PMT16-03218 City of Menifee Permit No.: PMT16-03218
29714 HAUN RD. Type: Residential Plumbing
'[7�CCIELA-? MENIFEE,CA 92686
c--z��dt— MENIFEE Date Issued: 09/29/2016
P E R M I T
Site Address: 29935 FOX CREEK DR, MENIFEE, CA Parcel Number: 338-35D-012
92586 Construction Cost: $2,799.00
Existing Use: Proposed Use:
Description of REPLACE 50 GAL WATER HEATER, SAME LOCATION
Work:
Owner Contractor
PAUL MARSHALL A R S AMERICAN RESIDENTIAL SERVICES OF
29935 FOX CREEK DRIVE CALIFORNIA INC
MENIFEE, CA 92586 965 RIDGE LAKE BLVD SUITE 201
Applicant Phone: 9512769744
KENNY PERREY License Number:765074
A R S INC DBA RIGHTIME
3030 MYERS STREET
RIVERSIDE, CA 92503
Fee Description Amount
Residential Water Heater 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 carded 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 BldgPerrnit-Ternplate.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 contnictor(s)pursuant to the Contractors state License Law),
Chapterg(commencing with section 7000)of Division 3 of the 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 effect the following reason:
Licenseclas! 416pEE6Z!;" License No. J�50 7zl
By mysignature below I acknowledge that,except for my personal residence
Expires_ ignature P.-A A A14 '67 in which I must have resided for at least one year prior to completion of
I I— F improvements covered by this permit I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATION d be"built as an owner-builder if it has not been constructed In Its entirety by
y hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand tha I 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 Rela tions 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 vAvw.Ieginfc,.ca.eoy/calaw.htmI
this permit is issued.
Polilcy# Date
PROPERTY OWNER OR AUTHORIZED AGENT
a I have and will maintain workees compensation insurance,as required by
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 owrier's behalf.I have read this
number are: application and the information I have provided is correct I agree to comply
Carrier with all applicable city and county ordinances and state laws relating to
Policy a !j()2,J.U6 J� Expires building construction.I authorize representatives of this city or county to
enter the above identified property for inspection purposes.
(This section need not to be completed is the permit W f or one-hundred Date
dollars($200)or less PROPERTY OWNER OR AUTHORIZED AGENT
o I certify that in the performance of the work for which this permit is issued, -T�
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE# Awob5lci
worker's compensation laws of California,and agree that if I should become H.4(2ARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,I shall forthw comply I nise provi.sions. 11 the applicant or future building occupant handle hazardous material or a
(�/(J /-�ifxture containing a hazardous material equal to or greater that the
Applicant 71, k0f)1AA Dz _ 61
� 1"19 16� - — _ I cified on the Hazardous Materials Inforniaticin Guide?
WARNING:FAILURE TO S916REWORRUS COMPENSATION COVERAGE IS o Yes elTo
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use o,f 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,AN D ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY aYes .1,3NO
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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 6e
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lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) a Yes cl
3
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklisL I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the California Health&Safety Code,Section 25505 and 25534 concerning
Contractor's License Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oY a No Cy
Business and Professions Code),Any city or county that requires a permit to ePA&W P,&A44 Date ---r
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNtR OR.AV90—KIIED
issuance,also requires the applicant for the permit to rile a signed statement
that he or she is licensed pursuant to the provisions of the Contnictor's State EPA RENOVATION,REPAIR AND PAINTING RRP)
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-certlfied firms and comply with
an Applicant for a permit subjects the applicant to a civil pena]Wof not more required practices.This includes rental property owners and property
than($500). managers who do the pamt-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( )all of or( )portion of the work,and the structure is wm.epa.F!ov/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 (3 An F PA Lead-Safe Certified Renovator will be responsible for this project
property who,through employeeser 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. o No EPA Lead-Safe Certified Firm is required for this project bemuse:
c;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 NUMBERI?�MIQ
TYPE: OCOMMERCIAL AESIDENTIAL CMULTI-FAMILY OMOBILEHOME OPOOL/SPA CSIGN
SUBTYPE: OADDI�ION -ALTERATION ODEMOLITION OELEcrRICAL OMECHANICAL
ONEW 4PLUMBING 0 RE-ROOF-NUMBER OF SQUARES_
DESCRIPTION OF WORK J56 6&LOA) LJ05�
PROJEcTADDRESS fi* CeFtr- Ak liMI(JI�e- E (2M 9J S E�L.
1' 0 M n11,16
fety
ASSESSOR'S PARCEL NUMBER SN— '1tv- QI9L LOT TRACT Buildqing' 8, Sae Del t.
OWNERNAME SEP 2 9 2M-
ADDRESS
PHONE 277 EMAIL Received
APPLICANTNAME P
ADDRESS -ST Al-12 <
PHONE EMAIL
CONTRACTOR'S NAMEa/ h Qilt e�7 OWNERBUILDER? OYESOO
BUSINESSNAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUM13ER f6 ;'211 LICENSE CLASSIFICATION �_rL), e
VALUATION SO FT LSQFT
�//' // L, -C_,�/
APPLICANT'S SIGNATURE DATE
CITYSTAFF USEONLY
DEPARTMENT DISTRIBUTION SMI--- CITY OF ME�IFEE BUSINESS LICENSE NUMBER
P
BUILDING PLANNING ENGINEERING FIRE GREEN MIP
INVOICE PAIDAMOUNT 1103.15
AMOUNT k\n-v-P5 � OCASH OCHECK# 0 CREDIT CARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK N 0 CREDIT CARD VIS MC
OWNER BUILDER VERIFIED 0 YES 0 NO DLNUMBER NOTARIZED LETTER 0 YES 0 NO
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 92586 951-6 72-6777
www.cityofmenifee.cis Inspection Request Line 951-246-6213
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