PMT16-03225 City of Menifee Permit No.: PMT16-03225
29714 HAUN RD. Type: Residential Plumbing
<A-CCEU� MENIFEE,CA 92586
MENIFEE Date Issued: 0913012016
P E R M I T
Site Address: 29680 THORNHILL DR, MENIFEE, CA Parcel Number: 336-120-026
92586 Construction Cost: $6,750.00
Existing Use: Proposed Use:
Description of INSTALL 4"CLEANOUTS ON SEWER LINE
Work:
Owner Contractor
PAUL FULLER A R S AMERICAN RESIDENTIAL SERVICES OF
29680 THORNHILL 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 CALIFORNU
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Fee Description Qty Amount
Plumbing Fixtures and Vents,fixtures 2 116.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 5.80
$149.80
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 perrnit 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_Perrnit-Ternplaterpt 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)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Bgpintss anl,-;7 ri I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full fn�me a nd oeffect the followin reason:
.11
License Clas; a 3(0 License N By my signature below I acknowledge that except for my personal residence
Expires :fii/oe—Signature- in which I must have resided for at least one year prior to completion of
I I. improvements covered by this permit.I ca root 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 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 Industrta I Relations as provid ad for this a.pplication is submitted or at the following websfte:
by Section 3700 of the Labor Code,for the performa nce of work for which www.leginfo.ca.goy/calaw.html.
this permit is issued.
Policy# Date
PROP TY OWNER OR AUTHORIZED AGENT
(1�have and will maintain worker's compensation insurance,as required by Z
section 3700 of the Labor Code,for the performance of the work for which y 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 am application and the information I have_0,w0ded is correct.I agree to comply
:L With all applicab:le�clj��noun"Oiffances an e laws relating to
C, "�.uth
rrier buildi con tr 0 au 5i�-�fepresenta e f this city or county to
Policy It :2 Expires ente t e�Z Eva- nti�e�dpropertyfior` ion purpos
-a
P
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
I work for which this permit is issued,
ci I certify that in the performance n�p
I shall not employ any persons. Yma as to rime subject to the CITY BUSINESS LICENSE#
41� at if
worker's compensation IPO a; anrcsao�fXeft' at if I should become HAZARDOUS MATERIAL DECLARATION
subject to thew rk. P 4EKO.E.:crWjection 3700 of the Labor
Code,I shall f co - III vislo"'. Will the applicant or future building occupant handle hazardous material or a
Applk:5��� I Date mixture containing a hazardous material equal to or greater that the
amountsspeci ied on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS Yes ,2c"
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the a pplicant or futu m building
AND CIVIL FIN ES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant reci uire a permit for the construction or modification from South
ADDITION TO TH E 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 gu idey,.%es
CONSTRUCrION LENDING AGENCY a Yes ci 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 permit is issued outer bou dary of a school?
(Section 3097 Civil Code) a Yes j?No
OWNER BUILDER DECLARATIONS I have read the H d Mat J 1'�7
azar ous :,rpa 1,=�;InfZm ation Gu 11 61D
' 'r"U" at
-Z-r heCAQ
a
.p quir
permitting cl cklit,ipcleV�.Wncl a," the State of
I I U
'th
f old
I herebyaffirm under penalty of perjurythatl am exemptfirom the
California He c!tion 255 aD 5534 concerning
ii I P., 'KI
Continictor's License Law for the reason(s)Indicated below by the ia
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 h3-4i'dous m Kal,�P-vii
Business and Professions Code).Any city or county that requires a permit to 7't'
construct,alter,improve,demolish or repair any structure,prior to its PR61PERTY OWNER OR AUTHORIZED AGE1.1
issuance,also requires the applicant for the permit to file a signed statement
that he or she is licensed pu nivant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING IRRPI
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 ficensure 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-certifiecl firms and comply with
an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes renta I property owners a nd 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 sole employees.For more information about EPKs Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.epa.goy/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 a An EPA Lead-Safe Certified Renovator will be responsible for th is 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 of Improvement is sold within one year of Firm Certiflution 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 because:
ri 1,as owner of the property a in 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
'�FMenifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: DCOMMERCIAL aRESIDEN-nAL F]MULTI-FAMILY F]MOBILEHOME F]POOL/SPA [:]SIGN
SUBTYPE: F]ADDITION DALTERATION F]DEMOLITION []ELECTRICAL FIMECHANICAL
[:]NEW 2[PLUMBING [-IRE-ROOF-NUMBER OF SQUARES-
DESCRIPTION OF WORK erVIQ,-4,75 on 5et,3e-V rne-
PROJECTADDRESS k0rjN�1, Qr
0
ASSESSOR'S PARCEL NUMBER "D�"L T TRACT D40-3
OWNER NAME Pao I &11,or
ADDRESS (RII(A 0 —T-TIOM hL11 Or f-t-7 —15ji'l Cite (A
PHONE &Iq 8-n -lan EMAIL
APPLICANT NAME Wl� Mer,
ADDRESS I'GD o �,j Lmderl givtv,6�t CA q,16-1-7
PHONE 9&-1 3L41 q3-7 1 EMAIL
CONTRACTOR'S NAME k5we- YL 5 QWNER BUILDER?
DOf ti [:]YESPN&
BUSINESS NAME
ADDRESS J!�aD LA VIj?JA 6�- (VtfC3 IA eO
PHONE qYI '�ql -TY7 1 EMAIL
CONTRACTOR'S STATE LIC NUMBER 7&15-115� LICENSE CLASSIFICATION C,3�,
VALUATION$ 5Q-F
LSQFT
APPLICANT'S SIGNATURE DATE 171W167
DEPARTMENT DISTRIBUTION Ito SMIP CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN
INVOICE PAIDAMOLINT
AMOUNT I 1 0 CASH 0 CHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES PAIDAMOUNT I I OCASH OCHECK# OCREDITCARD VISA/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 951-672-6777
www.cityoftnenifee.us Inspection Request Line 951-246-5213
City of Menifee
Building & Safety Dept.
Received
1-1 Y OF MENIFEE
3UILDING AND SAFETY DEPARTMENT
APPROVA I
;�EVIEWE;B
DATE
*Approvalof these plans shail not�e construed to bea*Mf6r,or an
approval of,anyviolation of anyprovisionsof the federal,state or city
regulations and ordina nces. This set of approved plant must be kept on the
jobsite until completion.