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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 CD fj) CC) c R OCD cr, (1) FFJ 0 rm 0 z Ln rn rn iT In rm A rn Fg, rn rn 1A