PMT16-03344 City of Menifee Permit No.: PMT16-03344
29714 HAUN RD. Type: Residential Plumbing
<A—CCJEI-A> MENIFEE,CA 92586
MENIFEE Date Issued: 1011112016
P E R M I T
SiteAddress: 28549 DELPHINUS DR,MENIFEE, CA Parcel Number: 339-272-014
92586 Construction Cost: $6,270.00
Existing Use: Proposed Use:
Description of INSTALL 4"LINER ON EXISTING SEWER LINE
Work:
Owner Contractor
MIKE HARTER A R S AMERICAN RESIDENTIAL SERVICES OF
28549 DELPHINUS 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 CALIFORNIj
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, CA 38120
Fee Description Pk Amount
Plumbing Fixtures and Vents,fixtures 1 116.00
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 errom 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�13ldgPernill-Ternplate.rpt Page I of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
I herebyaffirm 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:
Ulcense Class Ulcense No By my signature below I acknowledge that,except formy personal residence
Expires Signature in which I must have resided for at least one year priorto completion of
Z improvements covered by this permit I cannot legallysell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
ci 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 webslte:
by Section 370D of the Labor Code,for the performance of work for which
this permit is Issued. www.leglnfo.ca.gov/calaw.htmL
Policy# Date
�,Lhave and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
iection 3700 of the Labor Code,for the performance of the work for which a my signature below I certify to each of the folloVing:I am the property
a"my
this permit is issued.My workees compensation insurance carrier and policy ewmer 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
-6 with all applicable city and coun"lornances and state laws relating to
Carrier build' g to st ru I aut��4errepresentatives of this city or county to
,-I fvl,4 1(1 11 Expires.
Policyli0c (b enter th entift erty for inspection purposes.
(This section need-not to be completed is the permit is Ar o I ne-hundred Date vlh
dollars($100)or less k6PERTY OWNER OR AUTHORIZED AGENT
,gl—ciartffy that in the performa nce of the work for which this permit is Issued,
-Ishallnotermal any perso��In any mannersW to become subject to the CITY BUSINESS LICENSE#
worker's compens;;.o HAZARDOUS MATERIAL DECLARATION
ati ..nlargs'of Sis 107nia,9,rAre e tha t if I should become
subject to the worl cc;5l; ivons.tif Section 3700 f th Lab
andous material or a
mixture containing a hazardous material equal to or greater that the
Applic Date' f nts
Code,I shall f�o no ns Will the applicant or future building occupant handle be
a amou :;spep led on the Hazardous Materials Information Guide?
'Vtl� 14.
WARNING:FAILURE TO SECURE WORKER'S COMPENSATIOd COVERAGE IS Dyes 140
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMI NAL PENALTIES Will the intended use of the building by the applicant or futu re 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 Qua lity Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguldellnes
CONSTRUCTION LENDING AGENCY a Yes -CIIN�.
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) Dyes/It"'o
OWNER BUILDER DECLARATIONS I have read the Hazardo"aterial Information Guide and the SCAQM D
J45 fi myre( under the State of
permitting checklist. ndersta lube
I hereby affirm under penalty of perjury that I am exempt from the California Healt a e,Section and 25534 concerning
Sa
Contractoes License Law for the reason(s)indicated below by the us ;=�
hazardous efla rting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 0
Business and Professions Code).Any city or county that requires a permit to t!(Yes 0 Date
construct,alter,improve,demolish or repair any structure,prior to its ROPERTY OWNER OR AUTHORIZED AGEN I
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 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 Rcensure receiving compensation for most work that disturbs paint in a pre-1978
a nd the basis for the alleged exemption.Any violation of Section 7032.5 by residence or childcare facility to be RRP-certified firms and comply with
an Appilica nit 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 sole employees.For more information about EPA's Renovation Program Visit:
compensation,will do( I all of or( )portion of the work,and the structure is www.epa.goy/lead or contact the National Lead Inforitation 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 became:
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 RAP rule please fill out the RRP
Acknowledgement.
Wi,
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
z,i�4Menifee
DATE PERMIT/PLAN CHECK NUMBER
TYPE: []COMMERCIAL [E]RESIDENTIAL [:]MULTI-FAMILY [:]MOBILEHOME []POOL/SPA E]SIGN
SUBTYPE: [-]ADDITION [-]ALTERATION []DEMOLITION [-]ELECTRICAL DIVECHANICAL
F]NEW [APLUMBING []RE-ROOF-NUMBEROFSQUARES-
DESCRIPTION OF WORK 14-��A R � I Iler M 6e4Qer-
PROJECTADDRESS Dclalnjj5 .0/,
ASSESSOR'5 PARCEL NUMBER -0jj LOT I TRACT
OWNER NAME 'M I V( #4
ADDRESS 65-Yq Dollokno-s a ;:Wc
PHONE 29 -76-7 EMAIL
APPLICANT NAME A 4(/al
ADDRESS "So w%-(- 64LO-e,
PHONE 9lS'f 3q f I b-I EMAIL
CONTRACTOR'S NAME �e5c(x OWNERBUILDER? []YESEINO
BUSINESS NAME
ADDRESS 1"ZO t .)
PHONE fS73�(?3 7/ EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ LSQFT
APPLICANT'S SIGNATURE DATE
DEPARTMENT DISTRIBUTION SMIP CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN 1
INVOICE PAIDAMOUNT CASH OCHECK# 0 CREDIT CARD VISA/MC
AMOUNT
PLAN CHECK FEES PAIDAMOUNT 0 CASH 0 CHECK# 0 CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED 0 YES 0 No DL NUMBER NOTARIZED LE17ER 0 YES 0 NO
City of Menifee Building&Safety Deportment 29714 Houn Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us Inspection Request Line 951-246-6213
Oe�hlnvj z91-
City of Menifee
2wildipg & 208ty Dept,
CITY OF MENIFEE OCT 1 1 2016
BUILDING AND SAI ETY DEPARTMENT Received
PILAN APPROVAL
REVIEWK) F -1wW
DATE
�,,,ofova;a, (hpsv o ;ns shall at 7beconstrued to be a pemit fo�OF n
of a provis f
jp,,, maj at any viiiatton of a provis f ionsofthefe ral,stateorcitv
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r4ulations and ordmances. T is set of appmed pla 1i must be kePt On the
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