PMT16-03724 City of Menifee Permit No-: PMT16-03724
< _6CEL_ 29714 HAUN RD. Type: Residential Plumbing
A A—> MENIFEE, CA 92586
MENIFEE Date Issued: 11/18/2016
P E R M I T
Site Address: 27130 EL RANCHO RD, MENIFEE, CA Parcel Number: 336-111-012
92586 Construction Cost: $1,500.00
Existing Use: Proposed Use:
Description of CHANGE SHOVVER VALVE AND MOVE DRAIN
Work:
Owner Contractor
CAROLSARGENT A A A RESTORATION INC
27130 EL RANCHO RD 29850 2ND STREET
MENIFEE,CA 92586 LAKE ELSINORE, CA 92532-2420
Applicant Phone: 9514715828
LANCE REMINGTON License Number:834839
A A A RESTORATION INC
29850 2ND STREET
LAKE ELSINORE, CA
Fee Descripfion P!Y Amount f$)
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 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�B1dg_Pemit_Temp1ate.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contractsforthe 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 Business and a I am exempt from Rcensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
'9 F Ucense_No. �65)537
License Class If——'T C.,S'5 By my signature below I acknowledge that,except for my personal residence
E x p I re s 'CO 1'3 S ig n a t u in which I must have resid ed for at least one year prior to completion of
_"107 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
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 website:
by Section 3700 of the Labor Code,for the performance of work for which
this permit is issued. www.leginfo.ca.Roy/nIaw.html.
Policy# PROPERTY OWNER OR AUTHORIZED AGENT Date
%have and will maintain worker's compensation insurance,as required by
section 3700 of the Labor Code,for the performance of the work for which ci 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 owner's behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
with all applicable city and county ordinances and state laws relating to
CarrierAo*�;n�w,_ myntzmre.-_ 7!�ns%j�e.�s building construction.I authorize representatives of this city or county to
Policy If c-<:�F5an-7 262!�� —Expires '�/t /?—,D(7 enter the above identified property for Inspection purposesi.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
ci I certify that in the performance of the work for which this permit Is Issued,
Ishallnotemplo any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
worker's compensation lam of California,and agree that If I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,I shall forthw comp t use provisions. Will the applicant or future building occupant handle hazardous material or a
Applicapo Date mixture containing a hazardous material equal to or greater that the
Ox*_ amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECU"'RE WORKER'S COMPENSATION COVERAGE IS ci Yes )gNo
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applica nt or future building
AND CIVIL FINES UP TO ON E HU NDRED THOUSAND DOLLARS($100,000),IN occupant req uire 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 forguidelines
CONSTRUCTION LENDING AGENCY ciYes )rNo
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) 0yes )CNO
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
California Health&Safety Code,Section 25505 and 25534 concerning
Contnictor's License Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable ftem(s)(Section 7031.5 'Isly,
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,prior to its �/154k�jb
issuance,also requires the applicant for the permit to file a signed statement FROPERTY OWNER OR-90THORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING JRRP)
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-certifled firms and comply with
an Applicant for a permit subjects the applicant to a civil penalty of not more
than($500). required practices.This includes rental property owners and property
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 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 Contnctor's State License Law does not apply to an owner of a o An EPA Lead-Safe Certified Renovator will he responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements a re 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 because:
ci 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.
& SAFETY PERMIT/PLAN CHECK APPLICATION
'P'Menifee
DATE PERMIT/PLAN CHECK NUMBER Tw v4 C)
TYPE: OCOMMERCIAL KRESIDENTIAL omu-n-FAmiLy OMOBILEHOME 0 POOL/SPA 0 SIGN
SUBTYPE: OADDITION 0ALTERATION ODEMOLITION CIELECTRICAL OMECHANICAL
ONEW XPLUMBING 0 RE-ROOF-NUMBER OF SQUARES—
DESCRIPTION OF WORK
PROJECTADDRESS EL ZancA\o YA S,-v\ CAV r--A 9,25W2
ASSESSOR'S PARCEL NUMBER !� 111 - Oil— LOT TRACT 'ZI(35
OWNER NAME CX�-6k
ADDRESS :;?71-.:?,I-_) _rl- Yd
PHONE EMAIL
APPLICANT NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S NAME OWNER BUILDER? 0 YES 00
BUSINESS NAME A A R
ADDRESS QJ �9020
PHONE 1'5/-11-71 EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION "S C--j ,C-33
VALUATION$ 5t)C)rc)C� SQ FT L SO FT
APPLICANT'S SIGNATUR� DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GIEEN SMIP
INVOICE PAIDAMOUNT
AMOUNT to P, OCASH OCHECK# OCREDITCARD VISA/MC
PLAN CHECK FEES AIDAMOUNT
P) OCASH OCHECK# 0 CREDIT CARD VISA/MC_
OWNER BUILDER VER1FIED OYES 0 NO DILNUMBER NOTARIZEDLETTER 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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