILDING PLANNING ENGINEERING FIRE GREEN
INVOICE I PAID AMOUNT 0 CASH 0 CHECK# OCREDITCARD VISA/MC
AMOUNT I
PLAN CHECK FEES PAID AMOUNT I OCASH OCHECK# OCREDITCARD VISA/MC
OWNER BUILDER VERIFIED OYES 0 NO DLNUMBER NOTARIZED LETTER 0 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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